Severe COVID-19 Outcomes Research Articles

6.M. Scientific session: Risk And Resilience Factors Of Mental Health During COVID: European Multi-country Data Findings

Abstract The COVID-19 pandemic significantly affected mental health. It worsened the mental health and well-being of those already vulnerable or exposed to excess pandemic-related stress. In addition, lockdowns and other measures created additional obstacles to mental health support access. In response, the European Commission funded the RESPOND project in 2020, aimed at enhancing the preparedness of mental health systems for pandemics and global crises. As part of the RESPOND project, (meta-)analyses were conducted on prospective cohort datasets, national health register data, and multi-country individual participant data (IPD). The aim was to examine whether there was a change in prevalence rates of mental health conditions (e.g., anxiety and depression) in the general adult population of the EU during, compared to before and in between, the COVID-19 pandemic waves. Analyses on risk factors (e.g. sociodemographic- and economic factors, severity of COVID-19 infection, (lack of) social activity and support, and loneliness) associated with psychological distress and mental disorders as well as resilience and well-being (coping strategies and core value orientations) in the general population or specific vulnerable groups were conducted as well. This workshop will feature five talks covering various aspects of the RESPOND epidemiological analyses. First, an introduction and rationale of the RESPOND study on short- and long-term impacts of the COVID-19 pandemic and outbreak response, will be provided. Subsequently, findings from the multi-country longitudinal COvid MEntal healTh Survey (COMET) on forecasting psychological distress throughout the pandemic will be presented. Second, findings from the French TEMPO (Trajectoires EpideMiologiques en POpulation) cohort and merged datasets will be presented indicating associations and interactions between socioeconomic factors, mental health, and public health behaviours during the pandemic. Third, using data of a large Belgian prospective cohort, fluctuations in risk of psychological distress across study waves and the factors associated with individual trajectories of psychological distress during the COVID-19 pandemic will be presented. Fourth, the risk of SARS-CoV-2 infection, severe COVID-19 outcomes, and death among individuals with various mental disorders, based on Spanish health records, will be presented with specific attention to sex differences. Finally, based on the IPD meta-analyses of 9 European cohorts, findings on stressor reactivity, resilience trajectories, and factors associated with resilient outcomes and vulnerability are presented. By presenting a selection of findings from large datasets together, we aim to facilitate discussions on critical topics such as vulnerability and resilience to mitigate mental health impacts in future public health crises. Key messages • Targeting specific individual vulnerabilities appears to be more effective in reducing the pandemics’ mental health impact than solely responding to pandemic-related fluctuations. • Research and harmonised data on vulnerability and resilience factors are essential for guiding the development of targeted interventions and support systems for vulnerable populations during crises.

SARS-CoV-2 Infection And COVID-19 Outcomes Among Mental Disorders: A Register-based Study in Catalonia

Abstract This study aimed to study the risk of SARS-CoV-2 infection and severe COVID-19 outcomes across different mental diagnoses and to assess the role of sex in these associations. We used electronic health records from Catalonia to identify adults receiving inpatient/outpatient mental health care between 2017-2019 with diagnosis of non-affective psychosis (NAP), bipolar disorder (BD), depressive disorder (DEP), stress-related disorders, neurotic/somatoform disorders (NSD), and substance misuse (SUB) (exposed). Outcomes included SARS-CoV-2 infection, COVID-19 hospitalization, and COVID-19-related death. Adjusted logistic regression analyses were conducted. 785,378 adults were included (70.3% < 65 years old; 57.1% women). Compared to unexposed, those with NAP [OR (95%CI): 0.84 (0.80-0.88)], BD [0.80 (0.75-0.86)], DEP [0.97 (0.94-1.00)] and SUB [0.81 (0.78-0.84)] had a lower risk of SARS-CoV-2 infection, while people with NSD presented an increased risk [1.03 (1.01-1.06)]. Among those infected, people with DEP, NSD, and SUB had a lower risk of COVID-19 hospitalization, but higher risk of COVID-19-related death [1.23 (1.07-1.41); 1.26 (1.07-1.48); 1.48 (1.24-1.71), respectively]. A higher COVID-19-related death was also found in people with NAP and BD [1.68 (1.34-2.12); 2.02 (1.50-2.73)]. Sex-stratified analysis showed that women with NSD were especially vulnerable to infection [1.07 (1.03-1.11)], and women with DEP and NSD to COVID-19-related death [1.24 (1.05-1.47); 1.26 (1.02-1.54)]. These results suggest different vulnerabilities to infection and COVID-19 hospitalization and death across mental disorders. These findings have implications for pandemic preparedness, highlighting the need for specific public health strategies to mitigate the excess of mortality of people with certain mental disorders.

Characteristics of fatal COVID-19 among pregnant women admitted to hospitals in Kazakhstan

Abstract Background The factors contributing to the fatal outcome of COVID-19 in pregnant women remain not entirely clear. We compared the prevalence rates of comorbidities and laboratory test results in pregnant survivors and non-survivors. Methods This retrospective study relied on clinical and laboratory data obtained from medical records of pregnant women with COVID-19 admitted to three hospitals of the Republic of Kazakhstan from 16.07.2021 to 31.01.2022. Overall, we obtained data on 157 pregnant women with COVID-19, of whom 95.9 % survived and 4.1 % died in the hospitals. Results Arterial hypertension was present in 50% of non-survivors vs. 7.9% of survivors (P = 0.001), diabetes mellitus was diagnosed in 16.7% of non-survivors vs. 2.3% of survivors (P = 0.044), and the rate of hyperglycemia was 40% and 7.2%, respectively (P = 0.009). Heart rhythm disturbance was present in 50% of non-survivors vs. 6.4% of survivors (P < 0.001), and already at the time of admission to the hospital, the non-survivors had significantly higher heart and respiratory rates. Laboratory tests showed that non-survivors had higher erythrocytes sedimentation rate, C-reactive protein, leukocyte count, and D-dimer levels (P = 0.001, P < 0.001, P = 0.038, P = 0.014, respectively). The creatinine level was within the normal range in both study groups, but it was relatively higher in the deceased pregnant women (71.3; IQR: 66-251.75) vs. 52; IQR: 43-63; P = 0.001). Finally, a higher proportion of those who died presented with abnormal chest CT as compared with the survivors (33.3% vs. 4.2%, P < 0.001). Conclusions The deceased had a higher rate of comorbidities. Given the vulnerability of pregnant women to COVID-19, it is essential to plan a prospective study to provide insights into the factors that contribute to severe COVID-19 outcomes in pregnant women. Key messages • Determining risk factors for fatal COVID-19 is crucial for effective medical care of pregnant women. • Identifying potential risk factors of fatal COVID-19 among pregnant women could help inform public health policies and clinical guidelines.

Environment, climate, socio-economics & restrictions impact on COVID-19 in Northen Italy

Abstract Up to now, studies on environmental, climatic, socio-economic factors, and non-pharmacological interventions (NPI) show diverse associations, often contrasting, with COVID-19 spread or severity. Most studies used large-scale, aggregated data, with limited adjustment for individual factors, and most of them focused on viral spread rather than severe outcomes. Moreover, evidence simultaneously evaluating variables belonging to different exposure domains is scarce, and none analysing their collective impact on an individual level. Our population-based retrospective cohort study aimed to assess the comprehensive role played by exposure variables belonging to four different domains, environmental, climatic, socio-economic, and non-pharmacological interventions (NPI), on individual COVID-19-related risk of hospitalization and death, analysing data from all patients (n.68472) tested positive to a SARS-CoV-2 swab in Modena Province (Northern Italy) between February 2020 and August 2021. Using adjusted Cox proportional hazard models, we estimated the risk of severe COVID-19 outcomes, investigating dose-response relationships through restricted cubic spline modelling for hazard ratios. Several significant associations emerged: long-term exposure to air pollutants (NO2, PM10, PM2.5) was linked to hospitalization risk in a complex way and showed an increased risk for death; while humidity was inversely associated; temperature showed a U-shaped risk; wind speed showed a linear association with both outcomes. Precipitation increased hospitalization risk but decreased mortality. Socio-economic and NPI indices showed clear linear associations, respectively negative and positive, with both outcomes. Our findings offer insights for evidence-based policy decisions, improving precision healthcare practices, and safeguarding public health in future pandemics. Refinement of pandemic response plans by healthcare authorities could benefit significantly. Key messages • Evaluating simultaneously four exposure domains on COVID-19 outcomes informs public health policy for future pandemic management. • The comprehension of risk factors associated with severe outcomes, such as hospitalization and mortality, is pivotal for planning responses to similar health emergencies in the future.

The silent predictors: exploring galectin-3 and Irisin’s tale in severe COVID-19

ObjectiveThis study aimed to evaluate the roles of galectin-3 and irisin as biomarkers in predicting severe outcomes in COVID-19 patients.ResultsWe analyzed serum levels of galectin-3 and irisin in 59 patients with severe COVID-19 and 30 healthy controls. Elevated galectin-3 levels were associated with increased risks of mortality, need for intensive care, and severe acute respiratory distress syndrome. The optimal cut-off value for galectin-3 was 13.47 ng/ml, with a sensitivity of 72.7% and specificity of 76.6%. Irisin levels did not differ significantly between survivors and non-survivors at admission or on the 3rd day post-admission, but approached significance on the 7th day. These findings suggest that galectin-3 could be a valuable prognostic biomarker for severe COVID-19 outcomes, while irisin’s role remains to be clarified in further studies.

Impact of Immunosuppressants and Vaccination on COVID-19 Outcomes in Autoimmune Patients and Solid Organ Transplant Recipients: A Nationwide Propensity Score-Matched Study.

This study investigates the impact of varying degrees of immunosuppression on the clinical outcomes of immunocompromised individuals, particularly those with autoimmune diseases or post-solid organ transplant statuses, in the context of COVID-19. By focusing on these highly vulnerable populations, the study underscores the significant health inequalities faced by immunocompromised patients, who experience disproportionately worse outcomes in comparison to the general population. A retrospective cohort analysis of the K-COV-N dataset was conducted, comparing the effects of immunosuppression in autoimmune and transplant groups with matched control groups. Propensity score matching was employed to minimize inequalities in baseline characteristics, ensuring a more equitable comparison between immunocompromised and non-immunocompromised individuals. Outcomes included COVID-19-related in-hospital mortality, 28-day mortality, ICU admissions, and the need for respiratory support among 323,890 adults in the Republic of Korea. Patients with cancer or other immunosuppressive conditions, such as HIV, were excluded. Subgroup analyses assessed the influence of specific immunosuppressive medications and vaccination extent. Significantly elevated in-hospital mortality was found for patients with autoimmune diseases (adjusted Odds Ratio [aOR] 2.749) and transplant recipients (aOR 7.567), with similar patterns in other outcomes. High-dose steroid use and a greater number of immunosuppressant medications markedly increased the risk of poor outcomes. Vaccination emerged as a protective factor, with a single dose substantially improving outcomes for autoimmune patients and at least two doses necessary for transplant recipients. Immunocompromised patients, particularly those with autoimmune diseases and transplant recipients, are highly vulnerable to severe COVID-19 outcomes. High-dose steroid use and multiple immunosuppressants further increase risks. Vaccination significantly improves outcomes, with at least one dose benefiting autoimmune patients and two doses necessary for transplant recipients. Personalized vaccination schedules based on immunosuppression levels are essential to mitigate healthcare inequalities and improve outcomes, particularly in underserved populations, informing both clinical and public health strategies.

Clinically Guided Adaptive Machine Learning Update Strategies for Predicting Severe COVID-19 Outcomes

Background: Machine learning algorithms are essential for predicting severe outcomes during public health crises like COVID-19. However, the dynamic nature of diseases requires continual evaluation and updating of these algorithms. This study aims to compare three update strategies for predicting severe COVID-19 outcomes post-diagnosis: 'naive' (a single initial model), 'frequent' (periodic retraining), and 'context-driven' (retraining informed by clinical insights). The goal is to determine the most effective timing and approach for adapting algorithms to evolving disease dynamics and emerging data. Methods: A dataset of 1.11 million COVID-19 patients from diverse U.S. regions was used to develop and validate an XGBoost algorithm for predicting severe outcomes upon diagnosis. Data included patient demographics, vital signs, comorbidities, and immunity-related factors (prior infection and vaccination status) from January 2007 to November 2021. The study analyzed the performance of the three update strategies from March 2020 to November 2021. Results: Predictive features changed over the pandemic, with comorbidities and vitals being significant initially, and geography, demographics, and immunity-related variables gaining importance later. The 'naive' strategy had an average AUC of 0.77, the 'frequent' strategy-maintained stability with an average AUC of 0.81, and the 'context-driven' strategy averaged an AUC of 0.80, outperforming the 'naive' strategy and aligning closely with the 'frequent' strategy. Conclusion: A context-driven approach, guided by clinical insights, can enhance predictive performance and offer cost-effective solutions for dynamic public health challenges. These findings have significant implications for efficiently managing healthcare resources during evolving disease outbreaks.

The impact of COVID-19 vaccination on patients with congenital heart disease in England: a case-control study

BackgroundStudies predating widespread COVID-19 vaccination identified patients with congenital heart disease (CHD) as a group at increased risk of severe outcomes from COVID-19. Here we evaluate the impact of vaccination...

Genetic signatures of AKT1 variants associated with worse COVID-19 outcomes - a multicentric observational study.

The COVID-19, triggered by the SARS-CoV-2 virus, has varied clinical manifestations, ranging from mild cases to severe forms such as fatal pneumonia and acute respiratory distress syndrome (ARDS). Disease severity is influenced by an exacerbated immune response, characterized by high pro-inflammatory cytokine levels. Inhibition of AKT can potentially suppress pathological inflammation, cytokine storm and platelet activation associated with COVID-19. In this study, we aimed to investigate the rs2494746 and rs1130214 variants in the AKT1 gene associated with severe COVID-19 outcomes. Peripheral blood samples and sociodemographic data from 508 individuals with COVID-19, measuring plasma cytokine concentrations using ELISA and genotyped the AKT1 variants. The rs2494746-C allele was associated with severity, ICU admission, and death from COVID-19. The C allele at rs1130214 was linked to increased TNF and D-dimer levels. Moreover, both variants exhibited an increased cumulative risk of disease severity, ICU admission, and mortality caused by COVID-19. In the predictive analysis, the rs2494746 obtained an accuracy of 71%, suggesting a high probability of the test determining the severity of the disease. Our findings contribute to understanding the influence of the AKT1 gene variants on the immunological damage in individuals infected with SARS-CoV-2.

Environmental, climatic, socio-economic factors and non-pharmacological interventions: A comprehensive four-domain risk assessment of COVID-19 hospitalization and death in Northern Italy

IntroductionUp to now, studies on environmental, climatic, socio-economic factors, and non-pharmacological interventions (NPI) show diverse associations, often contrasting, with COVID-19 spread or severity. Most studies used large-scale, aggregated data, with limited adjustment for individual factors, most of them focused on viral spread than severe outcomes. Moreover, evidence simultaneously evaluating variables belonging to different exposure domains is scarce, and none analysing their collective impact on an individual level. MethodsOur population-based retrospective cohort study aimed to assess the comprehensive role played by exposure variables belonging to four different domains, environmental, climatic, socio-economic, and non-pharmacological interventions (NPI), on individual COVID-19-related risk of hospitalization and death, analysing data from all patients (no. 68472) tested positive to a SARS-CoV-2 swab in Modena Province (Northern Italy) between February 2020 and August 2021.Using adjusted Cox proportional hazard models, we estimated the risk of severe COVID-19 outcomes, investigating dose-response relationships through restricted cubic spline modelling for hazard ratios. ResultsSeveral significant associations emerged: long-term exposure to air pollutants (NO2, PM10, PM2.5) was linked to hospitalization risk in a complex way and showed an increased risk for death; while humidity was inversely associated; temperature showed a U-shaped risk; wind speed showed a linear association with both outcomes. Precipitation increased hospitalization risk but decreased mortality. Socio-economic and NPI indices showed clear linear associations, respectively negative and positive, with both outcomes. ConclusionsOur findings offer insights for evidence-based policy decisions, improving precision healthcare practices, and safeguarding public health in future pandemics. Refinement of pandemic response plans by healthcare authorities could benefit significantly.

Mental illness and COVID-19 vaccination: a multinational investigation of observational & register-based data

Individuals with mental illness are at higher risk of severe COVID-19 outcomes. However, previous studies on the uptake of COVID-19 vaccination in this population have reported conflicting results. Using data from seven cohort studies (N = 325,298) included in the multinational COVIDMENT consortium, and the Swedish registers (N = 8,080,234), this study investigates the association between mental illness (defined using self-report measures, clinical diagnosis and prescription data) and COVID-19 vaccination uptake. Results from the COVIDMENT cohort studies were pooled using meta-analyses, the majority of which showed no significant association between mental illness and vaccination uptake. In the Swedish register study population, we observed a very small reduction in the uptake of both the first and second dose of a COVID-19 vaccine among individuals with vs. without mental illness; the reduction was however greater among those not using psychiatric medication. Here we show that uptake of the COVID-19 vaccine is generally high among individuals both with and without mental illness, however the lower levels of vaccination uptake observed among subgroups of individuals with unmedicated mental illness warrants further attention.

The Interplay between COVID-19 and Diabetes: Understanding Hyperglycemia, Complications, and Management Challenges in Diabetic Patients

The COVID-19 pandemic has significantly impacted individuals with diabetes, revealing a complex interplay between the virus and pre-existing hyperglycemia. This review explores how COVID-19 exacerbates hyperglycemia in diabetic patients, primarily through mechanisms such as stress response, cytokine storms, and increased insulin resistance. Diabetic individuals are particularly susceptible to severe COVID-19 outcomes, including heightened mortality rates, due to compromised immune responses and coexisting conditions like cardiovascular and renal complications. The review also addresses the unique challenges of managing diabetes during COVID-19, including the need for adjustments in insulin therapy and the impact of COVID-19 treatments, such as corticosteroids, on glucose control. Additionally, it highlights the potential long-term effects of COVID-19 on diabetic patients, including the onset of new diabetes and persistent metabolic issues. The review emphasizes the importance of glycemic control, vaccination, and holistic care approaches to mitigate the severity of COVID-19 in diabetic patients. Furthermore, it examines the psychological and socioeconomic impacts of the pandemic on this vulnerable population. As ongoing research continues to investigate the interaction between COVID-19 and diabetes, this review provides a comprehensive understanding of the challenges and future directions in managing diabetic patients during and after the pandemic. Keywords: COVID-19, Diabetes, Hyperglycemia, Complications, Management Challenges, Diabetic Patients

Navigating the Evolving Landscape of COVID-19: Strategies to Increase Vaccine Confidence and Improve Vaccination Rates in the United States.

The COVID-19 pandemic has had a significant impact on every individual in the United States. The launch of the COVID-19 vaccines is estimated to have averted millions of deaths and reduced over 18 million COVID-19-related hospitalizations. In September 2023, the updated 2023-2024 COVID-19 vaccine, which includes a monovalent component that corresponds to the omicron variant XBB.1.5, reflecting the predominant circulating variant at the time of strain selection, was approved and was recommended for use in all people ≥ 6 months of age. Despite this recommendation, the US uptake of the updated COVID-19 vaccines over the 2023-2024 season has been far from optimal, placing many people at unnecessary risk of severe COVID-19 outcomes. This paper provides an overview of the current state of COVID-19 in 2023-2024 and barriers to vaccine uptake. With the continued evolution of the virus, the potential for more virulent variants, reduced public acceptance of vaccination, and the potential barriers that contributed to low vaccine uptake are explored to provide solutions for improving COVID-19 protection for future seasons.

A Comprehensive Genetic and Bioinformatic Analysis Provides Evidence for the Engagement of COVID-19 GWAS-Significant Loci in the Molecular Mechanisms of Coronary Artery Disease and Stroke

Cardiovascular diseases (CVDs) significantly exacerbate the severity and mortality of COVID-19. We aimed to investigate whether GWAS-significant SNPs correlate with CVDs in severe COVID-19 patients. DNA samples from 199 patients with severe COVID-19 hospitalized in intensive care units were genotyped using probe-based PCR for 10 GWAS SNPs previously implicated in severe COVID-19 outcomes. SNPs rs17713054 SLC6A20-LZTFL1 (risk allele A, OR = 2.14, 95% CI 1.06–4.36, p = 0.03), rs12610495 DPP9 (risk allele G, OR = 1.69, 95% CI 1.02–2.81, p = 0.04), and rs7949972 ELF5 (risk allele T, OR = 2.57, 95% CI 1.43–4.61, p = 0.0009) were associated with increased risk of coronary artery disease (CAD). SNPs rs7949972 ELF5 (OR = 2.67, 95% CI 1.38–5.19, p = 0.003) and rs61882275 ELF5 (risk allele A, OR = 1.98, 95% CI 1.14–3.45, p = 0.01) were linked to a higher risk of cerebral stroke (CS). No associations were observed with AH. Bioinformatics analysis revealed the involvement of GWAS-significant loci in atherosclerosis, inflammation, oxidative stress, angiogenesis, and apoptosis, which provides evidence of their role in the molecular mechanisms of CVDs. This study provides novel insights into the associations between GWAS-identified SNPs and the risk of CAD and CS.

Inequalities in severe COVID-19 outcomes in Wales, UK

ObjectiveResearch evidence shows that COVID-19 has disproportionately affected people from more deprived backgrounds. In Wales (UK), there is strong evidence of a socioeconomic gradient in total hospitalisations, critical care admissions and deaths. This study focussed on a cohort of the Welsh population using anonymised individual-level linked population-scale data in the SAIL Databank. ApproachThis analysis examines the impact of confounding/mediating factors on severe health outcomes. We used logistic regression, considering the Welsh Index of Multiple Deprivation (WIMD) 2019 as a predictor, to investigate how the coefficient for WIMD is changed when other variables (such as comorbidities, smoking status, Body Mass Index) are added, aiming to understand whether inequalities are mediated by observed characteristics or related to other unobserved factors. ResultsInitial findings show that age-standardised rates of hospital admissions, Intensive Care Unit (ICU) admissions and deaths were roughly twice as high in the most deprived vs least deprived WIMD quintile in Wales. We estimated Years of Life Lost per 1,000 due to COVID-19 as 28.9, with variation between WIMD quintiles of 38.4 for the most deprived and 22.2 for the least deprived. The project also produced regression formulas to evaluate the contribution of the different confounding factors. ConclusionThis study built on existing research findings and further explored the potential reasons for known socioeconomic inequalities in relation to COVID-19 outcomes. Insights from this study have broadened the knowledge around the impact of mediating factors and may contribute to future pandemic preparedness and the formation of future policies.

Salivary immune responses after COVID-19 vaccination.

mRNA-based COVID-19 vaccines have played a critical role in reducing severe outcomes of COVID-19. Humoral immune responses against SARS-CoV-2 after vaccination have been extensively studied in blood; however, limited information is available on the presence and duration of SARS-CoV-2 specific antibodies in saliva and other mucosal fluids. Saliva offers a non-invasive sampling method that may also provide a better understanding of mucosal immunity at sites where the virus enters the body. Our objective was to evaluate the salivary immune response after vaccination with the COVID-19 Moderna mRNA-1273 vaccine. Two hundred three staff members of the U.S. Centers for Disease Control and Prevention were enrolled prior to receiving their first dose of the mRNA-1273 vaccine. Participants were asked to self-collect 6 saliva specimens at days 0 (prior to first dose), 14, 28 (prior to second dose), 42, and 56 using a SalivaBio saliva collection device. Saliva specimens were tested for anti-spike protein SARS-CoV-2 specific IgA and IgG enzyme immunoassays. Overall, SARS-CoV-2-specific salivary IgA titers peaked 2 weeks after each vaccine dose, followed by a sharp decrease during the following weeks. In contrast to IgA titers, IgG antibody titers increased substantially 2 weeks after the first vaccine dose, peaked 2 weeks after the second dose and persisted at an elevated level until at least 8 weeks after the first vaccine dose. Additionally, no significant differences in IgA/IgG titers were observed based on age, sex, or race/ethnicity. All participants mounted salivary IgA and IgG immune responses against SARS-CoV-2 after receiving the mRNA-1273 COVID-19 vaccine. Because of the limited follow-up time for this study, more data are needed to assess the antibody levels beyond 2 months after the first dose. Our results confirm the potential utility of saliva in assessing immune responses elicited by immunization and possibly by infection.

COVID-19 Vaccination Recommendations: Challenges and Strategies for High-Risk Populations

<p>COVID-19（新冠併發重症）大流行對全球，尤其是有潛在醫療狀況的易感染之高風險族群，造成深遠的影響。為因應全球不斷演變的疫情趨勢以及台灣持續增加病例的疫苗防治需求，台灣家庭醫學醫學會建立了針對易感染之高風險族群的COVID-19疫苗接種建議。本研究進行全面性的文獻回顧並經由專家小組討論後，擬定具證據力的建議以作為防疫策略參考。總計提出25項建議，說明糖尿病、肥胖症、慢性腎臟疾病、心血管疾病和呼吸系統疾病病友感染COVID-19後的重症風險為高，因此強調COVID-19 mRNA（訊息核糖核酸）疫苗在這些易感染之高風險族群中的安全性和有效性以及家庭醫師在COVID-19疫情的關鍵作用，包括常規篩檢、衛教、疫苗接種服務的提供和持續的研究。此建議為醫界與政府相關單位在為易感染高風險族群制定疫苗接種計畫時，提供了兼具客觀實證依據與符合臨床實務需求的具體指引，同時強化家庭醫師在防疫工作中的核心角色，透過持續的監測與積極推動疫苗施打，在不斷變化的COVID-19疫情趨勢中發揮重要作用。</p> <p> </p><p>The COVID-19 pandemic has had a profound global impact, particularly on high-risk populations, such as those with underlying medical conditions. In response to the evolving pandemic landscape and the constant surge in the need to vaccinate among vulnerable cases in Taiwan, the Taiwan Association of Family Medicine (TAFM) has developed recommendations on COVID-19 vaccination for high-risk groups. Based on a comprehensive literature review and expert panel discussions, a total of 25 evidence-based recommendations have been developed to serve as a reference for vaccination strategies, highlighting the increased risk of severe COVID-19 outcomes among individuals with complications such as diabetes, obesity, chronic kidney disease, cardiovascular disease, and respiratory illnesses. The recommendations emphasize the safety and effectiveness of COVID-19 vaccines, particularly mRNA vaccines, for the aforementioned high-risk populations and underscore the critical roles of family physicians in response to severe COVID-19 outcomes, including routine screening, health education, vaccine administration, and continuous research to optimize strategies. The TAFM recommendations provide a robust, evidence-based framework that meets clinical practice requirements and provides effective guidelines for physicians, healthcare institutions, and governments in tailoring vaccination efforts to address the unique needs of high-risk groups in Taiwan. Ongoing monitoring and proactive vaccination drives are essential for ensuring the effectiveness of these recommendations in the evolving COVID-19 landscape, while also accentuating the continuous efforts of family physicians in preventing endemic diseases.</p> <p> </p>

Relative effectiveness of bivalent boosters against severe COVID-19 outcomes among people aged ≥ 65 years in Finland, September 2022 to August 2023.

BackgroundLong-term effectiveness data on bivalent COVID-19 boosters are limited.AimWe evaluated the long-term protection of bivalent boosters against severe COVID-19 among ≥ 65-year-olds in Finland.MethodsIn this register-based cohort analysis, we compared the risk of three severe COVID-19 outcomes among ≥ 65-year-olds who received a bivalent booster (Original/Omicron BA.1 or Original/BA.4-5; exposed group) between 1/9/2022 and 31/8/2023 to those who did not (unexposed). We included individuals vaccinated with at least two monovalent COVID-19 vaccine doses before 1/9/2022 and ≥ 3 months ago. The analysis was divided into two periods: 1/9/2022-28/2/2023 (BA.5 and BQ.1.X predominating) and 1/3/2023-31/8/2023 (XBB predominating). The hazards for the outcomes between exposed and unexposed individuals were compared with Cox regression.ResultsWe included 1,191,871 individuals. From 1/9/2022 to 28/2/2023, bivalent boosters were associated with a reduced risk of hospitalisation due to COVID-19 (hazard ratio (HR): 0.45; 95% confidence interval (CI): 0.37-0.55), death due to COVID-19 (HR: 0.49; 95% CI: 0.38-0.62), and death in which COVID-19 was a contributing factor (HR: 0.40; 95% CI: 0.31-0.51) during 14-60 days since vaccination. From 1/3/2023 to 31/8/2023, bivalent boosters were associated with lower risks of all three severe COVID-19 outcomes during 61-120 days since a bivalent booster (e.g. HR: 0.53; 95% CI: 0.39-0.71 for hospitalisation due to COVID-19); thereafter no notable risk reduction was observed. No difference was found between Original/Omicron BA.1 and Original/BA.4-5 boosters.ConclusionBivalent boosters initially reduced the risk of severe COVID-19 outcomes by ca 50% among ≥ 65-year-olds, but protection waned over time. These findings help guide vaccine development and vaccination programmes.

Proportion of Patients in the United States Who Fill Their Nirmatrelvir/Ritonavir Prescriptions.

Although real-world studies demonstrate that those prescribed nirmatrelvir/ritonavir (and particularly within 5days of symptom onset) are less likely to experience severe COVID-19 outcomes, prior studies show that only a small fraction of patients with COVID-19 who are eligible for nirmatrelvir/ritonavir receive a prescription. Studies calculating the proportion of nirmatrelvir/ritonavir prescriptions filled and identifying individual- and pharmacy-level correlates of filling nirmatrelvir/ritonavir are lacking. This retrospective cohort study included individuals aged ≥ 12years with a nirmatrelvir/ritonavir prescription ordered at a large national retail pharmacy (December 22, 2021-August 12, 2023). Those taking contraindicated medications were excluded. For those with only one nirmatrelvir/ritonavir prescription ordered, the outcome was whether the prescription was filled (yes/no). In a subanalysis of these individuals, the outcome was whether the prescription was filled within 5days of symptom onset (yes/no). For those with multiple prescriptions ordered, the outcome was whether > 1 (vs. 0 or 1) prescriptions were filled. A log-binomial regression with generalized estimating equations was used to identify individual (clinical and demographic) and pharmacy-level (percentage of trade area that is non-Hispanic white, urbanicity, US Census region, and tract-level area deprivation index) correlates. A total of 2,103,570 unique nirmatrelvir/ritonavir prescriptions were ordered for 1,985,990 individuals. Among the 95% of individuals prescribed only one nirmatrelvir/ritonavir course, 88% filled their prescription. Among those with > 1 prescription ordered, 77% (82,993/108,411) filled one and 13% (13,662/108,411) filled > 1. Patients ≥ 50years of age and those with documented high-risk conditions were slightly more likely to fill prescriptions, regardless of whether one or multiple courses were ordered. Individuals with cancer, asthma, or taking corticosteroids or immunosuppressive medications were more likely to fill multiple prescriptions. Most patients filled their nirmatrelvir/ritonavir prescriptions. Interventions to improve uptake should focus on increasing patient and provider awareness, reducing nirmatrelvir/ritonavir prescribing disparities, and ensuring treatment initiation within 5days.

Impact of Cardiorespiratory Fitness on COVID-19–Related Outcomes: The Exercise Testing and Health Outcomes Study (ETHOS)

ObjectiveTo assess the association between cardiorespiratory fitness (CRF) and COVID-19–related health outcomes including mortality, hospitalization, and mechanical ventilation. Patients and MethodsIn a retrospective analysis of 750,302 patients included in the Exercise Testing and Health Outcomes Study, we identified 23,140 who had a positive result on COVID-19 testing between March 2020 and September 2021 and underwent a maximal exercise test in the Veterans Affairs Health Care System between October 1, 1999 to September 3, 2020. The association between CRF and risk for severe COVID-19 outcomes, including mortality, hospitalization due to COVID-19, and need for intubation was assessed after adjustment for 15 covariates. Patients were stratified into 5 age-specific CRF categories (Least-Fit, Low-Fit, Moderate-Fit, Fit, and High-Fit), based on peak metabolic equivalents achieved. ResultsDuring a median of follow-up of 100 days, 1643 of the 23,140 patients (7.1%) died, 4995 (21.6%) were hospitalized, and 927 (4.0%) required intubation for COVID-19–related reasons. When compared with the Least-Fit patients (referent), the Low-Fit, Moderate-Fit, Fit, and High-Fit patients had hazard ratios for mortality of 0.82 (95% CI, 0.72 to 0.93), 0.73 (95% CI, 0.63 to 0.86), 0.61 (95% CI, 0.53 to 0.72), and 0.54 (95% CI, 0.45 to 0.65), respectively. Patients who were more fit also had substantially lower need for hospital admissions and intubation. Similar patterns were observed for elderly patients and subgroups with comorbidities including hypertension, diabetes, cardiovascular disease, and chronic kidney disease; for each of these conditions, those in the High-Fit category had mortality rates that were roughly half those in the Low-Fit category. ConclusionAmong patients positive for COVID-19, higher CRF had a favorable impact on survival, need for hospitalization, and need for intubation regardless of age, body mass index, or the presence of comorbidities.