COVID-19 Related Deaths Research Articles

470. Clinical Effectiveness of The Monoclonal Antibody Combination Tixagevimab-Cilgavimab (T/C) as Pre-Exposure Prophylaxis (PReP) of COVID-19 among Patients (pts) with Moderate to Severe Immunocompromised (IC) Conditions across a Large U.S. Healthcare System: A Propensity Score-Matched Retrospective Cohort Study

Abstract Background T/C authorization in the US for PrEP of COVID-19 in IC individuals was initially based on a randomized trial (PROVENT). However, < 5% of enrollees in PROVENT were IC. We sought to assess real-world effectiveness of T/C PrEP among IC pts. Methods We conducted a retrospective, observational, propensity-score matched cohort study at UPMC from Jan 1, 2022, to Mar 31, 2023. We assessed effectiveness at ≤ 6 months of T/C 600 mg (as initial dose, or as 300 mg then 300 mg ≤ 3 months later) against chart confirmed COVID-19 hospitalizations and COVID-19–related deaths among IC pts. Results Before matching, there were 2931 T/C vs 157,225 non-T/C pts. After matching, 2301 matched pairs remained (78.5% vs 1.8% of all eligible T/C vs non-T/C pts). Most pts had moderate/severe IC conditions (Table 1). During the study period encompassing circulating variants both susceptible and resistant to T/C, there were 15 vs 18 COVID-19 hospitalizations across 377,832 person-days in T/C vs non-T/C pts (Table 2). Thus, 0.72% vs 0.87% of T/C exposed vs unexposed pts were hospitalized for COVID-19 (HR 0.833, 95% CI 0.39 – 1.75, p = 0.73) (Table 2; Figure 1). There was no difference in effectiveness by T/C dosing pattern (Table 2). Effectiveness was numerically higher in the BA.5 period, although there were few events in other variant eras (Table 2). There was a non-significant 50% lower risk of hospitalization in T/C patients with solid tumors or autoimmune conditions, and no significant difference by exposure status in patients with organ transplant or hematologic cancer (Table 2). There were 5 COVID-19 ICU admissions per exposure group, and 2 inpatient COVID-19–related deaths (1 per group) (Table 3). Limitations included overall low event rate limiting power and an open healthcare system leading to possibility of missing hospitalizations due to pts seeking care elsewhere. Conclusion The overall low number of chart-confirmed COVID-19 hospitalizations for the entire cohort limited our ability to detect a statistical difference between T/C exposed vs. unexposed patients. Possible clinical benefit of T/C is suggested for solid tumor and autoimmune patients, although larger studies will need to confirm this observation.Figure 1.Time-to-COVID-19 hospitalization (chart-review confirmed) for entire period among T/C exposed (red) vs unexposed (blue) patients. Disclosures Ghady Haidar, MD, Allovir: Grant/Research Support|AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|Karius: Advisor/Consultant|Karius: Grant/Research Support|NIH: Grant/Research Support Graham M. Snyder, MD, SM, Infectious Diseases Connect: Advisor/Consultant Cátia Ferreira, PhD, AstraZeneca: Employee Lisa Glasser, MD, AstraZeneca: Stocks/Bonds Kathleen Heil, RN, BSN, AstraZeneca: Employee Andrew Lee, MSc, AstraZeneca: Employee Carla Talarico, PhD, MPH, AstraZeneca: Stocks/Bonds Sudhir Venkatesan, MPH, PhD, AstraZeneca: Employee Sylvia Taylor, PhD, MPH, MBA, AstraZeneca: Stocks/Bonds Erin K. McCreary, PharmD, Abbvie: Advisor/Consultant|Ferring: Advisor/Consultant|GSK: Honoraria|La Jolla (Entasis): Advisor/Consultant|LabSimply: Advisor/Consultant|Merck: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Honoraria John W. Mellors, MD, AstraZeneca: Grant/Research Support|Gilead Sciences: Grant/Research Support

Moral Distress, Mental Health, and Risk and Resilience Factors among Canadian Armed Forces Personnel Deployed to Canadian Long-Term Care Facilities during COVID-19 (Operation LASER COVID-19 Response): Research Protocol and Participation Metrics.

The earliest days of the COVID-19 pandemic in Canada were marked by a significant surge in COVID cases and COVID-related deaths among residents of long-term care facilities (LTCF). As part of Canada's response to the COVID-19 pandemic, Canadian Armed Forces (CAF) personnel were mobilized for an initial emergency domestic deployment to the hardest-hit LTCFs (Operation LASER LTCF) to support the remaining civilian staff in ensuring the continued delivery of care to residents. Akin to what was observed following past CAF international humanitarian missions, there was an expected increased risk of exposure to multiple stressors that may be psychologically traumatic and potentially morally injurious in nature (i.e., related to important values; e.g., witnessing human suffering). The objective of the research study is to identify and quantify the individual-, group-, and organizational-level risk and resilience factors associated with moral distress, moral injury and traditional mental health and well-being outcomes of Operation (Op) LASER LTCF CAF personnel. The objective of this manuscript is to document the methodology, implementation procedures, and participation metrics. A multimethod research initiative was conducted, consisting of two primary data collection studies (a quantitative survey and qualitative interviews). The quantitative arm was a complete enumeration survey with online self-report questionnaires administered at three timepoints (3, 6, and 12 months post-deployment). The qualitative arm consisted of individual interviews conducted virtually, with a focus on understanding the nuanced lived experiences of individuals taking part in the Op LASER LTCF deployment. CAF personnel deployed to Op LASER LTCF (n = 2,595) were invited to participate in the study. Data collection is now complete. Overall, 1,088, 582, and 497 individuals responded to the survey at Time 1 (3 months), Time 2 (6 months), and Time 3 (12 months) post-deployment, providing a participation rate of 41.9%, 22.4%, and 19.2% for Time 1, Time 2, and Time 3, respectively. Data for all three timepoints was obtained from 212 participants (representing 19.5% of all Time 1 responses). Interest in participating in qualitative interviews surpassed expectations with over 200 individuals expressing interest; this allowed for purposive sampling across key characteristics, including gender, rank, Op LASER LTCF role, and province. In total, 53 interviews were conducted. The data generated by this research has the potential to inform and better understand the well-being and mental health of Op LASER LTCF personnel over time, identify general and Op LASER LTCF-specific risk and protective factors, provide necessary supports to the military personnel who served in this mission, and to inform preparation and interventions for future missions, especially those more of a domestic and humanitarian nature. DERR1-10.2196/44299.

Mortality in Norway and Sweden during the COVID-19 pandemic 2020–22: A comparative study

BackgroundNorway and Sweden picked two different ways to mitigate the dissemination of the SARS-CoV-2 virus. Norway introduced the strictest lockdown in Europe with strict border controls and intense virus tracking of all local outbreaks while Sweden did not. That resulted in 477 COVID-19 deaths (Norway) and 9737 (Sweden) in 2020, respectively. MethodsWeekly number of COVID-19 related deaths and total deaths for 2020–22 were collected as well as weekly number of deaths for 2015–19 which were used as controls when calculating excess mortality. During the first 12–18 months with high rate of virus transmission in the society, excess mortality rates were used as substitute for COVID-19 deaths. When excess mortality rates later turned negative because of mortality displacement, COVID-19 deaths adjusted for bias due to overreporting were used. ResultsThere were 17521 COVID-19 deaths in Sweden and 4272 in Norway in the study period. The rate ratio (RR) of COVID-19 related deaths in Sweden vs. Norway to the end of week 43, 2022, was 2.11 (95% CI 2.05–2.19). RR of COVID-19 related deaths vs. excess number of deaths were 2.5 (Sweden) and 1.3 (Norway), respectively. RR of COVID-19 deaths in Sweden vs. Norway after adjusting for mortality displacement and lockdown, was 1.35 (95% CI 1.31–1.39), corresponding to saving 2025 life in Norway. If including all deaths in 2022, RR= 1.28 (95% CI 1.24–1.31). ConclusionsBoth COVID-19 related mortality and excess mortality rates are biased estimates. When adjusting for bias, mortality differences declined over time to about 30% higher mortality in Sweden after 30 months with pandemics.

Effectiveness and waning of protection with the BNT162b2 vaccine against the SARS-CoV-2 Delta variant in immunocompromised individuals.

In Hungary, the HUN-VE 3 study determined the comparative effectiveness of various primary and booster vaccination strategies during the Delta COVID-19 wave. That study included more than 8 million 18-100-year-old individuals from the beginning of the pandemic. Immunocompromised (IC) individuals have increased risk for COVID-19 and disease course might be more severe in them. In this study, we wished to estimate the risk of SARS-CoV-2 infection and COVID-19 related death in IC individuals compared to healthy ones and the effectiveness of the BNT162b2 vaccine by reassessing HUN-VE 3 data. Among the 8,087,988 individuals undergoing follow-up from the onset of the pandemic in the HUN-VE 3 cohort, we selected all the 263,116 patients with a diagnosis corresponding with IC and 6,128,518 controls from the second wave, before vaccinations started. The IC state was defined as two occurrences of corresponding ICD-10 codes in outpatient or inpatient claims data since 1 January, 2013. The control group included patients without chronic diseases. The data about vaccination, SARS-CoV-2 infection and COVID-19 related death were obtained from the National Public Health Center (NPHC) during the Delta wave. Cases of SARS-CoV-2 infection were reported on a daily basis using a centralized system via the National Public Health Center (NPHC). Out of the 263,116 IC patients 12,055 patients (4.58%) and out of the 6,128,518 healthy controls 202,163 (3.30%) acquired SARS-CoV-2 infection. Altogether 436 IC patients and 2141 healthy controls died in relation to COVID-19. The crude incidence rate ratio (IRR) of SARS-CoV-2 infection was 1.40 (95%CI: 1.37-1.42) comparing IC patients to healthy controls. The crude mortality rate ratio was 4.75 (95%CI: 4.28-5.27). With respect to SARS-CoV-2 infection, interestingly, the BNT162b2 vaccine was more effective in IC patients compared to controls. Primary vaccine effectiveness (VE) was higher in IC patients compared to controls and the booster restored VE after waning. VE regarding COVID-19 related death was less in IC patients compared to healthy individuals. Booster vaccination increased VE against COVID-19-related death in both IC patients and healthy controls. There is increased risk of SARS-CoV-2 infection and COVID-19 related mortality in IC patient. Moreover, booster vaccination using BNT162b2 might restore impaired VE in these individuals.

Pre-Graft Vaccination or Infection Do Not Provide More Protection Against COVID-19 Infections in Post-Graft Vaccinated Recipients of Allogeneic Stem Cell Transplantation

Background : Available just one year after the beginning of the pandemic, in December 2020, vaccination has been a revolution allowing to avoid severe forms of the deadly COVID-19 infectious disease in the healthy population as well as in immunocompromised hosts, including recipients of allogeneic stem cell transplantation (Allo-SCT). These patients (pts) were first vaccinated after transplant but rapidly both pts and donors could receive vaccine before Allo-SCT. The impact of vaccination pre- or post- Allo-SCT or both has not been clearly evaluated yet. Moreover, the role of a previous COVID-19 infection before Allo-SCT remains to be specified. Methods : The impact of pre- and post-Allo-SCT COVID-19 vaccination and previous COVID-19 infection in adults allografted in our Hematology Department between October 2020 and March 2023 and with a follow-up of at least 3 months post-transplant was investigated. Data were collected up to July 2023 and pts or donors were joined by phone if needed to ensure updated information. Three groups were defined : 1) pts or donors with no vaccine and no previous COVID-19 infection before Allo-SCT and vaccination after transplant, 2) pts and/or donors vaccinated and without COVID-19 infection before transplant (with or without vaccine after transplant), and 3) pts and/or donors with a previous COVID-19 infection (with or without vaccine pre and post-transplant). The rates of overall and severe forms of COVID-19 infections after Allo-SCT were collected overall and in each group. Severe forms were defined by COVID-19-related hospitalizations (including those in intensive care unit) and/or death. Some pts also received tixagevimab and cilgavimab (Tix/cil) as preventive treatment after Allo-HSCT during the Delta wave. Results : A total of 157 pts was considered (Table 1.median age : 59 yo, range : 20-74 ; male n=91; myeloid disease n=122 ; lymphoid disease n=31; other disease n= 4; conditioning regimen : myeloablative n=17 ; reduced-intensity n=133 ; sequential n=7 ; donor type : sibling n=39, matched unrelated n=56, haploidentical n=59, one mismatch unrelated n=2, cord blood n=1). Post-Allo-HSCT vaccination rates were 100% in group 1 (n=58/58), 50% in group 2 (n=31/62) and 32% (n=12/37) in group 3. Most pts were considered during the delta/omicron waves. The first vaccination post-graft was performed at a median of 168 days (range: 27-482) while COVID-19 infection occurred at a median of 312 days (range: 0-1027) post-graft. Results are summarized in Table 2. Overall and severe COVID-19 infection rates were 35% and 9.5%, respectively while there were 3% of COVID-related deaths for the whole cohort. Post-Allo-HSCT vaccination was clearly associated with protection against COVID-19 infection (incidence of 20% in vaccinated pts vs 62.5% in non-vaccinated, p<0.001). However, rates of severe forms or deaths related to COVID-19 were similar between vaccinated and non-vaccinated pts. COVID-19 infection rates were 24%, 31% and 32% in groups 1, 2 and 3, respectively. Severe COVID-19 infection and death rates were also similar between the three groups at 12%, 11% and 3%, and 3%, 3% and 3%, respectively. Considering only pts vaccinated after transplant, all rates were again similar between each group, suggesting that pre-graft vaccination or infection before Allo-HSCT do not provide more protection. Interestingly, pts in the first year post-transplant had no superior risk of COVID-19 infection or severe forms of the disease. Tix/cil was used mainly in non-vaccinated post-transplant patients and was associated with the same rate of COVID-19 infections compared to patients not receiving Tix/cil. As these latter patients were almost all vaccinated after transplant (90%), this confirms that Tix/cil was as efficient as vaccine use during the Delta wave to protect patients who did not receive vaccine after transplant. Deaths and relapse rates were also comparable between the three groups suggesting no impact of pre-Allo-SCT vaccine or infection on outcomes. Conclusion : In this study, post-Allo-SCT vaccination appears to be of crucial importance to protect recipients against COVID-19 infections. Pre-graft vaccine or infection are not associated with less COVID-19 infections nor severe forms of the disease in pts vaccinated after transplant, suggesting that post-graft vaccination is sufficient to ensure good protection in these pts.

“Messengers matter”: Assessing the impact of racially concordant care on vaccine hesitation

With the rise in COVID-related deaths among the unvaccinated, understanding coronavirus vaccine hesitancy is critical to maintaining public health. Previous research has shown that sociodemographic factors, such as race, are essential for understanding vaccine hesitancy; yet, the specific factors driving racial disparities in vaccination continue to be a matter of intense debate. This study uses a novel survey experiment to uncover the linkages between race, physician trust, and vaccine hesitancy. Using a standard prompt on the release of the COVID-19 vaccine, it tests whether patient-physician race concordance affects the likelihood of vaccine uptake among US citizens. Analyses reveal that racially concordant care has a negligible effect on vaccine hesitancy, but does ameliorate other harmful beliefs regarding one's likelihood of experiencing discrimination and racism in healthcare more generally. These findings suggest that increasing diversity in the medical field should be paired with efforts to address systemic inequalities to promote increased vaccination.

The Shift: COVID-19-Associated Deaths are Now Trending Lower Among Blacks and Hispanics Compared to Whites.

Throughout the coronavirus (COVID-19) pandemic, research revealed people of color were more likely to be infected, have severe illness, and die due to the virus. However, some areas in the USA are now reporting a new shift; lower Black and Hispanic COVID-19 mortality rates compared to their White counterparts. Research indicates that this shift is the result of COVID-19's impact on disparities by race. In this paper, we analyze death data to determine if the new shift has occurred locally. Specifically, we examined COVID-19 prevalence and related death data in Connecticut by comparing race/ethnicity through two periods of time: one before and one after the first case of the Omicron variant of COVID-19. This cross-sectional epidemiological analysis to examine cases and deaths by racial/ethnic status utilizes Connecticut data from March 2020 to February 2022. The following assumption is applied: expected pre-Omicron cases and deaths from March 5, 2020 to November 27, 2021 are equal to the number of cases and deaths during Omicron cases and deaths from November 28, 2021 to February 17, 2022. Race/ethnicity are operationalized as non-Hispanic White, non-Hispanic Black, and Hispanic. Pre-Omicron (March 5, 2020 to November 27, 2021) compared to the monthly aged adjusted COVID-19 case rate for Whites (394/10,000 populations), Blacks had a higher rate (501/10,000 populations), and Hispanics had the highest (585/10,000 populations). During the Omicron period (November 28 to February 17, 2022), significant changes in COVID-19 case rates were observed in all three ethnic groups, but the biggest changes were observed in Hispanics, followed by Blacks, and then Whites. The rate ratios further showed a remarkable reduction of 47% in case rates (from 1.0 pre-Omicron and from 1.47 during Omicron, p < 0.0001) for Hispanics, when compared to that of Whites. While Blacks showed a significant, smaller reduction of 5% in case rates (from 1.27 pre-Omicron and from 1.22 during the Omicron, p < 0.001) when compared to Whites. Regarding COVID-19-related mortality, the racial differences were similar. By examining Connecticut's COVID-19 death and case data, this study identified the new shift that occurred locally. The current shift may be anchored in the evolution of the COVID-19 virus, public health guidelines/policies, and the degree to which populations have complied with public health recommendations.

COVID-19 risks in private equity nursing homes in Hesse, Germany – a retrospective cohort study

BackgroundPrivate-equity-owned nursing homes (PENH) represent the strongest form of profit orientation in the nursing care market. Private equity firms aim to increase the profitability of nursing care facilities, which often leads to cost-cutting measures and the use of less qualified staff. Our study aims to fill the existing knowledge gap by examining the association between private equity ownership and COVID-19 related infections and deaths among residents and staff during the COVID-19 pandemic.MethodsWe analyzed outbreak and mortality data for the period from 20/03/2020 to 05/01/2022 from 32 long-term care facilities in the Federal State of Hesse, Germany, which included 16 PENH that were propensity score matched on regional population density and number of beds with 16 non-PENH. We used logistic regression to determine the odds ratios (OR) for above-median values for the independent variables of PENH-status, number of beds, proportion of single rooms, registered nurses' ratio, and copayments.ResultsPENH had substantially fewer outbreaks in number, but longer and larger outbreaks among nursing home residents, as well as a markedly increased proportion of deceased residents. The odds of the outcome "infections & deaths" were 5.38 (p <. 05) times higher among PENH compared to non-PENH.ConclusionsThe study indicates a need for further research into the quality of care in PENH to inform evidence-based policy decisions, given the higher infection and death rates. Improved documentation and public visibility of PENH is also recommended, in line with existing practices for for-profit and non-profit nursing homes in Germany. Given our findings, regulatory bodies should closely observe PENH operational practices.

COVID-19 mortality and its associated factors in Nepal: A cross-sectional study

ObjectivesReports from other countries have indicated that severe forms and fatal cases of COVID-19 in older adults and people with underlying comorbidities. The aim of this study was to assess the risk factors associated with COVID-19 mortality in Nepal. MethodsA cross-sectional study was conducted from April 12 to July 23, 2021 to identify the underlying factors associated with COVID-19 deaths. Our sample included all cases diagnosed and registered as COVID-19–related deaths at 30 hospitals of Nepal. ResultsA total of 1459 COVID-19 hospital-based death records were collected from 30 hospitals. Mean age at death was 60.2 (±15.6) years. One-third of cases were admitted with fever, cough, and shortness of breath. The computerized tomography Severity Score showed that 7.3% of the individuals who underwent high-resolution computerized tomography chest had a severe form of lung involvement, and 3.6% had mild to moderate involvement. The most common comorbidities were hypertension (43.7%) followed by diabetes mellitus (25.8%). Among the deceased, 37.7% were diagnosed as cases of COVID-19 pneumonia. The most common recorded causes of death were respiratory failure followed by cardio-pulmonary arrest. ConclusionsIndividuals with comorbidities including hypertension and diabetes mellitus were at greater risk of developing complications and had a higher rate of mortality.

A descriptive analysis of COVID-19 associated mortality in Parma Province: concordance between official national mortality register provided by ISTAT (National Institute of Statistics) and local ADS (Automated Data System) real-time surveillance flow.

The Public Health Department of the Parma Local Health Authority (AUSL) has implemented a computerized system called ADS (Automated Data System) to collect data on COVID-19 cases and related deaths, as required by the Emilia-Romagna Region and the Italian Ministry of Health, to improve the daily flow of real-time information. However, official mortality data for all causes was collected even from the National Institute of Statistics (ISTAT) through death forms that were completed by certifying doctors in each municipality. This analysis aims to verify the agreement between the data collected by ISTAT and the data collected by ADS. The study period went from January 1st to December 31st, 2021. The population under observation consisted of residents in the province of Parma who died due to COVID-19, as identified through the ISTAT and/or ADS data flow. In 2021, a total of 448 deaths due to COVID-19 were reported in the Parma Province, with a median age of 83 years. The ADS system identified 408 of these deaths, whereas ISTAT certified only 347. Three hundred and seven deaths were identified by both flows. The survey suggests that the ADS surveillance system may have overestimated the COVID-19 mortality data compared to the ISTAT flow. The ADS has been valuable in the immediate response to emergencies, providing a more sensitive system that prioritizes the precautionary principle and enables decisions aimed at minimizing risks for vulnerable populations. However, it is not recommended for routine surveillance, as it is less reliable compared to the ISTAT flow.

SP9.15 Rates of COVID-19 infection and mortality following elective surgery at a tertiary NHS Trust in relation to operative caseload

Abstract Aims Elective surgery globally has been halted by COVID-19 due to apparent significant mortality rates with changes in planned surgery pathways. This audit examines COVID-19 infection and mortality rates at key intervals throughout the UK COVID-19 pandemic in relation to operative elective caseload at an NHS Trust. Methods Prospective cohort of elective surgical patients at a tertiary NHS Trust between March 2020-March 2022, examining three time periods. Period 1: 1st UK Lockdown (April-July 2020). Period 2: 2nd-3rd UK Lockdowns (November 2020-March 2021). Period 3: Omicron wave (December 2021-February 2022). Post-operative PCR positive COVID-19 infection rates within 30-days, proportion fully “double-jabbed” vaccinated, 90-day mortality and any COVID-19 related deaths are reported. Audit registration 20-190C. Results Between March 2020-2022, of 50,247 operations, 518 (1.03%) developed COVID-19 infection of which 62 (11.97%) died giving an overall COVID-19 death rate of 0.12%. Between Periods 1 and 3, despite a 53% increase in operations per week (294 to 450) the proportion of COVID-19 infected patients remained similar (1.12% and 1.14%). Between Periods 2-3, despite an almost 6-fold increase in fully vaccinated patients (9.80% to 57.74%), the proportion of vaccinated COVID-19 positive patients increased (4.20% to 55.38%). However, the overall proportion of COVID-19 infections decreased (2.53% to 1.14%) as well as the mortality of those infected (15.97% to 9.23%). Conclusions Overall COVID-19 infection and mortality rates are low. These have been maintained despite increases in operative caseload, suggesting further sustained elective surgery can re-commence. This may relate to an increase in fully vaccinated patients undergoing surgery.

Comparative effectiveness of bivalent BA.4-5 and BA.1 mRNA booster vaccines among adults aged ≥50 years in Nordic countries: nationwide cohort study

ObjectiveTo estimate the effectiveness of the bivalent mRNA booster vaccines containing the original SARS-CoV-2 and omicron BA.4-5 or BA.1 subvariants as the fourth dose against severe covid-19.DesignNationwide cohort analyses, using...

Comparative effectiveness of heterologous third dose vaccine schedules against severe covid-19 during omicron predominance in Nordic countries: population based cohort analyses

ObjectiveTo investigate the comparative vaccine effectiveness of heterologous booster schedules (ie, three vaccine doses) compared with primary schedules (two vaccine doses) and with homologous mRNA vaccine booster schedules (three vaccine...

Results of the first nationwide cohort study of outcomes in dialysis and kidney transplant patients before and after vaccination for COVID-19.

Patients on kidney replacement therapy (KRT) have been identified as a vulnerable group during the coronavirus disease 2019 (COVID-19) pandemic. This study reports the outcomes of COVID-19 in KRT patients in Sweden, a country where patients on KRT were prioritized early in the vaccination campaign. Patients on KRT between January 2019 and December 2021 in the Swedish Renal Registry were included. Data were linked to national healthcare registries. The primary outcome was monthly all-cause mortality over 3years of follow-up. The secondary outcomes were monthly COVID-19-related deaths and hospitalizations. The results were compared with the general population using standardized mortality ratios. The difference in risk for COVID-19-related outcomes between dialysis and kidney transplant recipients (KTRs) was assessed in multivariable logistic regression models before and after vaccinations started. On 1 January 2020, there were 4097 patients on dialysis (median age 70years) and 5905 KTRs (median age 58years). Between March 2020 and February 2021, mean all-cause mortality rates increased by 10% (from 720 to 804 deaths) and 22% (from 158 to 206 deaths) in dialysis and KTRs, respectively, compared with the same period in 2019. After vaccinations started, all-cause mortality rates during the third wave (April 2021) returned to pre-COVID-19 mortality rates among dialysis patients, while mortality rates remained increased among transplant recipients. Dialysis patients had a higher risk for COVID-19 hospitalizations and death before vaccinations started {adjusted odds ratio [aOR] 2.1 [95% confidence interval (CI) 1.7-2.5]} but a lower risk after vaccination [aOR 0.5 (95% CI 0.4-0.7)] compared with KTRs. The COVID-19 pandemic in Sweden resulted in increased mortality and hospitalization rates among KRT patients. After vaccinations started, a distinct reduction in hospitalization and mortality rates was observed among dialysis patients, but not in KTRs. Early and prioritized vaccinations of KRT patients in Sweden probably saved many lives.

Modeling the dynamics of COVID-19 in the presence of Delta and Omicron variants with vaccination and non-pharmaceutical interventions

Since its inception in December 2019, many safe and effective vaccines have been invented and approved for use against COVID-19 along with various non-pharmaceutical interventions. But the emergence of numerous SARS-CoV-2 variants has put the effectiveness of these vaccines, and other intervention measures under threat. So it is important to understand the dynamics of COVID-19 in the presence of its variants of concern (VOC) in controlling the spread of the disease. To address these situations and to find a way out of this problem, a new mathematical model consisting of a system of non-linear differential equations considering the original COVID-19 strain with its two variants of concern (Delta and Omicron) has been proposed and formulated in this paper. We then analyzed the proposed model to study the transmission dynamics of this multi-strain model and to investigate the consequences of the emergence of multiple new SARS-CoV-2 variants which are more transmissible than the previous ones. The control reproduction number, an important threshold parameter, is then calculated using the next-generation matrix method. Further, we presented the discussion about the stability of the model equilibrium. It is shown that the disease-free equilibrium (DFE) of the model is locally asymptotic stable when the control reproduction is less than unity. It is also shown that the model has a unique endemic equilibrium (EEP) which is locally asymptotic stable when the control reproduction number is greater than unity. Using the Center Manifold theory it is shown that the model also exhibits the backward bifurcation phenomenon when the control reproduction number is less than unity. Again without considering the re-infection of the recovered individuals, it is proved that the disease-free equilibrium is globally asymptotically stable when the reproduction threshold is less than unity. Finally, numerical simulations are performed to verify the analytic results and to show the impact of multiple new SARS-CoV-2 variants in the population which are more contagious than the previous variants. Global uncertainty and sensitivity analysis has been done to identify which parameters have a greater impact on disease dynamics and control disease transmission. Numerical simulation suggests that the emergence of new variants of concern increases COVID-19 infection and related deaths. It also reveals that a combination of non-pharmaceutical interventions with vaccination programs of new more effective vaccines should be continued to control the disease outbreak. This study also suggests that more doses of vaccine should provide to combat new and deadly variants like Delta and Omicron.

The Hypothetical Psychological Impact of the COVID-19 Pandemic on Pediatrics and Pediatric Emergency Admissions: Evidence from Autoregressive Distributed Lag Model Method.

The COVID-19 pandemic and related deaths affected the number of admissions of patients to hospitals. However, no study has been found that examines the short and long-term psychological effects of children or their possible psychiatric admissions to hospitals during the pandemic period. In this context, the study aims to analyze the behaviors of individuals under the age of 18 in their health service utilization during the COVID-19 pandemic period. For the study, whether the pandemic and psychiatry department (PSY) admissions affect the pediatrics department (PD) and pediatric emergency department (PED) admissions of children was investigated. The sample was taken from hospitals in Sivas between 2019 and 2021. Autoregressive dis- tributed lag (ARDL) model is applied. The ARDL is an econometric method that can estimate the existence of the long-term correlations (cointegration) of variables and the short and long-term effects of explanatory variables on the dependent variable. In thePEDapplication model, the number of deaths, representing the impact of the pandemic, decreased the number of PED applications, while the number of vaccinations increased. On the other hand, applications to the PSY decreased in the short term, but increased in the long term. In the model of pediatric department admissions, in the long term, the number of new COVID-19 cases has decreased the number of PD admissions, while the number of vaccines has increased. While applications made to PSY in the short term have decreased the applications of PD, they have increased in the long term. As a result, the pandemic decreased both children's department admissions. In addition, admissions to PSY, which had greatly decreased in the short term, increased rapidly in the long term. Providing psychological support to both children and adolescents and their guardians during and after the pandemic should be included in planning.

Evaluating Factors Influencing COVID-19 Outcomes across Countries Using Decision Trees (Student Abstract)

While humanity prepares for a post-pandemic world and a return to normality through worldwide vaccination campaigns, each country experienced different levels of impact based on natural, political, regulatory, and socio-economic factors. To prepare for a possible future with COVID-19 and similar outbreaks, it is imperative to understand how each of these factors impacted spread and mortality. We train and tune two decision tree regression models to predict COVID-related cases and deaths using a multitude of features. Our findings suggest that, at the country-level, GDP per capita and comorbidity mortality rate are best predictors for both outcomes. Furthermore, latitude and smoking prevalence are also significantly related to COVID-related spread and mortality.

Risk prediction of covid-19 related death or hospital admission in adults testing positive for SARS-CoV-2 infection during the omicron wave in England (QCOVID4): cohort study

ObjectivesTo derive and validate risk prediction algorithms (QCOVID4) to estimate the risk of covid-19 related death and hospital admission in people with a positive SARS-CoV-2 test result during the period...

SARS-CoV-2 seroprevalence among blood donors in Uganda: 2019-2022.

The true burden of COVID-19 in low- and middle-income countries remains poorly characterized, especially in Africa. Even prior to the availability of SARS-CoV-2 vaccines, countries in Africa had lower numbers of reported COVID-19 related hospitalizations and deaths than other regions globally. Ugandan blood donors were evaluated between October 2019 and April 2022 for IgG antibodies to SARS-CoV-2 nucleocapsid (N), spike (S), and five variants of the S protein using multiplexed electrochemiluminescence immunoassays (MesoScale Diagnostics, Rockville, MD). Seropositivity for N and S was assigned using manufacturer-provided cutoffs and trends in seroprevalence were estimated by quarter. Statistically significant associations between N and S antibody seropositivity and donor characteristics in November-December 2021 were assessed by chi-square tests. A total of 5393 blood unit samples from donors were evaluated. N and S seropositivity increased throughout the pandemic to 82.6% in January-April 2022. Among seropositive individuals, N and S antibody levels increased ≥9-fold over the study period. In November-December 2021, seropositivity to N and S antibody was higher among repeat donors (61.3%) compared with new donors (55.1%; p = .043) and among donors from Kampala (capital city of Uganda) compared with rural regions (p = .007). Seropositivity to S antibody was significantly lower among HIV-seropositive individuals (58.8% vs. 84.9%; p = .009). Despite previously reported low numbers of COVID-19 cases and related deaths in Uganda, high SARS-CoV-2 seroprevalence and increasing antibody levels among blood donors indicated that the country experienced high levels of infection over the course of the pandemic.

Understanding mental health trends during COVID-19 pandemic in the United States using network analysis.

The emergence of COVID-19 in the United States resulted in a series of federal and state-level lock-downs and COVID-19 related health mandates to manage the spread of the virus. These policies may negatively impact the mental health state of the population. This study focused on the trends in mental health indicators following the COVID-19 pandemic amongst four United States geographical regions, and political party preferences. Indicators of interest included feeling anxious, feeling depressed, and worried about finances. Survey data from the Delphi Group at Carnegie Mellon University were analyzed using clustering algorithms and dynamic connectome obtained from sliding window analysis. Connectome refers to the description of connectivity on a network. United States maps were generated to observe spatial trends and identify communities with similar mental health and COVID-19 trends. Between March 3rd, 2021, and January 10th, 2022, states in the southern geographic region showed similar trends for reported values of feeling anxious and worried about finances. There were no identifiable communities resembling geographical regions or political party preference for the feeling depressed indicator. We observed a high degree of correlation among southern states as well as within Republican states, where the highest correlation values from the dynamic connectome for feeling anxious and feeling depressed variables seemingly overlapped with an increase in COVID-19 related cases, deaths, hospitalizations, and rapid spread of the COVID-19 Delta variant.