COVID-19 Morbidity Research Articles

Immunogenicity of a Third Dose of BNT162b2 Vaccine among Lung Transplant Recipients-A Prospective Cohort Study.

Two doses of mRNA SARS-CoV-2 vaccines elicit an attenuated humoral immune response among immunocompromised patients. Our study aimed to assess the immunogenicity of a third dose of the BNT162b2 vaccine among lung transplant recipients (LTRs). We prospectively evaluated the humoral response by measuring anti-spike SARS-CoV-2 and neutralizing antibodies in 139 vaccinated LTRs ~4-6 weeks following the third vaccine dose. The t-cell response was evaluated by IFNγ assay. The primary outcome was the seropositivity rate following the third vaccine dose. Secondary outcomes included: positive neutralizing antibody and cellular immune response rate, adverse events, and COVID-19 infections. Results were compared to a control group of 41 healthcare workers. Among LTRs, 42.4% had a seropositive antibody titer, and 17.2% had a positive t-cell response. Seropositivity was associated with younger age (t = 3.736, p < 0.001), higher GFR (t = 2.355, p = 0.011), and longer duration from transplantation (t = -1.992, p = 0.024). Antibody titer positively correlated with neutralizing antibodies (r = 0.955, p < 0.001). The current study may suggest the enhancement of immunogenicity by using booster doses. Since monoclonal antibodies have limited effectiveness against prevalent sub-variants and LTRs are prone to severe COVID-19 morbidity, vaccination remains crucial for this vulnerable population.

Impact on COVID-19 morbidity and mortality according to the regulations on the use of face mask.

Currently, the face mask represents an incomparable symbol whose value went from clinical work to impacting the containment of the spread of SARS-CoV-2, although it has become an element of discord in the general population. To establish the impact of face mask use policies on COVID-19 morbidity and mortality. Face mask use policy variables, obtained from the website of the #Masks4All scientific movement, were associated with the number of infections, deaths and flattening of the curve published by the Johns Hopkins University resource center and EndCoronavirus.org. Face mask use policies were universal (required in shops, restaurants, public transport), partial (recommended, required in any public place) and absent. Associations of the face mask use policy with total cases (p = 0.01), cases per million (p = 0.04) and deaths per million population (p = 0.02) were statistically significant. Associations of the variables with the epidemiological curve trend were also statistically significant (p = 0.00). The recommendation for face mask widespread use is a measure with sufficient scientific support to reduce the number of COVID-19-related infections and deaths.

School closures during COVID-19: an overview of systematic reviews

ObjectivesTo assess the benefits and drawbacks of school closures and in-school mitigations during the COVID-19 pandemic.DesignOverview of systematic reviews (SRs).Search methodsWe searched six databases and additional resources on 29 July...

What is the optimal country for minimum COVID-19 morbidity and mortality rates?

The SARS-CoV-2 is a deceptive virus. Despite the remarkable progress in genetic sequencing and subsequent vaccine development, the world continues to grapple with the ominous threats of rapidly appearing SARS-CoV-2 variants. The objective of this manuscript is to rank world countries based on the anticipated scope of COVID-19 morbidity and mortality, measured in terms of prevalence per 1 million persons, from the lowest to the highest. The ranking of 162 countries is based on predictions of empirical models, which include three explanatory variables: hospital beds per thousand persons, population density, and the median age of the country's population. Referring to the COVID-19 scope of morbidity, the lowest likelihood of infection is obtained in Niger and Mali, where the dominant characteristic is the young median age (15.1-16.4years). Referring to the COVID-19 scope of mortality, the lowest likelihood is obtained in Singapore. For Singapore, the dominant feature is the high population density. The optimal solution is intensive vaccination campaigns in the initial phase of the pandemic, particularly among countries with low GDP per capita. Yet, vaccinations may work only where the personal immune system is healthy and thus respond by creating antibodies to the SARS-CoV2 virus. Referring to populations that lack the natural protection of the healthy immune system and thus cannot be vaccinated (e.g., old people, cancer patients undergoing chemotherapy treatments), a complementary solution might be coordination between countries and the establishment of field hospitals, testing laboratories, isolation of areas, humanitarian aid-in the same manner of treatment in other disasters like earthquakes.

Dynamic Trends in Sociodemographic Disparities and COVID-19 Morbidity and Mortality-A Nationwide Study during Two Years of a Pandemic.

Social epidemiological research has documented that health outcomes, such as the risk of becoming diseased or dying, are closely tied to socioeconomic status. The aim of the current study was to investigate the impact of socioeconomic status on morbidity, hospitalization, and mortality outcomes throughout five waves of the pandemic amongst the Israeli population. A retrospective archive study was conducted in Israel from March 2020 to February 2022 in which data were obtained from the Israeli Ministry of Health's (MOH) open COVID-19 database. Our findings, though requiring careful and cautious interpretation, indicate that the socioeconomic gradient patterns established in previous COVID-19 literature are not applicable to Israel throughout the five waves of the pandemic. The conclusions of this study indicate a much more dynamic and complex picture, where there is no single group that dominates the realm of improved outcomes or bears the burden of disease with respect to morbidity, hospitalization, and mortality. We show that health trends cannot necessarily be generalized to all countries and are very much dynamic and contingent on the socio-geographical context and must be thoroughly examined throughout distinct communities with consideration of the specific characteristics of the disease. Furthermore, the implications of this study include the importance of identifying the dynamic interplay and interactions of sociodemographic characteristics and health behavior in order to enhance efforts toward achieving improved health outcomes by policymakers and researchers.

Green Tea Consumption and the COVID-19 Omicron Pandemic Era: Pharmacology and Epidemiology.

In spite of the development of numerous vaccines for the prevention of COVID-19 and the approval of several drugs for its treatment, there is still a great need for effective and inexpensive therapies against this disease. Previously, we showed that green tea and tea catechins interfere with coronavirus replication as well as coronavirus 3CL protease activity, and also showed lower COVID-19 morbidity and mortality in countries with higher green tea consumption. However, it is not clear whether green tea is still effective against the newer SARS-CoV-2 variants including omicron. It is also not known whether higher green tea consumption continues to contribute to lower COVID-19 morbidity and mortality now that vaccination rates in many countries are high. Here, we attempted to update the information regarding green tea in relation to COVID-19. Using pharmacological and ecological approaches, we found that EGCG as well as green tea inhibit the activity of the omicron variant 3CL protease efficiently, and there continues to be pronounced differences in COVID-19 morbidity and mortality between groups of countries with high and low green tea consumption as of December 6, 2022. These results collectively suggest that green tea continues to be effective against COVID-19 despite the new omicron variants and increased vaccination.

COVID-19 in patients with neuroendocrine neoplasms: two-year results of the INTENSIVE study.

Preliminary results regarding 85 patients of the INTENSIVE study have been published in 2021. Now we are reporting the 2-year analysis. We conducted a retrospective/prospective worldwide study on patients with neuroendocrine neoplasms (NENs) and a molecularly proven SARS-CoV-2 positivity. Here we are reporting data from consecutive patients enrolled between June 01, 2020, and May 31, 2022. Among the 118 contacted centers, 25 were active to enroll and 19 actively recruiting at the time of data cut-off for a total of 280 patients enrolled. SARS-CoV-2 positivity occurred in 47.5% of patients in 2020, 35.1% in 2021 and 17.4% in 2022. Median age at COVID-19 diagnosis was 60 years. Well differentiated tumors, non-functioning, metastatic stage and gastroenteropancreatic (GEP) primary site represented most of NENs. COVID-19-related pneumonia occurred in 22.8% of the total, with 61.3% of them requiring hospitalization; 11 patients (3.9%) needed sub-intensive or intensive care unit therapies and 14 patients died (5%), in 11 cases (3.9%) directly related to COVID-19. Thoracic and other NEN primary site were associated with hospitalization for COVID-19 and with sub-intensive or intensive care. A significant decrease in both hospitalization and pneumonia occurred in 2022 versus 2020. In our largest series of NEN patients with COVID-19, the NEN population is similar to the general population regardless of COVID-19. However, older age, non-GEP primary sites and diabetes mellitus should be carefully considered for increased COVID-19 morbidity and mortality. Relevant information could be derived by integrating our results with NENs patients included in other cancer patients and COVID-19 registries.

Adenosine deaminase augments SARS-CoV-2 specific cellular and humoral responses in aged mouse models of immunization and challenge.

Despite numerous clinically available vaccines and therapeutics, aged patients remain at increased risk for COVID-19 morbidity. Furthermore, various patient populations, including the aged can have suboptimal responses to SARS-CoV-2 vaccine antigens. Here, we characterized vaccine-induced responses to SARS-CoV-2 synthetic DNA vaccine antigens in aged mice. Aged mice exhibited altered cellular responses, including decreased IFNγ secretion and increased TNFα and IL-4 secretion suggestive of TH2-skewed responses. Aged mice exhibited decreased total binding and neutralizing antibodies in their serum but significantly increased TH2-type antigen-specific IgG1 antibody compared to their young counterparts. Strategies to enhance vaccine-induced immune responses are important, especially in aged patient populations. We observed that co-immunization with plasmid-encoded adenosine deaminase (pADA)enhanced immune responses in young animals. Ageing is associated with decreases in ADA function and expression. Here, we report that co-immunization with pADA enhanced IFNγ secretion while decreasing TNFα and IL-4 secretion. pADA expanded the breadth and affinity SARS-CoV-2 spike-specific antibodies while supporting TH1-type humoral responses in aged mice. scRNAseq analysis of aged lymph nodes revealed that pADA co-immunization supported a TH1 gene profile and decreased FoxP3 gene expression. Upon challenge, pADA co-immunization decreased viral loads in aged mice. These data support the use of mice as a model for age-associated decreased vaccine immunogenicity and infection-mediated morbidity and mortality in the context of SARS-CoV-2 vaccines and provide support for the use of adenosine deaminase as a molecular adjuvant in immune-challenged populations.

Nursing Implementation Case Study: Health Education on Self-care Management of Asthma Patients During the COVID-19 Pandemic in Indonesia

Asthma is an incurable disease and is considered a risk factor for the morbidity of COVID-19. Self-care management is highly recommended as routine maintenance therapy, especially during the pandemic. This study aims to describe the nursing implementation related to health education about self-care management of asthma patients during the pandemic in Indonesia. This study used an exploratory case study method using the nursing process approach. The data were obtained using purposive sampling. The data were collected in various ways, such as interviews, physical assessments, and environmental observation. The nursing problems identified were ineffective breathing patterns and non-compliance. After implementing nursing through health education on self-care management, it was found that the development of the situation had improved. Nursing implementation through health education on self-care management in asthma patients can be applied to optimize asthma symptom control, reduce the risk of asthma exacerbations, and reduce the side effects of treatment, especially during the COVID-19 pandemic.&#x0D; Keywords: implementation of nursing, health education, self-care management, asthma, COVID-19

A248 OUTCOMES OF COVID-19 ILLNESS AND ACCESS TO APPROPRIATE TREATMENT IN LIVER TRANSPLANT RECIPIENTS IN BRITISH COLUMBIA THROUGHOUT THE PANDEMIC

Abstract Background COVID-19 continues to cause significant illness and mortality worldwide. Solid Organ Transplant Recipients (SOTR) have a higher rate of COVID-19 infection and worse outcomes than those who are immunocompetent. Dexamethasone, tocilizumab, and baricitinib have improved inpatient outcomes. Sotrovimab, remdesivir, and nirmatrelvir/ritonavir have recently been approved for used in high risk, minimally symptomatic outpatients. Previous experience has shown that use of monoclonal antibodies and oral antiviral agents have reduced morbidity and mortality of COVID-19 in SOTR. Purpose To assess the experiences and outcomes of COVID-19 and access to directed therapy in SOTR in British Columbia (BC). Method Data was compiled from patient disclosure to liver transplant clinicians on COVID-19 infection and gathered from patient charts in the SOTR Clinic at Vancouver General Hospital. Inclusion criteria were patients followed at the clinic with a positive COVID-19 test or clinical confirmation of COVID-19 syndrome. This is a retrospective, quality assurance study and did not require ethics review. Result(s) 158 SOTR reported COVID-19 infections between March 2020 and September 2022. 3 patients died within 30 days of COVID-19 infection, 2 (1.26%) of which the cause of death was directly due to COVID-19, and the other who had cholangitis with severe sepsis and multi-organ system failure. 24 patients required admission to hospital, 7 requiring critical care support. 41 patients did not receive any therapy for COVID-19: there was none available at that time (n=26), it was contraindicated due to a drug interaction (n=2) or medical condition (n=1), was refused (n=1), or the infection was reported too late to qualify (n=10). 83% (92/112) of outpatients received available anti-viral treatment: sotrovimab (n=27), remdesivir (n=63), or nirmatrelvir/ritonavir (n=2). In inpatients (n=24), 13 received corticosteroids, 6 dual treated with tocilizumab (n=4) or baracitinib (n=2). 4 inpatients received remdesivir. Three patients were treated in hospital after initiating outpatient therapy, one with progression of COVID-19 illness despite starting remdesivir. Two patients had adverse effects of medications provided: one was prescribed nirmatrelvir/ritonavir by a physician outside of the transplant program, which caused tacrolimus toxicity (serum concentration of 69.4 ng/mL) with nausea, vomiting, and diarrhea. Another patient had an episode of hypotension after receiving sotrovimab and sustained an acute kidney injury (AKI). Both patients fully recovered. There were no deaths on antiviral therapy. Of 145 patients who had laboratory investigations done within 30 days of COVID-19 infection, 16 had a transient rise in liver enzymes, 14 had an AKI and 11required an adjustment in their tacrolimus dose. Conclusion(s) Involving the liver transplant team early in the course of COVID-19 illness allows patients to safely access COVID-19 directed therapy to avoid progression of illness, and medication interactions or toxicity. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

The COVID-19-wildfire smoke paradox: Reduced risk of all-cause mortality due to wildfire smoke in Colorado during the first year of the COVID-19 pandemic

BackgroundIn 2020, the American West faced two competing challenges: the COVID-19 pandemic and the worst wildfire season on record. Several studies have investigated the impact of wildfire smoke (WFS) on COVID-19 morbidity and mortality, but little is known about how these two public health challenges impact mortality risk for other causes. ObjectivesUsing a time-series design, we evaluated how daily risk of mortality due to WFS exposure differed for periods before and during the COVID-19 pandemic. MethodsOur study included daily data for 11 counties in the Front Range region of Colorado (2010–2020). We assessed WFS exposure using data from the National Oceanic and Atmospheric Administration and used mortality counts from the Colorado Department of Public Health and Environment. We estimated the interaction between WFS and the pandemic (an indicator variable) on mortality risk using generalized additive models adjusted for year, day of week, fine particulate matter, ozone, temperature, and a smoothed term for day of year. ResultsWFS impacted the study area on 10% of county-days. We observed a positive association between the presence of WFS and all-cause mortality risk (incidence rate ratio (IRR) = 1.03, 95%CI: 1.01–1.04 for same-day exposures) during the period before the pandemic; however, WFS exposure during the pandemic resulted in decreased risk of all-cause mortality (IRR = 0.90, 95%CI: 0.87–0.93 for same-day exposures). DiscussionWe hypothesize that mitigation efforts during the first year of the pandemic, e.g., mask mandates, along with high ambient WFS levels encouraged health behaviors that reduced exposure to WFS and reduced risk of all-cause mortality. Our results suggest a need to examine how associations between WFS and mortality are impacted by pandemic-related factors and that there may be lessons from the pandemic that could be translated into health-protective policies during future wildfire events.

Efficacy of pulmonary rehabilitation in patients with post-acute COVID-19.

The most important cause of mortality and morbidity of COVID-19 is lung involvement. In this study, the effects of pulmonary rehabilitation (PR) in the post-acute COVID-19 period on lung functions, functional capacity, dyspnea, quality of life, and psychiatric state were investigated. Patients were admitted to a PR program after discharge when their general condition had stabilized. The patients' scores of forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC ratio, maximum vital capacity (VCmax), peripheral arterial oxygen saturation (PaO2), 6-minute walking distance (6MWD), Medical Research Council Dyspnea Scale (MRC), St. George Respiratory Questionnaire (SGSA), and Hospital Anxiety and Depression Scale (HADS) before and after pulmonary rehabilitation were compared. The patients were divided into three groups, mild, moderate, and severe, according to their thorax CT findings. A total of 52 patients [mean age: 46.7 ± 12.5 (range: 19-76) years] were included in the study. Nineteen patients were in the mild group, 16 in the moderate group, and 17 patients comprised the severe group. Comparing the parameters before and after PR, significant improvement was observed in all three groups in the evaluation parameters after treatment including FVC, FEV1, FEV1/FVC, 6MWD, and MRSC; SGSA symptoms, activity, effects and total scores; HADS depression, anxiety, and total scores (p<0.05 for all). PR is a beneficial treatment for patients with COVID-19 with lung involvement for improving lung functions, eliminating dyspnea, and improving functional capacity, psychological status, and life quality of the patient.

Association of preoperative COVID-19 and postoperative respiratory morbidity during the Omicron epidemic wave: the DROMIS-22 multicentre prospective observational cohort study

Preoperative COVID-19 has been associated with excess postoperative morbi-mortality. Consequently, guidelines were developed that recommended the postponement of surgery for at least 7 weeks after the infection. We hypothesised that vaccination against the SARS-CoV-2 and the large predominance of the Omicron variant attenuated the effect of a preoperative COVID-19 on the occurrence of postoperative respiratory morbidity. We conducted a prospective cohort study in 41 French centres between 15 March and 30 May 2022 (ClinicalTrials NCT05336110), aimed at comparing the postoperative respiratory morbidity between patients with and without preoperative COVID-19 within 8 weeks prior to surgery. The primary outcome was a composite outcome combining the occurrence of pneumonia, acute respiratory failure, unexpected mechanical ventilation, and pulmonary embolism within the first 30 postoperative days. Secondary outcomes were 30-day mortality, hospital length-of-stay, readmissions, and non-respiratory infections. The sample size was determined to have 90% power to identify a doubling of the primary outcome rate. Adjusted analyses were performed using propensity score modelling and inverse probability weighting. Of the 4928 patients assessed for the primary outcome, of whom 92.4% were vaccinated against the SARS-CoV-2, 705 had preoperative COVID-19. The primary outcome was reported in 140 (2.8%) patients. An 8-week preoperative COVID-19 was not associated with increased postoperative respiratory morbidity (odds ratio 1.08 [95% CI 0.48-2.13]; p=0.83). None of the secondary outcomes differed between the two groups. Sensitivity analyses concerning the timing between COVID-19 and surgery, and the clinical presentations of preoperative COVID-19 did not show any association with the primary outcome, except for COVID-19 patients with ongoing symptoms the day of surgery (OR 4.29 [1.02-15.8]; p=0.04). In our Omicron-predominant, highly immunised population undergoing general surgery, a preoperative COVID-19 was not associated with increased postoperative respiratory morbidity. The study was fully funded by the French Society of Anaesthesiology and Intensive Care Medicine (SFAR).

COVID-19 and Periodontal Conditions — A Narrative Review of Implications for Oral Health Providers

Background Studies suggest a possible role for oral dysbiosis and periodontitis as contributing factors to COVID-19. Based on current knowledge, this review summarizes the potential connection between COVID-19, oral pathogens, and periodontitis. It also describes gingival side effects of COVID-19 vaccines and discusses the likely rise in the prevalence of periodontal conditions due to the pandemic.Types of Studies Reviewed This study was designed as a narrative review. Medline, Scopus, and Google Scholar were searched up to May 2022 for articles in English addressing the link between oral bacteria, periodontitis, and COVID-19. All clinical studies addressing the link between periodontitis and COVID-19 were included.Results The anatomical connection between the oral cavity and the lungs through blood vessels and the pharynx provides a plausible pathway for microorganisms and inflammatory molecules to reach the respiratory tract from the oral cavity. Periodontal bacteria can trigger cytokine production and promote SARS-CoV-2 infection of host cells. Despite limited clinical studies, the potential for oral dysbiosis and periodontitis to intensify inflammation, thereby increasing COVID-19 morbidity and mortality, should not be underestimated. Some patients can develop temporary gingival bleeding as a result of COVID-19 vaccines.Practical Implications Given the significance of oral health for general health and the potential for periodontitis and oral dysbiosis to make COVID-19 more severe and deadly, this is a highly relevant topic for health professionals and society.

Severity Status of COVID-19 and Its Associated Factors at the Nyarugenge Treatment Center in Rwanda.

Background The COVID-19 pandemic has continued to be a public health emergency currently; on March 11, 2020, the World Health Organization (WHO) declared it a global pandemic. Despite the Rwanda National Health Measures that have been put in place to protect the public including lockdowns, curfew, face mask mandate, handwashing sensitization, etc., severe morbidity and mortality cases of COVID-19 are continued to be seen. Some studies have linked COVID-19 complications to its direct chain of mechanism; however, other studies have linked comorbidity or underlying disease conditions to its poor prognosis. Studies have not yet been conducted in Rwanda on the severe status of COVID-19 and its associated factors among patients. Therefore, this study aimed to assess the severe status of COVID-19 and its associated factors at the Nyarugenge Treatment Center. Methods A descriptive cross-sectional study was done. All patients admitted to the Nyarugenge Treatment Center from January 8, 2021, when the hospital opened, until the end of May 2021 were recruited in the study. The eligible participants were all patients who were admittedand tested positive for COVID-19 by RT-PCR method according to the Rwanda Ministry of Health criteria. Results All data were analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 25 (IBM Corp., Armonk, NY). The number of patients admitted during the study period was 648, with a median age of 53; 45.2% of them were females, and 54.2% were males. Of these, 81.2% (526) were discharged from the hospital, while 18.8% (122) died. The proportion of severe status of COVID-19 was 42.1%. The factors that showed a risk of severe COVID-19 status were age and the number of comorbidities. Patients aged above 60 years(OR = 11.7, 95% CI:5.35-25.67, p-value < 0.001) and those between the age of 51 and 60 (OR = 6.86, 95% CI:2.96-15.93, p-value < 0.001) were 12 and seven times more likely to have severe COVID-19 statuscompared to those aged below 30 years. Having two comorbidities had twice the risk of developing a severe COVID-19 status compared to those with no comorbidity (OR = 2.13, 95% CI:1.20-3.77, p-value < 0.001). Conclusion Elderly people and those with comorbidities are encouraged to obtain all standard operating proceduresand comply with the vaccination program.

Comparison of new psychiatric diagnoses among Finnish children and adolescents before and during the COVID-19 pandemic: A nationwide register-based study.

Coronavirus Disease 2019 (COVID-19) restrictions decreased the use of specialist psychiatric services for children and adolescents in spring 2020. However, little is known about the pattern once restrictions eased. We compared new psychiatric diagnoses by specialist services during pandemic and pre-pandemic periods. This national register study focused on all Finnish residents aged 0 to 17 years from January 2017 to September 2021 (approximately 1 million a year). The outcomes were new monthly diagnoses for psychiatric or neurodevelopmental disorders in specialist services. These were analyzed by sex, age, home location, and diagnostic groups. The numbers of new diagnoses from March 2020 were compared to predictive models based on previous years. The predicted and observed levels in March to May 2020 showed no significant differences, but the overall difference was 18.5% (95% confidence interval 12.0 to 25.9) higher than predicted in June 2020 to September 2021, with 3,821 more patients diagnosed than anticipated. During this period, the largest increases were among females (33.4%, 23.4 to 45.2), adolescents (34.4%, 25.0 to 45.3), and those living in areas with the highest COVID-19 morbidity (29.9%, 21.2 to 39.8). The largest increases by diagnostic groups were found for eating disorders (27.4%, 8.0 to 55.3), depression and anxiety (21.0%, 12.1 to 51.9), and neurodevelopmental disorders (9.6%, 3.0 to 17.0), but psychotic and bipolar disorders and conduct and oppositional disorders showed no significant differences and self-harm (-28.6, -41.5 to -8.2) and substance use disorders (-15.5, -26.4 to -0.7) decreased in this period. The main limitation is that data from specialist services do not allow to draw conclusions about those not seeking help. Following the first pandemic phase, new psychiatric diagnoses in children and adolescents increased by nearly a fifth in Finnish specialist services. Possible explanations to our findings include changes in help-seeking, referrals and psychiatric problems, and delayed service access.

Primordial prevention: Reducing consumption of sugar-sweetened beverages in racial/ethnic populations

Beyond pharmacotherapy in adulthood, primordial prevention in United States (U.S.) children and adolescents is needed to avoid the upcoming tsunami of cardiometabolic and cardiovascular disease (CVD). Healthcare disparities were unmasked by the disparate morbidity and mortality of COVID-19 in racial/ethnic populations, especially in persons with obesity, diabetes, and CVD. One potential successful strategic improvement of childhood cardiovascular health is to reduce sugar consumption in early life as CVD is the number one cause of death in patients with Type 2 diabetes (T2D). Furthermore, cardiologists treat more patients with T2D than endocrinologists. This commentary challenges cardiovascular specialists and other clinicians to address the increasing burden of cardiometabolic and CVD in adults, especially in racial/ethnic populations, by supporting primordial prevention in childhood.

Previous exposure to common coronavirus HCoV-NL63 is associated with reduced COVID-19 severity in patients from Cape Town, South Africa

BackgroundGlobally, the most significant risk factors for adverse COVID-19 outcome are increasing age and cardiometabolic comorbidities. However, underlying coinfections may modulate COVID-19 morbidity and mortality, particularly in regions with high prevalence of infectious diseases.MethodsWe retrospectively analyzed serum samples for IgG antibodies against the common circulating coronaviruses HCoV-NL63, HCoV-229E, HCoV-OC43 and HCoV-HKU1 from non-hospitalized and hospitalized confirmed COVID-19 patients recruited during the first (June-August 2020) and second (October 2020-June 2021) COVID-19 wave in Cape Town, South Africa. Patients were grouped according to COVID-19 disease severity: Group 1: previously SARS-CoV-2 infected with positive serology and no symptoms (n=94); Group 2: acutely SARS-CoV-2 infected, hospitalized for COVID-19 and severe symptoms (n=92).ResultsThe overall anti-HCoV IgG seroprevalence in the entire patient cohort was 60.8% (95% CI: 53.7 – 67.8), with 37.1% HCoV-NL63 (95% CI: 30 – 44), 30.6% HCoV-229E (95% CI: 24 – 37.3), 22.6% HCoV-HKU1 (95% CI: 16.6 – 28.6), and 21.0% HCoV-OC43 (95% CI: 15.1 – 26.8). We observed a significantly higher overall HCoV presence (72.3% versus 48.9%) and coinfection frequency (43.6% versus 19.6%) in group 1 compared to group 2 patients with significantly higher presentation of HCoV-NL63 (67.0% versus 6.6%) and HCoV-HKU1 (31.1% versus 14.1%). However, only antibody titers for HCoV-NL63 were significantly higher in group 1 compared to group 2 patients (p&amp;lt; 0.0001, 1.90 [95% CI: 0.62 – 2.45] versus 1.32 [95% CI: 0.30 – 2.01]) which was independent of the participants’ HIV status. Logistic regression analysis revealed significantly protective effects by previous exposure to HCoV-NL63 [p&amp;lt; 0.001, adjusted OR = 0.0176 (95% CI: 0.0039 – 0.0786)], while previous HCoV-229E exposure was associated with increased COVID-19 severity [p = 0.0051, adjusted OR = 7.3239 (95% CI: 1.8195–29.4800)].ConclusionWe conclude that previous exposure to multiple common coronaviruses, and particularly HCoV-NL63, might protect against severe COVID-19, while no previous HCoV exposure or single infection with HCoV-229E might enhance the risk for severe COVID-19. To our knowledge, this is the first report on HCoV seroprevalence in South Africa and its possible association with cross-protection against COVID-19 severity.

“Let me touch him”: Perceptions and experiences of family caregivers of nursing home residents during the COVID-19 outbreak in Israel

Older adults in nursing homes were particularly vulnerable to COVID-19 morbidity and mortality worldwide. Due to the COVID-19 pandemic, visitations in nursing homes were restricted. The present study examined the perceptions and experiences of family caregivers of nursing home residents during the COVID-19 crisis in Israel and their coping strategies. Online focus group interviews were held with 16 family caregivers of nursing home residents. Three main categories were identified through Grounded Theory techniques: (a) Anger and decreased trust in nursing homes; (b) Perception of the residents as victims of the nursing home policy; (c) Coping strategies at different levels. The outbreak redefined family caregivers' understanding of their role. Practical implications include making the voice of the family caregivers heard, identifying effective coping strategies, and creating a dialogue between family caregivers, nursing home managements, and staff.

Coping with COVID in corrections: a qualitative study among the recently incarcerated on infection control and the acceptability of wastewater-based surveillance

BackgroundCorrectional settings are hotspots for SARS-CoV-2 transmission. Social and biological risk factors contribute to higher rates of COVID-19 morbidity and mortality among justice-involved individuals. Rapidly identifying new cases in congregate settings is essential to promote proper isolation and quarantine. We sought perspectives of individuals incarcerated during COVID-19 on how to improve carceral infection control and their perspectives on acceptability of wastewater-based surveillance (WBS) accompanying individual testing.MethodsWe conducted semi-structured interviews with 20 adults who self-reported being incarcerated throughout the United States between March 2020 and May 2021. We asked participants about facility enforcement of the Centers for Disease Control and Prevention (CDC) COVID-19 guidelines, and acceptability of integrating WBS into SARS-CoV-2 monitoring strategies at their most recent facility. We used descriptive statistics to characterize the study sample and report on acceptability of WBS. We analyzed qualitative data thematically using an iterative process.ResultsParticipants were predominantly Black or multiple races (50%) and men (75%); 46 years old on average. Most received a mask during their most recent incarceration (90%), although only 40% received counseling on proper mask wearing. A quarter of participants were tested for SARS-CoV-2 at intake. Most (70%) believed they were exposed to the virus while incarcerated. Reoccurring themes included (1) Correctional facility environment leading to a sense of insecurity, (2) Perceptions that punitive conditions in correctional settings were exacerbated by the pandemic; (3) Importance of peers as a source of information about mitigation measures; (4) Perceptions that the safety of correctional environments differed from that of the community during the pandemic; and (5) WBS as a logical strategy, with most (68%) believing WBS would work in the last correctional facility they were in, and 79% preferred monitoring SARS-CoV-2 levels through WBS rather than relying on just individual testing.ConclusionParticipants supported routine WBS to monitor for SARS-CoV-2. Integrating WBS into existing surveillance strategies at correctional facilities may minimize the impact of future COVID-19 outbreaks while conserving already constrained resources. To enhance the perception and reality that correctional systems are maximizing mitigation, future measures might include focusing on closer adherence to CDC recommendations and clarity about disease pathogenesis with residents.