Cumulative Coronavirus Disease 2019 Incidence Research Articles

The evaluation of the correlation between some variables of the countries and COVID-19 incidence of cases and deaths in different variant periods

Objective: The aim of this study is to evaluate the correlation between the incidence case/death rate of coronavirus disease 2019 (COVID-19) and some variables of the countries. Methods: This research is an Ecological study. We analyzed the association of COVID‐19 incidence of cases/deaths with population rates over 65, Gini index, GDP per capita (current US$), burden of disease (DALYs-2019), literacy rate of over 15 years old, Coefficient of Variation (CV) of caloric intake, prevalence of obesity among adults, total COVID-19 vaccine doses administered per 100 people, total test (per 1M). Furthermore, we analyzed the data on COVID-19 incidence of cases/death in the cross-sectionally for three periods: Alpha-Beta-Gamma, Delta and Omicron periods. Spearman correlation test was used for statistical analysis. Results: Positive correlations were found in COVID-19 cumulative incidence of cases/deaths (per 1M), and population rates over 65, GDP (per capita), literacy rate of over 15 years old, prevalence of obesity among adults, total COVID-19 vaccine doses administered per 100 people. On the other hand, negative correlation was found with DALYs, Coefficient of Variation (CV) of caloric intake and Gini index. When the variant periods of COVID-19 were examined respectively (Alpha-Beta-Gamma, Delta and Omicron), the positive correlation and the negative correlation were further increased during the Omicron period. Conclusion: It is recommended to consider the demographic and socioeconomic characteristics of the countries as well as the characteristics of the disease agent for the prevention and control of a possible pandemic in the future.
 Keywords: COVİD-19, DALYs, aged, obesity, vaccine, correlation study

Risk of Coronavirus Disease 2019 (COVID-19) among those up-to-date and not up-to-date on COVID-19 vaccination by US CDC criteria.

The CDC recently defined being "up-to-date" on COVID-19 vaccination as having received at least one dose of a COVID-19 bivalent vaccine. The purpose of this study was to compare the risk of COVID-19 among those "up-to-date" and "not up-to-date". Employees of Cleveland Clinic in Ohio, USA, in employment when the COVID-19 bivalent vaccine first became available, and still employed when the XBB lineages became dominant, were included. Cumulative incidence of COVID-19 since the XBB lineages became dominant was compared across the"up-to-date" and "not up-to-date" states, by treating COVID-19 bivalent vaccination as a time-dependent covariate whose value changed on receipt of the vaccine. Risk of COVID-19 by vaccination status was also evaluated using multivariable Cox proportional hazards regression adjusting for propensity to get tested for COVID-19, age, sex, most recent prior SARS-CoV-2 infection, and number of prior vaccine doses. COVID-19 occurred in 1475 (3%) of 48 344 employees during the 100-day study period. The cumulative incidence of COVID-19 was lower in the "not up-to-date" than the "up-to-date" state. On multivariable analysis, being "up-to-date" was not associated with lower risk of COVID-19 (HR, 1.05; 95% C.I., 0.88-1.25; P-value, 0.58). Results were very similar when those 65 years and older were only considered "up-to-date" after 2 doses of the bivalent vaccine. Since the XBB lineages became dominant, adults "up-to-date" on COVID-19 vaccination by the CDC definition do not have a lower risk of COVID-19 than those "not up-to-date", bringing into question the value of this risk classification definition.

Pre-exposure prophylaxis with tixagevimab/cilgavimab for coronavirus disease 2019 (COVID-19) during the Omicron BA.5 wave at a single institution in Japan.

Pre-exposure prophylaxis with tixagevimab/cilgavimab was considered a useful strategy to protect immunocompromised patients from COVID-19 based on the phase 3 PROVENT trial conducted between November 2020 and March 2021. However, after late 2021, the dominant substrains of COVID-19 changed to Omicron substrains, which showed resistance to tixagevimab/cilgavimab. Therefore, it is important to re-evaluate the real-world efficacy of tixagevimab/cilgavimab for the prevention of COVID-19 in the Omicron era. To this end, we retrospectively evaluated the efficacy and safety of tixagevimab/cilgavimab prophylaxis for COVID-19 during the Omicron BA.5 wave in Japan. A total of 240 consecutive patients with hematologic malignancies received tixagevimab/cilgavimab at our institution from October 18, 2022, to January 31, 2023. Among them, the cumulative incidence of COVID-19 at 90days was 6.4%. A total of 10/14 (71.4%) had mild infection, and 4/14 (28.5%) had severe infection. No patient died due to COVID-19. Adverse events consisted of deep vein thrombosis in 2 patients. Our analysis indicated that pre-exposure prophylaxis with tixagevimab/cilgavimab might have clinical effectiveness in reducing the severity of COVID-19 in Japanese HM patients, even in the Omicron BA.5 surge. It also suggested that tixagevimab/cilgavimab may be associated with cardiovascular complications.

Geographic Information Database of Herbs against COVID-19 in Thailand: The Medicinal Plants those Folk Healers Commonly Used for Treatment and Boosting People's Immunity

The rapid outbreak of coronavirus disease 2019 (COVID-19) has demonstrated the need for the development of new vaccine candidates and therapeutic drugs to fight against the underlying virus, severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Currently, no antiviral treatment is available to treat COVID-19, as treatment is mostly directed at relieving the symptoms, and retrospectively, herbal medicinal plants have been used for thousands of years as a medicinal alternative, including for the treatment of various viral illnesses. The aim of this study is to conduct a survey in terms of identifying the area where the population commonly uses the medicinal plant in comparison to the cumulative number of COVID-19 reports in each area, including the classification of medicinal plants by type and a stepwise approach shown in the form of geographic information maps in those areas. An observational study on the cultivation of medicinal plants those folk healers commonly used for healing. beneficial for treatment and strengthening the immunity of the people in 9 provinces of Thailand. According to the situation of the spread of COVID-19, there are people infected in Thailand. In each area where medicinal plants were used, there was a significant positive result when compared to the cumulative COVID-19 incidence; the majority was with the lowest cumulative COVID-19 incidence and the most commonly used medicinal plants, such as Artemisia annua, Harrisonia perforate (Blanco) Merr, Capparis micracantha, Tacca leontopetaloides, Andrographis paniculata, Phyllanthus emblica, Ficus carica, Tiliacora triandra, Terminalia bilaria, and Cannabis indica. This study exercise may lend enough credence to the potential value of Thai medicinal plants (herbs) as possible leads in anti-COVID-19 drug discovery through research and development.

Hybrid Immunity Provides Protective Advantage Over Vaccination or Prior Remote Coronavirus Disease 2019 Alone.

The protective efficacy of prior coronavirus disease 2019 (COVID-19) with or without vaccination remains unknown. This study sought to understand if 2 or more messenger RNA (mRNA) vaccine doses provide additional protection in patients with prior infection, or if infection alone provides comparable protection. We conducted a retrospective cohort study of the risk of COVID-19 from 16 December 2020 through 15 March 2022, among vaccinated and unvaccinated patients of all ages with and without prior infection. A Simon-Makuch hazard plot illustrated the incidence of COVID-19 between groups. Multivariable Cox proportional hazards regression was used to examine the association of demographics, prior infection, and vaccination status with new infection. Among 101 941 individuals with at least 1 COVID-19 polymerase chain reaction test prior to 15 March 2022, 72 361 (71.0%) received mRNA vaccination and 5957 (5.8%) were previously infected. The cumulative incidence of COVID-19 was substantially higher throughout the study period for those previously uninfected and unvaccinated, and lowest for those previously infected and vaccinated. After accounting for age, sex, and the interaction between vaccination and prior infection, a reduction in reinfection risk was noted during the Omicron and pre-Omicron phases of 26% (95% confidence interval [CI], 8%-41%; P = .0065) to 36% (95% CI, 10%-54%; P = .0108), respectively, among previously infected and vaccinated individuals, compared to previously infected subjects without vaccination. Vaccination was associated with lower risk of COVID-19, including in those with prior infection. Vaccination should be encouraged for all including those with prior infection, especially as new variants emerge and variant-specific booster vaccines become available.

The Prevalence of COVID-19 in Europe by the End of November 2022: A Cross-Sectional Study.

Background The world has been affected differently by the coronavirus disease 2019 (COVID-19), and Europe reaped the largest number of cases and deaths. Moreover, COVID-19 statistics are dynamic. Objectives The current study aimed to use COVID-19 data to examine the COVID-19 prevalence in Europe by the end of November 2022 and compare the findings globally. Methods The primary data on COVID-19 for each European country were obtained from the "Worldometer" website. The data include the cumulative incidence of COVID-19 per country, the cumulative number of deaths, the total number of tests performed, the number of cases per million population, the number of deaths per million, the number of tests per million, and the total population. The case-fatality rate was calculated (number of deaths/number of cases). In addition, the median age and the vaccination coverage rate (people who received two doses) for each European country were extracted from the "United Nations" website and the "Our World in Data" website, respectively. To compare European countries to the globe, COVID-19 data for each continent were obtained. The analysis of variance (ANOVA) test was used to compare variances across the means of the four parts of Europe based on the geographic division. An independent sample t-test was also used to compare the means between the European Union (EU) states and non-EU states. The Spearman correlation coefficient was used to determine the relationship between different variables across Europe. Results As of December 1, 2022, about 648 million COVID-19 cases and 6.6 million deaths have been recorded worldwide. Europe accounted for nearly 36.8% and 29.5% of all cases and deaths, respectively. Based on the number of deaths per million, Europe was the most affected continent after South America. Nearly 6.8 billion tests have been conducted worldwide, 41% done in Europe; 43 European countries have performed tests more than their population. However, COVID-19 statistics were inconsistent across the four parts of Europe. A significant difference was noticed between Eastern Europe and others, especially Northern Europe and Western Europe. By affiliation with the EU, there was no significant difference. For global comparison, the mean deaths per million, the mean cases per million, and the mean tests per population for European countries were higher than those of the world's countries, although they recorded a lower mean case-fatality rate (CFR). Thirteen European countries were among the 15 most affected countries worldwide based on the number of deaths per million, most located in Eastern and Southern Europe. The number of cases and the number of deaths were significantly proportional to the number of tests performed. Conclusions By the end of November 2022, Europe had the most cases of COVID-19, the most deaths, and the most tests performed, even though it accounts for 9.4% of the world's population. However, COVID-19 data were inconsistent across the four parts of Europe, especially between Eastern Europe and others. Given the natural immunity acquired during the three years and the excellent vaccine coverage in Europe, it is essential to reconsider the definition of a suspected case and establish more specific criteria for testing.

COVID-19 Statistics in the Arab World by the End of October 2022: A Cross-Sectional Study.

Background The coronavirus disease 2019 (COVID-19) has affected almost all world countries, including all 22 Arab countries. However, over the last 34 months, the world has suffered from the pandemic unevenly, and COVID-19 statistics are dynamic. Objectives The current study aimed to use COVID-19 data to examine COVID-19 statistics (including the number ofcases/deaths/tests) in Arab countries by the end of October 2022 and compare the findings with global statistics. This study was also used to determine the extent to which statistics vary across Arab countries. Methods The primary data on COVID-19 for each Arab country were obtained from the "Worldometer" website. The data include the cumulative incidence of COVID-19 per country, the cumulative number of deaths, the total number of tests performed, the number of cases per million population, the number of deaths per million, the number of tests per million, and the total population. The case-fatality rate (CFR) was calculated (number of deaths/number of cases). In addition,the median age for each Arab country was extracted from the United Nations website. The rate of vaccination coverage (people who received two doses) was extracted from the "Our World in Data" website. COVID-19 statistics were further analyzed in Arab countries in Asia compared to those in Africa at the end of 2020, 2021, and October 2022. To compare the Arab countries to the globe, COVID-19 data for each continent were obtained. The Spearman correlation coefficient was used to determine the relationship between different variables across Arab countries. Results As of November 1, 2022, about 636 million COVID-19 cases and 6.6 million deaths had been recorded worldwide. Arab countries accounted for nearly 2.21% and 2.62% of all cases and deaths, respectively. In general, the mean deaths per million and the mean cases per million for Arab countries were lower than those of the world's countries, although Arab countries recorded a higher mean case-fatality rate. Alternatively, Arab countries in aggregate recorded fewer deaths per million (381) than the world (830). However, statistics across Arab countries have been inconsistent; Arab countries in Africa were less affected. Arab countries have performed approximately 359 million tests (5.29% of all tests), 93% of which were performed by Arab countries in Asia. Moreover, 54.4% of all tests were performed in the United Arab Emirates. Yemen, Somalia, Sudan, Algeria, Syria, Comoros, and Djibouti were the least affected Arab countries based on the number of deaths per million. With the exception of Comoros, these countries were among the least vaccinated in the Arab world. Conclusions In general, Arab countries have been less affected by the COVID-19 pandemic than the rest of the world. However, statistics vary across Arab countries, especially regarding the number of tests performed. Given the natural immunity acquired during the three years and the relatively good vaccine coverage in the Arab world, it is important to reconsider the definition of a suspected case and establish more specific criteria for testing.

ODP349 Risk of Coronavirus Disease 2019 (COVID-19) in patients with Cushing's Disease (CD) is increased and independently associated with both obesity and disease activity

Abstract Patients with Cushing's disease (CD) are usually immunosuppressed due to chronic hypercortisolism, therefore more susceptible to COVID-19. Comorbidities like obesity, hypertension and diabetes mellitus (DM), highly prevalent in CD, have been shown to increase severity of COVID-19 in the general population. The aim of this study was to evaluate the incidence, risk factors, and outcome of COVID-19 in a cohort of CD patients from February/15 2020 to November/15 2021 (before the arrival of the Omicron variant in Brazil). Sixty out of 66 CD patients were included (54F). From October/1 to November/30/2021, patients or family members answered a questionnaire about the diagnosis and time of COVID-19 infection (PCR-confirmed), its outcome and vaccination status through phone interview. Clinical and biochemical data, obtained from our electronic medical records, showed that 15 patients were in hypercortisolism (25%) and 45 were in remission (75%). A similar proportion was found among those 6 patients that did not participate in the study. The cumulative incidence of COVID-19 in the cohort during the entire observation period (22 months) was 32% (19/60), much higher than reported in the general reference population within the same area during the same period (9.5%). Since vaccination only started in February/2021, 55 patients were considered as not fully vaccinated (less than two doses) up to July/2021 (observation period: 17 months). In those patients, the cumulative incidence of COVID-19 during that period of time was also higher (27%) than in the reference population (8.4%). When CD patients were stratified according to comorbidities, the cumulative incidence of COVID-19 was shown to be significantly higher in patients with active disease (hypercortisolism) [57%vs 17%,P= 0. 012] and in those with obesity [54%vs 9%,P<0. 001], but not with hypertension or DM. In multivariate analysis, both hypercortisolism and obesity were independent risk factors for COVID-19 in CD patients [RR=2.1 (CI: 1-4.4),P=0. 05 andRR=4.8 (CI: 1.5-15.5),P=0. 009, respectively]. One single patient (5.2%) died from COVID-19 (she had hypercortisolism, obesity, hypertension and DM). During the next 5 months, when all 60 patients had been fully vaccinated, there were four (4/41) new infections and no (0/19) reinfection. The incidence of COVID-19 is higher in CD patients and is associated with hypercortisolism, as expected, and more strongly with obesity, which is a novel and unexpected finding that has only recently been reported in the general population (1). Thus, correction of hypercortisolism, obesity, and preventive measures should be more aggressively implemented in CD patients during the current COVID-19 pandemia. Reference: (1) Recalde et al., J Clin Endocrinol Metab. 2021 Nov 19;106(2): e5030-e5042. Presentation: No date and time listed

Coronavirus disease 2019 and cardiovascular disease: what we have learnt during the last 2 years.

Coronavirus disease 2019 and cardiovascular disease: what we have learnt during the last 2 years.

Risk and prognostic factors for SARS-CoV-2 infection in Spanish population with multiple sclerosis during the first five waves.

Data on coronavirus disease 2019 (COVID-19) incidence in patients with multiple sclerosis (MS) during the first wave have been published but are scarce for the remaining waves. Factors associated with COVID-19 infection of any grade are also poorly known. The aim of this study was to analyze the incidence, clinical features, and risk factors for COVID-19 infection of any grade in patients with MS (pwMS) during waves 1-5. This study prospectively analyzes the cumulative incidence of COVID-19 from the first to the fifth waves by periodic case ascertainment in pwMS followed at the University Hospital of Getafe (UHG). Global and stratified cumulative incidence was calculated. Logistic regression models were used to estimate the weight of selected variables as risk and prognostic factors. We included 431 pwMS, of whom 86 (20%) were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The overall cumulative incidence of confirmed cases was similar to that of Madrid (13,689 vs. 13,307 per 100,000 habitants) but 3 times higher during the first wave and slightly lower from the second to the fifth waves. The majority (86%) of pwMS developed mild forms of COVID-19. Smoking was the only factor associated with a decreased risk of SARS-CoV2 infection of any grade [odds ratio (OR) 0.491; 95% CI 0.275-0.878; p = 0.017]. Risk factors associated with severe forms were Expanded Disability Severity Scale (EDSS) ≥3.5 (OR 7.569; 95% CI 1.234-46.440) and pulmonary disease (OR 10.763; 95% CI 1.27-91.254). The incidence of COVID-19 was similar in this MS cohort to the general population. Smoking halved the risk of being infected. Higher EDSS and pulmonary comorbidity were associated with an increased risk of severe forms.

Leveraging Serosurveillance and Postmortem Surveillance to Quantify the Impact of Coronavirus Disease 2019 in Africa.

The coronavirus disease 2019 (COVID-19) pandemic has had a devastating impact on global health, the magnitude of which appears to differ intercontinentally: For example, reports suggest that 271 900 per million people have been infected in Europe versus 8800 per million people in Africa. While Africa is the second-largest continent by population, its reported COVID-19 cases comprise <3% of global cases. Although social and environmental explanations have been proposed to clarify this discrepancy, systematic underascertainment of infections may be equally responsible. We sought to quantify magnitudes of underascertainment in COVID-19's cumulative incidence in Africa. Using serosurveillance and postmortem surveillance, we constructed multiplicative factors estimating ratios of true infections to reported cases in Africa since March 2020. Multiplicative factors derived from serology data (subset of 12 nations) suggested a range of COVID-19 reporting rates, from 1 in 2 infections reported in Cape Verde (July 2020) to 1 in 3795 infections reported in Malawi (June 2020). A similar set of multiplicative factors for all nations derived from postmortem data points toward the same conclusion: Reported COVID-19 cases are unrepresentative of true infections, suggesting that a key reason for low case burden in many African nations is significant underdetection and underreporting. While estimating the exact burden of COVID-19 is challenging, the multiplicative factors we present furnish incidence estimates reflecting likely-to-worst-case ranges of infection. Our results stress the need for expansive surveillance to allocate resources in areas experiencing discrepancies between reported cases, projected infections, and deaths.

Global, regional, and national incidence and mortality of COVID-19 in 237 countries and territories, January 2022: a systematic analysis for World Health Organization COVID-19 Dashboard

Objective: To estimate global, regional, and national incidences and mortality of the coronavirus disease 2019 (COVID-19) in 237 countries and territories since the outbreak of the COVID-19 pandemic to 31 January, 2022. Methods: Comprehensive estimates were produced through global, regional, and national studies of cumulative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections for the duration of the COVID-19 pandemic. The incidence and mortality rate of COVID-19 was analyzed based on the World Health Organization (WHO) COVID-19 Dashboard data since the outbreak of the COVID-19 pandemic to 31 January, 2022. The number of cumulative total confirmed cases, the number of cumulative total confirmed cases (cumulative incidence) per 100,000, the number of cumulative total death cases, and the number of cumulative total death cases (cumulative death rate) per 100,000 population were calculated according to the WHO regions, World Bank income groups, and each country. Results: A total of 349,641,119 of confirmed COVID-19 cases were reported globally on 31 January, 2022 (cumulative incidence of COVID-19, 4,485.72 per 100,000 population). Europe demonstrated the highest cumulative incidence of COVID-19 (14,039.95 per 100,000 population), followed by the Americas (12,512.57 per 100,000 population) showing a cumulative total death cases and cumulative death rate of COVID-19 of 5,592,266 and 71.75 per 100,000 population, respectively. The Americas presented highest cumulative death rate of COVID-19 (14,039.95 per 100,000 population), followed by Europe (12,512.57 per 100,000 population). The nation with the highest cumulative total cases of COVID-19 was the United States of America (n=69,727,991). However, the cumulative death rate of the COVID-19 was found higher in developing and underdeveloped countries. Conclusion: From the start of the COVID-19 pandemic to 31 January, 2022, 349.6 million of the worldwide population suffered symptoms of SARS-COV-2 and 5.6 million lost their lives due to it. The population in Europe and other high-income groups showed high incidence rates of COVID-19 while the death rate was high in Americas and other upper middle-income nations. According to figures of nationalities, the countries with compromised economic status presented a higher death rate despite relatively lower incidence of COVID-19 than the developed countries. The results of this study may provide crucially important for COVID-19 research and proper public health policies and strategies.

Racial and ethnic disparities in coronavirus disease 2019 disease incidence independent of comorbidities, among people with HIV in the United States.

To define the incidence of clinically detected coronavirus disease 2019 (COVID-19) in people with HIV (PWH) in the United States and evaluate how racial and ethnic disparities, comorbidities, and HIV-related factors contribute to risk of COVID-19. Observational study within the CFAR Network of Integrated Clinical Systems cohort in seven cities during 2020. We calculated cumulative incidence rates of COVID-19 diagnosis among PWH in routine care by key characteristics including race/ethnicity, current and lowest CD4+ cell count, and geographic area. We evaluated risk factors for COVID-19 among PWH using relative risk regression models adjusted with disease risk scores. Among 16 056 PWH in care, of whom 44.5% were black, 12.5% were Hispanic, with a median age of 52 years (IQR 40-59), 18% had a current CD4+ cell count less than 350 cells/μl, including 7% less than 200; 95.5% were on antiretroviral therapy (ART), and 85.6% were virologically suppressed. Overall in 2020, 649 PWH were diagnosed with COVID-19 for a rate of 4.94 cases per 100 person-years. The cumulative incidence of COVID-19 was 2.4-fold and 1.7-fold higher in Hispanic and black PWH respectively, than non-Hispanic white PWH. In adjusted analyses, factors associated with COVID-19 included female sex, Hispanic or black identity, lowest historical CD4+ cell count less than 350 cells/μl (proxy for CD4+ nadir), current low CD4+ : CD8+ ratio, diabetes, and obesity. Our results suggest that the presence of structural racial inequities above and beyond medical comorbidities increased the risk of COVID-19 among PWH. PWH with immune exhaustion as evidenced by lowest historical CD4+ cell count or current low CD4+ : CD8+ ratio had greater risk of COVID-19.

Incidence and Prevalence of Coronavirus Disease 2019 Within a Healthcare Worker Cohort During the First Year of the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic.

BackgroundPreventing SARS-CoV2 infections in healthcare workers (HCWs) is critical for healthcare delivery. We aimed to estimate and characterize the prevalence and incidence of COVID-19 in a US HCW cohort and to identify risk factors associated with infection.MethodsWe conducted a longitudinal cohort study of HCWs at 3 Bay Area medical centers using serial surveys and SARS-CoV-2 viral and orthogonal serological testing, including measurement of neutralizing antibodies. We estimated baseline prevalence and cumulative incidence of COVID-19. We performed multivariable Cox proportional hazards models to estimate associations of baseline factors with incident infections and evaluated the impact of time-varying exposures on time to COVID-19 using marginal structural models.Results2435 HCWs contributed 768 person years of follow-up time. We identified 21/2435 individuals with prevalent infection, resulting in a baseline prevalence of 0.86% (95% CI, 0.53% to 1.32%). We identified 70/2414 (2.9%) incident infections yielding a cumulative incidence rate of 9.11 cases per 100 person years (95% CI 7.11 to 11.52). Community contact with a known COVID-19 case most strongly correlated with increased hazard for infection (HR 8.1, 95% CI, 3.8, 17.5). High-risk work-related exposures (i.e., breach in protective measures) drove an association between work exposure and infection (HR 2.5, 95% CI, 1.3-4.8). More cases were identified in HCW when community case rates were high.ConclusionWe observed modest COVID-19 incidence despite consistent exposure at work. Community contact was strongly associated with infections but contact at work was not unless accompanied by high-risk exposure.

Necessity of Coronavirus Disease 2019 (COVID-19) Vaccination in Persons Who Have Already Had COVID-19.

BackgroundThe purpose of this study was to evaluate the necessity of COVID-19 vaccination in persons with prior COVID-19.MethodsEmployees of Cleveland Clinic working in Ohio on Dec 16, 2020, the day COVID-19 vaccination was started, were included. Anyone who tested positive for COVID-19 at least once before the study start date was considered previously infected. One was considered vaccinated 14 days after receiving the second dose of a COVID-19 mRNA vaccine. The cumulative incidence of COVID-19, symptomatic COVID-19, and hospitalizations for COVID-19, were examined over the next year.ResultsAmong 52238 employees, 4718 (9%) were previously infected, and 36922 (71%) were vaccinated by the study’s end. Cumulative incidence of COVID-19 was substantially higher throughout for those previously uninfected who remained unvaccinated than for all other groups, lower for the vaccinated than unvaccinated, and lower for those previously infected than those not. Incidence of COVID-19 increased dramatically in all groups after the Omicron variant emerged. In multivariable Cox proportional hazards regression, both prior COVID-19 and vaccination were independently associated with significantly lower risk of COVID-19. Among previously infected subjects, a lower risk of COVID-19 overall was not demonstrated, but vaccination was associated with a significantly lower risk of symptomatic COVID-19 in both the pre-Omicron (HR 0.60, 95% CI 0.40–0.90) and Omicron (HR 0.36, 95% CI 0.23–0.57) phases.ConclusionsBoth previous infection and vaccination provide substantial protection against COVID-19. Vaccination of previously infected individuals does not provide additional protection against COVID-19 for several months, but after that provides significant protection at least against symptomatic COVID-19.

Incidence of COVID-19 after pulmonary function tests: a retrospective cohort study

Introduction: It has been proposed that exposure to pulmonary function tests (PFT) could be associated with a higher risk of viral transmission. The risk of the Coronavirus Disease 2019 (COVID-19) transmission after performing PFT is unknown. We aimed to assess the incidence of COVID-19 after a PFT at an academic teaching facility in Buenos Aires, Argentina.&#x0D; Materials and methods: We conducted a retrospective cohort study including all consecutive adult patients that performed PFT between April 1, 2020 and September 30, 2020. Patients with prior COVID-19 were excluded. We defined a 15-day time window to ascertain PFT related COVID-19. The primary outcome was ascertained by consulting a national database, which has information on all patients with nasopharyngeal swabs for SARS-CoV-2 in Argentina.&#x0D; Results: We included 278 patients who performed a PFT. Fifty percent were women, the mean age was 54 years (SD 18), and the main comorbidities were obesity (31%), smoking (31%), hypertension (29%), and chronic lung disease (28%). The main indication for performing PFT was anesthetic preoperative risk assessment. Swabs were collected from 27 patients (10%). Twenty-two swabs (8%) were taken according to surgical protocols; five swabs (2%) were taken due to clinical suspicion of COVID-19, with only one testing positive. The cumulative incidence of COVID-19 after PFT was 0.36% (95% CI 0.01-20%). None of the technicians developed symptomatic disease.&#x0D; Conclusion: Given the right setting and strict adherence to international recommendations, the SARS-CoV-2 infection after having a PFT appears to be low, which follows that these procedures can be performed safely for both patients and staff.

Coronavirus disease 2019 in liver transplant patients: Clinical and therapeutic aspects.

The coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted liver transplant (LT) activity across the world, with notable decreases in the number of donations and procedures in most Western countries, in particular throughout the first wave. The cumulative incidence of COVID-19 in LT recipients (with estimates ranging from 0.34% to 1.56%) appears to be at least comparable to that observed for the general population. Clinical and radiological features at presentation are also similar to non-transplant patients. The risk of death among LT recipients requiring hospital admission is high (from 12% to 19%), although some authors have suggested that overall mortality may be actually lower compared to the general non-transplant population. It is likely that these poor outcomes may be mainly influenced by the older age and higher comorbidity burden of LT recipients, rather than by the transplant status itself. In fact, it has been hypothesized that post-transplant immunosuppression would exert a protective role, with special focus on tacrolimus-containing regimens. There is scarce evidence to guide the optimal management of post-transplant COVID-19 and the use of antiviral or immunomodulatory therapies, although both clinical practice and guidelines support the dose reduction or withdrawal of anti-proliferative agents such as mofetil mycophenolate. Preliminary reports suggest that the antibody response to messenger RNA vaccines is significantly impaired as compared to non-immunocompromised individuals, in line with other transplant populations. Finally, it is foreseeable that the future will be conditioned by the emerging variants of severe acute respiratory syndrome coronavirus 2 with increased transmissibility among LT recipients.

Association of COVID-19 case fatality rate with disease burden: an ecological analysis in Italy during the first wave

Objectives: In Italy, the case fatality rate (CFR) of coronavirus disease 2019 (COVID-19) during the first wave of the pandemic showed significant geographic heterogeneity. The aim of this study was to explore the possible association between the CFR and measures of disease burden in the Italian regions using an ecological approach.Methods: Cumulated regional data for the period February 24 to May 11, 2020 were analysed to assess the association of the CFR with the cumulative incidence of COVID-19 and the ratio between the maximum number of COVID-19 patients in intensive care units (ICU) and ICU beds available before the pandemic (ICU load), adjusting for median age of the patients at disease onset, number of nasopharyngeal swabs performed per confirmed case, and prevalence of chronic diseases .Results: During the study period, the COVID-19 CFR in the Italian regions ranged between 5.0% and 18.4%. On multivariable regression analysis, the CFR was found to be significantly associated with the cumulative incidence (relative rate (RR) 1.02 per 100 cases/1 million increase), median patient age (RR 1.07 per 1 year increase), and ICU load (RR 1.72, 2.18, and 2.57, for >40–70% vs ≤40%, 70–140% vs ≤40%, and ≥140 vs ≤40%, respectively).Conclusions: A high burden of COVID-19 may contribute to increased disease fatality, possibly as a result of the increasing demand for care of critically ill patients beyond health system capability.

COVID-19 and Chronic Lymphocytic Leukemia: Where We Stand Now.

Coronavirus disease 2019 (COVID-19) has markedly impacted on the management of patients with chronic lymphocytic leukemia (CLL) and their outcome in the last year. The cumulative incidence of COVID-19 in patients with CLL in 1 year was approximately 3% in the recent Italian CAMPUS CLL survey; large retrospective studies have documented a higher mortality in patients with CLL hospitalized for severe COVID-19 compared with the general population. Controversial results for CLL-directed treatment have been reported, with some studies suggesting a potential benefit for BTK inhibitors. Reducing the number of hospital visits, delaying treatment whenever possible, and using oral therapy have become the mainstay of management in these patients. Available results with severe acute respiratory syndrome coronavirus 2 vaccines indicate an immune serological response in 40% of patients only, with a detrimental effect of recent therapy with or without anti-CD20 therapy, older age, and hypogammaglobulinemia. Further studies are needed to determine the best strategies in patients with CLL regarding (i) management of concomitant COVID-19, (ii) identification of patients in whom CLL therapy can be safely postponed, (iii) CLL treatment algorithms, and (iv) optimal severe acute respiratory syndrome coronavirus 2 vaccination strategies.

Association of the past epidemic of Mycobacterium tuberculosis with mortality and incidence of COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has created a remarkable and varying impact in every country, inciting calls for broad attention. Recently, the Bacillus Calmette-Guérin (BCG) vaccination has been regarded as a potential candidate to explain this difference. Herein, we hypothesised that the past epidemic of Mycobacterium tuberculosis (M. tuberculosis) may act as a latent explanatory factor for the worldwide differences seen in COVID-19 impact on mortality and incidence. We compared two indicators of past epidemic of M. tuberculosis, specifically, incidence (90 countries in 1990) and mortality (28 countries in 1950), with the mortality and incidence of COVID-19. We determined that an inverse relationship existed between the past epidemic indicators of M. tuberculosis and current COVID-19 impact. The rate ratio of the cumulative COVID-19 mortality per 1 million was 2.70 (95% confidence interval [CI]: 1.09-6.68) per 1 unit decrease in the incidence rate of tuberculosis (per 100,000 people). The rate ratio of the cumulative COVID-19 incidence per 1 million was 2.07 (95% CI: 1.30-3.30). This association existed even after adjusting for potential confounders (rate of people aged 65 over, diabetes prevalence, the mortality rate from cardiovascular disease, and gross domestic product per capita), leading to an adjusted rate ratio of COVID-19 mortality of 2.44, (95% CI: 1.32-4.52) and a COVID-19 incidence of 1.31 (95% CI: 0.97-1.78). After latent infection, Mycobacterium survives in the human body and may continue to stimulate trained immunity. This study suggests a possible mechanism underlying the region-based variation in the COVID-19 impact.