COVID-19 Deaths Research Articles

A randomized, double-blind, placebo controlled trial of IL-7 in critically ill COVID-19 patients.

Lymphopenia and failure of lymphocytes to mount an early IFN-γ response correlate with increased mortality in COVID-19. Given the essential role of CD4 helper and CD8 cytotoxic cells in eliminating viral pathogens, this profound loss in lymphocytes may impair patients' ability to eliminate the virus. IL-7 is a pleiotropic cytokine that is obligatory for lymphocyte survival and optimal function. We conducted a prospective, double-blind, randomized, placebo-controlled trial of CYT107, recombinant human IL-7, in 109 critically-ill lymphopenic COVID-19 patients. The primary endpoint was to assess CYT107's effect on lymphocyte recovery with secondary clinical endpoints including safety, ICU and hospital length-of-stay, incidence of secondary infections, and mortality. CYT107 was well-tolerated without precipitating a cytokine storm or worsening pulmonary function. Absolute lymphocyte counts increased in both groups without significant difference between CYT107 and placebo. COVID-19 patients receiving CYT107 but not concomitant antiviral medications, known inducers of lymphopenia, had a final lymphocyte count that was 43% greater than placebo (p=0.067). There were significantly fewer treatment-emergent adverse events in CYT107 versus placebo-treated patients (p<0.001), consistent with a beneficial drug effect. Importantly, CYT107 treated patients had 44% fewer hospital-acquired infections versus placebo-treated patients (p=0.014). Given that hospital-acquired infections are responsible for a large percentage of COVID-19 deaths, this effect of CYT107 to decrease nosocomial infections could substantially reduce late morbidity and mortality in this highly lethal disease. The strong safety profile of CYT107 and its excellent tolerability provide support for trials of CYT107 in other potential pandemic respiratory viral infections. NCT04379076, NCT04426201, NCT04442178, NCT04407689; NCT04927169.

COVID-19 death toll predictions show that triggering counterfactual thinking deteriorates judgmental performance.

Effective communication during a health crisis is critical as it directly influences psychological and behavioral responses that will shape the further progression of the crisis. Past research has suggested that one type of cognitive mechanism that is likely to be affected by the framing of public health messages relates to counterfactual thinking. Based on 6731 incentivized daily forecasts collected over 377 days (from April 2020-May 2021), we investigate the role of triggering counterfactual thinking when interpreting public information regarding the daily US death toll from COVID-19. Here we show that individuals who engaged in thinking about "interventions that could have led to an alternative evolution of the death toll" prior to making forecasts exhibit greater judgmental bias in their predictions compared to the control group. Specifically, subjects in the treatment group tend to generate upward counterfactuals and underestimate the death toll, potentially due to anchoring on more favorable scenarios and insensitivity to trend changes. Interestingly, this behavior is also observed among individuals who had recovered from COVID-19 (or someone in their close social circle). Our findings underscore the importance of using debiasing strategies and neutral communication during health crises to mitigate the generation of upward counterfactuals, thus reducing the likelihood of systematic misperceptions and flawed decision-making.

Risk of COVID-19 Hospitalization and Death in Patients on Chronic Opioid Therapy and With Opioid Use Disorder

Risk of COVID-19 Hospitalization and Death in Patients on Chronic Opioid Therapy and With Opioid Use Disorder

P-1956. COVID-19 in pediatric population in Peru, 2020-2023: national data analysis

Abstract Background Peru is the eighth country in South America with most COVID-19 cases (134 684 cases per million population) and the first country in the world with most COVID-19 deaths (6 595 deaths per million population). However, there is no systematic analysis of the prevalence and severity of COVID-19 in the pediatric and adolescent population in the country. This study aims to describe the distribution and disparities of COVID-19 in Peru. Methods We analyzed all COVID-19 cases, deaths, admissions, and vaccine doses administered reported in the open database of the Ministry of Health of Peru from March 2020 to June 2023. The main variables were the monthly number of COVID-19 cases, deaths, and hospital admissions. We calculated monthly incidence per 1,000 inhabitants, monthly mortality per 100,000 inhabitants, global lethality per 100 cases, and global hospitalization rate per 100 cases by sex, age group (under 1y, 1-5y, 6-11y, and 12-17y), poverty level (1 to 4 from least to highest poverty level), macroregion (metropolitan Lima, north, east [jungle], center, and south), and COVID-19 waves (1: Mar–Oct2020, 2: Nov2020–Oct2021, 3: Nov2021–Apr2022, 4: May–Oct2022, and 5: Nov2022–Jun2023). Results We analyzed 315,046 COVID-19 cases, 1,616 COVID-19 deaths, 6,936 hospital admissions and 16,476,930 vaccine doses administered. The mean monthly incidence were higher in adolescents (1.252), patients from the metropolitan Lima macroregion (1.126), from the lowest poverty level (1.062), and during the third and fourth waves (1.844 and 1.016). However, the mean monthly mortality were higher in children under 1 year (1.327), patients from the jungle macroregion (0.664), with the highest poverty level (0.642), and during the first and second COVID-19 waves (0.769 and 0.482). Lethality and hospital admission rates had similar distribution to monthly mortality (Tab 1). Analyzing COVID-19 cases by age group during each wave, we found that there are higher monthly incidence rates among adolescents and higher monthly mortality and global lethality rates in children under 1 year. (Tab 2, Fig 1 &amp; 2)Figure 1.Monthly COVID-19 incedence, mortality, lethality and hospital admission rate from march 2020 to june 2023 in pediatric population in Peru Conclusion COVID-19 in the pediatric population in Peru had great disparities, with the highest mortality among young infants, the poorest and children from the jungle.Figure 2.Monthly COVID-19 incidence, mortality, lethality and hospital admission rate by macroregion in children and adolescents from March 2020 to June 2023 in pediatric population in Peru.A: Mean monthly incidence per 1,000 inhabitants by macroregionB: Mean monthly mortality per 100,000 inhabitants by macroregionC: Lethality per 100 inhabitants by macroregionD: Hospital admission rate per 100 inhabitants by macroregion Disclosures Brian Peña, n/a, Pfizer: Grant/Research Support Gabriel Carrasco, n/a, Pfizer: Grant/Research Support Theresa Ochoa, PhD, Pfizer: Grant/Research Support Rafaella Navarro, n/a, Pfizer: Grant/Research Support

Immunocompromised individuals remain at risk of COVID-19: 2023 results from the observational INFORM study.

We aimed to characterise COVID-19 severity, mortality and healthcare utilisation in immunocompromised individuals in England during 2023, using INFORM study data. Retrospective cohort study (ISRCTN53375662) using pseudonymised electronic health records of individuals aged ≥12 years from a random 25% sample of England's population. Over 1 January-31 December 2023, adjusted incidence rate ratios (aIRRs; adjusted for age, sex, non-immunocompromising comorbidities) between immunocompromised and non-immunocompromised individuals for COVID-19-related hospitalisation, death, and healthcare utilisation were estimated. Immunocompromised individuals represented 4.0% of 12,056,685 individuals studied but accounted for 21.7% and 21.9% of COVID-19 hospitalisations and deaths, respectively. Risk of severe COVID-19 was elevated for immunocompromised vs. non-immunocompromised; aIRRs: 2.04, 95% CI 1.95-2.14 (COVID-19 hospitalisation); 1.69, 95% CI 1.53-1.87 (COVID-19 death). COVID-19 vaccination was more likely in immunocompromised vs. non-immunocompromised (≥4 doses 72.6% vs. 29.8%). The aIRRs for COVID-19-related general practitioner consultations and accident and emergency/day case visits were 2.26 (95% CI 2.22-2.29) and 3.02 (95% CI 2.84-3.20), respectively, for immunocompromised vs. non-immunocompromised. Beyond three years since the start of the COVID-19 pandemic, immunocompromised individuals remain disproportionately impacted from COVID-19 despite increased vaccination. These findings highlight a persistent need for additional COVID-19 interventions for immunocompromised populations.

P-1989. COVID-19 Mortality Among Immunocompromised Individuals is Consistently High Compared with Non-Immunocompromised Individuals: Results of the INFORM Study 2022, England

Abstract Background The INFORM study showed the disproportionate risk of COVID-19 hospitalization and mortality among immunocompromised (IC) versus non-immunocompromised (non-IC) individuals. This analysis aimed to describe the relationship between COVID-19 hospitalization and COVID-19 mortality by IC status. Methods The INFORM retrospective cohort study assessed electronic healthcare records from a random 25% sample of the population of England, aged ≥ 12 years, who were registered and active in the National Health Service. Individuals were categorized by COVID-19 hospitalization status and highest level of in-hospital care: no intensive care unit (ICU) admission or mechanical ventilation (MV); ICU without MV; and ICU with MV. COVID-19 deaths included those with COVID-19 recorded as the cause of death and/or in-hospital death during COVID-19 hospitalization (admission for &amp;gt; 24 hours with COVID-19 as the primary diagnosis) from January 1 to December 31, 2022. Results In 2022, IC individuals comprised 3.9% of the study population (N = 470,910/11,990,730). Of those with a recorded SARS-CoV-2 infection (N=1,746,820), COVID-19 deaths occurred in 1.1% of IC and 0.2% of non-IC individuals. Of those with a recorded COVID-19 hospitalization (N=20,995), COVID-19 deaths occurred in 12.0% of IC and 9.3% of non-IC individuals. There was a higher proportion of COVID-19 deaths, either during or after admission, among hospitalized IC individuals compared with non-IC individuals across all levels of care: no ICU and/or MV, 10.7% versus 8.6%; ICU, 48.1% versus 36.7%; MV, 77.8% versus 50.8%. Conclusion Among those who required hospitalization for COVID-19, the proportion who died of COVID-19 during or after admission was consistently high among IC individuals compared with non-IC individuals across all levels of care, further highlighting the disproportionate burden of COVID-19 in this vulnerable population. Disclosures Lucy Carty, PhD, AstraZeneca: Employee of, and may hold stock and/or stock options Sabada Dube, PhD, AstraZeneca: Employee of, and may hold stock and/or stock options Carla Talarico, PhD, MPH, AstraZeneca: Employee of AstraZeneca and may hold stock and/or stock options Richard McNulty, MD, AstraZeneca: Employee of, and may hold stock and/or stock options Nahila Justo, PhD, MBA, Evidera/AstraZeneca: Employee of Evidera, which received funding for the conduct of the current study from AstraZeneca Renata Yokota, PhD, P95 Epidemiology &amp; Pharmacovigilance/AstraZeneca: Employee of P95 Epidemiology &amp; Pharmacovigilance, which received a consultancy fee for the conduct of the current study from AstraZeneca Michelle Harley, MBBS, MRCP, MRCGP, AstraZeneca: Employee, holds or may hold stock Jurgens Peters, MD, MPH, MSc, MBA, AstraZeneca: Employee, holds or may hold stock Kathryn Evans, MPH, Evidera/AstraZeneca: Employee of Evidera, which received funding for the conduct of the current study from AstraZeneca Yi Lu, PhD, Evidera/AstraZeneca: Employee of Evidera, which received funding for the conduct of the current study from AstraZeneca Sylvia Taylor, PhD, MPH, MBA, AstraZeneca: Employee of, and may hold stock and/or stock options in, AstraZeneca Jennifer Quint, PhD, Asthma + Lung UK: Grant/Research Support|AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|Boehringer Ingelheim: Grant/Research Support|Evidera: Advisor/Consultant|Evidera: Funding|GSK: Advisor/Consultant|GSK: Grant/Research Support|Health Data Research UK (HDR UK): Grant/Research Support|Insmed: Advisor/Consultant|Medical Research Council (MRC): Grant/Research Support Rachael A. Evans, PhD FRCP, Boehringer Ingelheim: Speaker fees|Chiesi: Support for attending the British Thoracic Society (BTS)|Chiesi: Serving non-paid as the European Respiratory Society (ERS) Group 01.02 Pulmonary Rehabilitation and Chronic Care secretary|Chiesi: Serving non-paid as the American Thoracic Society (ATS) Pulmonary Rehabilitation Assembly chairperson|Evidera: Funding for providing advice throughout the current study|Genetec/Roche: Grant/Research Support|Moderna: Speaker fees|NIHR: Grant/Research Support|UKRI: Grant/Research Support|Wolfson Foundation: Grant/Research Support

P-1957. Spatiotemporal Association of COVID-19 Cases and Mortality with Exposure to Wildfire Particulate Matter in 2020

Abstract Background Climate change is anticipated to have profound effects on human health including infectious diseases. Wildfires have increased in frequency and intensity due to changes in precipitation and have been linked to worsening respiratory infections. We aimed to demonstrate whether an association existed between wildfire smoke and COVID-19 in California during 2020. Demographic data by county in California based on the 2020 American Census Survey and New York Times mask-use survey conducted in July 2020. The population of California is generally higher in the southern region, especially Los Angeles County. The median income is highest in the San Francisco Bay area. The outdoor laborer rate is generally higher in northern California, especially the rural county of Trinity. Self-reported mask use in July 2020 was high throughout the state, but lowest in the northern region. Methods We performed a population-based ecologic cohort study in California in 2020 using a spatial autoregressive model to test for associations between wildfire smoke and COVID-19 case and death incidence while adjusting for demographic and environmental factors. The counties of California were the units of analysis and all persons who lived in California were accounted for in the data. We used publicly available levels of particulate matter &amp;lt; 2.5 µm (µg/m3 PM2.5) specifically attributable to wildfire smoke in California during 2020. The median COVID-19 case and death incidence for each county in California and the overall case and death incidence in each county in California and the statewide county median case and death incidence is displayed in the first two plots below. The mean wildfire smoke PM2.5 exposure (µg/m3) in each California county and the median smoke exposure among California counties is displayed in the third plot. There was a surge in COVID-19 cases and deaths in California in the summer and winter of 2020 but a large degree of variation across counties. There was a surge in smoke exposure in the fall of 2020 and a large degree of variation across counties. Results In a model adjusted for spatial autocorrelation, environmental and demographic confounders, we found as smoke exposure increased per each 10 µg/m3 in PM2.5, there was an average increase of 175 COVID-19 cases/10,000 persons the following month (1-month lag) at the county level (P&amp;lt; 0.001) and an increase of 1.86 COVID-19 deaths/10,000 persons the following month at the county level (P&amp;lt; 0.001). These findings were attenuated in the 2nd month after smoke exposure where we found as smoke increased per each 10 µg/m3 in PM2.5 there was an average increase of 65.9 COVID-19 cases/10,000 persons the following 2nd month but no increase in deaths. Screenshot of the interactive Shiny app displaying COVID-19 cases, deaths, and smoke PM2.5 for each county in California and each month of 2020. Link: https://mchal053.shinyapps.io/smoke-covid/. Conclusion 2020 was a particularly strong year for wildfires in California and a unique year for infectious diseases with the COVID-19 pandemic. Our findings, using a spatially adjusted autoregressive model which controlled for important confounding variables, demonstrated that wildfire smoke exposure likely increased COVID-19 acquisition potentially via epithelial injury. This may have implications for the transmission risk for other upper respiratory tract infections. Table 1 Adjusted spatial lag model for the COVID-19 case and death incidence per 10,000 persons per 10 µg/m3 increase in PM2.5 smoke exposure in 2020. The model is adjusted for median income, outdoor laborer rate, average 2020 temperature per county, monthly 2020 precipitation per county, average elevation, month of the year, and rate of respondents reporting “Always” wearing a mask when in public within 6-feet of other another person. We found very strong evidence for a 1-month lag increase of 175 COIVD-19 cases/10,000 persons and 1.86 deaths/10,000 persons and a 2-month lag increase of 65.9 COVID-19 cases/10,000 persons. There was no 2-month lag increase in COVID-19 mortality. Disclosures Andrej Spec, MD, MSCI, F2G: Grant/Research Support George R. Thompson, III, MD, Astellas: Advisor/Consultant|Cidara: Advisor/Consultant|Cidara: Grant/Research Support|F2G: Advisor/Consultant|F2G: Grant/Research Support|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Mundipharma: Advisor/Consultant|Mundipharma: Grant/Research Support|Pfizer: Advisor/Consultant

P-2005. Long-term complications of COVID-19 in pediatric population in Lima, Peru

Abstract Background Peru is the eighth country in South America with most COVID-19 cases (134 684 cases per million population) and the first country in the world with most COVID-19 deaths (6 595 deaths per million population). However, is lacking data on the long term complications of COVID-19 in children and adolescents. Peru does not have guidelines for the diagnosis and management of long-term complications of COVID-19. Thus, studies are needed to develop evidence-based management and to propose the necessary infrastructure to provide comprehensive care. Methods A multicenter study was carried out in 16 hospitals from Lima to describe the long-term complications of COVID-19 in subjects under 18 years and to compare with subjects without a history of COVID-19 (controls). A history of COVID-19 episode was defined by a positive laboratory test or presence of symptoms with a confirmed household case. The comparison group included subjects with no history of COVID-19 symptoms, no history of COVID-19 epidemiological contact and/or negative laboratory tests. Enrolled patients were screened using a survey from the Long-COVID Clinic of Miami. If the screening was positive the Yorkshire Test was applied during a medical evaluation. Results 2,954 cases and 1,500 controls were enrolled, from which 2,558 cases and 1,452 controls completed the screening survey. A higher positive screening for long-term symptoms was found in subjects with COVID-19 history (1,389/2,558, 54.3%) in comparison with subjects without COVID-19 history (251/1452, 17.3%). Among subjects with a positive screening, 439 (31.6%) cases and 53 (21.1%) controls completed a medical evaluation; 381 (86.8%) cases had at least one new symptom posterior to COVID-19 that lasted at least 3 months (positive Yorkshire Rehabilitation Scale) and 32 (60.4%) among controls. (Tab 1) The most common symptoms were cough (53% vs 26%), pain (48% vs 21%), gastrointestinal symptoms (48% vs 16%), and anxiety (44% vs 30) among cases and controls, respectively. (Tab 2) Conclusion More than half of pediatric patients with COVID-19 have long-term symptoms. Study limitations are: recall bias, not all subjects with a positive screening were evaluated by a physician, and we could be overestimating the frequency of symptoms since we enrolled subjects in hospitals. Disclosures Rafaella Navarro, n/a, Pfizer: Grant/Research Support Theresa Ochoa, PhD, Pfizer: Grant/Research Support Gabriel Carrasco, n/a, Pfizer: Grant/Research Support Brian Peña, n/a, Pfizer: Grant/Research Support

P-1967. Characteristics of the first immunocompromised patients to receive Sipavibart as an early access treatment for COVID-19 pre-exposure prophylaxis in France

Abstract Background Immunocompromised patients account for a large proportion of COVID-19 hospitalizations and deaths, even in the most recent periods, despite having received several COVID-19 vaccine doses. Monoclonal antibodies effectively prevented COVID-19 in the general population in randomized control trials and the immunocompromised population in real-world studies. Unfortunately, the emergence of new variants precluded their use. Sipavibart (AZD3152) is an investigational long-acting monoclonal antibody designed to provide broad coverage across Omicron and ancestral viral variants currently being studied in the SUPERNOVA prevention trial. France was the first country to grant Sipavibart as a COVID-19 pre-exposure prophylaxis treatment in immunocompromised individuals with an early access authorization in December 2023. Methods We performed a retrospective multicentric study in France, including the first consecutive patients to receive one intramuscular dose of Sipavibart in January and February 2024, to collect their characteristics and COVID-19-related medical history. Results Overall, we included 47 patients with a median age of 61 years (IQR:64—69) and 64% male. The three main immunosuppressive conditions were Stem cell transplants (38%), solid organ transplants (32%), and immune-based therapies (mostly Rituximab) (19%) for chronic inflammatory diseases or haematologic malignancies. Nearly half had hypogammaglobulinemia and 71% had at least another key comorbidity (Table 1). 15% and 11% had a history of severe and persistent COVID-19, respectively. The median number of COVID-19 doses was 4 (IQR 3-6), and nearly one-third had previously received previous generation of monoclonal antibodies for COVID-19 prophylaxis (Casirivimab/imdevimab or Tixagevimab/Cilgavimab). SARS-CoV-2 serology results before Sipavibart administration were available in 11 patients (without Immunoglobulins substitution). The median anti-Spike IgG titers was 30 UI/L (IQR 0-179). Conclusion The first patients to receive Sipavibart in France had different profiles, but they were all highly immunocompromised with frequently associated hypogammaglobulinemia and other chronic conditions. Disclosures Paul LOUBET, MD, PhD, Astrazeneca: Advisor/Consultant|Gilead: Advisor/Consultant|Moderna: Advisor/Consultant|Pfizer: Advisor/Consultant Iliès Benotmane, n/a, Astrazeneca: Advisor/Consultant|Astrazeneca: Board Member

P-2002. Incidence and Risk of COVID-19 Hospitalization Among Unvaccinated Children

Abstract Background Although most children often experience mild illness following SARS-CoV-2 infection, some can develop severe disease requiring hospitalization, admission into an intensive care unit (ICU), or die. Methods Children aged 0 - &amp;lt; 18 years, members of Kaiser Permanente Northern California (KPNC), an integrated healthcare organization with more than 4 more million members, were followed from March 1, 2020, until the earliest occurrence of: chart-confirmed COVID-19 hospitalization, disenrollment from KPNC, age 18 years, receipt of COVID-19 vaccine, death, or study end (December 31, 2022). We calculated the incidence rate of hospitalization by SARS-CoV-2 variant period and by age group. We determined risk factors for hospitalization using Poisson regression. We also conducted descriptive analyses of hospitalized cases. Results Among 1,107,799 children, 423 were hospitalized for COVID-19 during follow-up. The incidence of hospitalization increased with each new SARS-CoV-2 variant and was highest among children aged &amp;lt; 6 months. Among the &amp;lt; 6-month-olds, the incidence rate per 100,000 person-months was 7 during pre-delta, 13.3 during delta and 22.4 during omicron. Black (RR= 2.05, 95% CI: 1.33 – 3.16) and Hispanic children (RR = 1.82, 95% CI: 1.34 – 2.46) and children with any comorbidities were at high risk of hospitalization (RR = 3.81, 95% CI: 2.94 – 4.95). Overall, 20.3% of hospitalized children were admitted to an intensive care unit (ICU), but ICU admission was 36.1% among 12 - &amp;lt; 18-year-olds. The majority of ICU admits (91.8%) had no comorbidities. Conclusion Children too young to be vaccinated had the highest incidence of COVID-19 hospitalization, while adolescents had the highest proportion of ICU admissions. To prevent severe disease in children and adolescents, everyone eligible should be vaccinated. Disclosures Nicola P. Klein, MD, PhD, CSL Seqirus: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Merck: Grant/Research Support|Pfizer: Grant/Research Support|Sanofi Pasteur: Grant/Research Support

Self-Reported Long COVID and Its Impact on COVID-19-Related Worries and Behaviors After Lifting the COVID-19 Restrictions in China

Objective: Since the lifting of the COVID-19 restrictions in China in November 2022, there has been a notable surge in the COVID-19 infection rate. Little is known about the prevalence of long COVID among the general adult population and its impact on COVID-19-related worries and behaviors after the policy change. Methods: This cross-sectional study recruited 1530 adults with prior COVID-19 infection in Guangzhou from February to March 2023. Logistic regression analyses and trend analyses were performed to investigate the associations between long COVID- and COVID-19-related worries and preventive behaviors. Results: The estimated prevalence of long COVID among adults in China was 18.0% (95% confidence interval: 16.1% to 20.0%). Common long COVID symptoms included cough (60.7%), fatigue (47.6%), dyspnea (34.5%), palpitation (26.2%), and insomnia (25.1%). Adjusted for background variables, individuals with long COVID exhibited higher level of COVID-19-related worries compared to those who had fully recovered from the infection (reference: without long COVID; adjusted odds ratios ranged from 1.87 to 2.55, all p values &lt; 0.001). Participants primarily expressed worries regarding the potential for COVID-19 reinfection, the impact of the pandemic on daily life, the increasing number of COVID-19 cases and deaths, and the capacity of the healthcare system. While long COVID did not statistically significantly affect their preventive behaviors. Conclusions: Long COVID was prevalent among the general adult population in China after lifting the COVID-19 restrictions, and it had a significant impact on COVID-19-related worries. This study highlights the importance of monitoring the mental health of individuals with long COVID and developing targeted intervention strategies to improve their adherence to preventive measures.

P-2000. A Case-Control Study of the Risk of COVID-19 Infection in Underserved Persons with HIV (PWH) in Middle Tennessee

Abstract Background The COVID-19 pandemic had disproportionately affected racial and ethnic minorities. We undertook this study to examine the risk factors for COVID-19 infection and death in African Americans with HIV. Methods We conducted a prospective case-control study to assess the risk for COVID-19 infection in a clinic serving predominantly underserved African Americans in Middle Tennessee. Matched cases and controls were tested for COVID-19 by PCR around the same time. COVID-19 information, demographics, clinical and social determinants of health (SDoH) data were collected from electronic health records. Chi-square and Fisher’s exact tests were applied to evaluate the associations between outcome and predictor variables. Binary logistic regression was used to examine the effects of 18 predictors on COVID-19 infection. R/RStudio version 4.3.2 was used. The local IRB approved the study protocol. Results From 4/2020 to 11/2023, 91 PWH tested COVID-19-positive and 181 negative. We excluded 11 cases and 29 controls due to missing SDoH data; 81.0% of the patients were African American, 26.3% were female, and 46.1% fell into the 45-64-year-old age group. Among 73 symptomatic cases, the most common symptoms were cough, fever, and chills. 28/91 were admitted to the hospital, 11/28 went to ICU, and 8/28 died. All the deceased had &amp;gt;1 cardiovascular risk factor. 12/91 cases had a CD4 cell count &amp;lt; 200/mm3 and 73/91 had an HIV-1 RNA level &amp;lt; 200 copies/mL. In the bivariate analysis, incarceration (p &amp;lt; 0.001), renal failure (p &amp;lt; 0.001), smoking (p &amp;lt; 0.001), alcoholism (p = 0.003), drug use (p = 0.023), and cardiovascular risk (p = 0.023) were highly associated with COVID-19 infection. In the multivariable model, the most strongly associated risks were incarceration [OR = 18.68; 95% CI: (4.66, 74.87); p &amp;lt; 0.001], renal failure [OR = 40.62; 95% CI: (3.96, 416.83); p = 0.002], hyperlipidemia [OR = 3.94; 95% CI: (1.54, 10.06); p = 0.004], 25-44 years of age [OR = 2.48; 95% CI: (1.10, 5.58); p = 0.028], no insurance [OR = 0.36; 95% CI: (0.14, 0.92); p = 0.033], and smoking [OR = 2.20; 95% CI: (1.01, 4.82); p = 0.048]. Conclusion Incarceration, renal failure, and cardiovascular disease were very strong risk factors for COVID-19 infection in this population of PWH in Middle Tennessee. Disclosures Vladimir Berthaud, MD MPH, GILEAD SCIENCES: Grant/Research Support|GSKVIIV: Grant/Research Support|MODERNA: Grant/Research Support|NOVAVAX: Grant/Research Support

P-180. Enhancing Mortality Surveillance: Insights from Excess Deaths Analysis during the COVID-19 Pandemic

Abstract Background The global repercussions of the COVID-19 pandemic extend beyond reported fatalities, imprinting a lasting effect on global health. The COVID-19 pandemic has presented substantial issues, encompassing not only direct infections but also excess mortality. The death rates in the Federation of Bosnia and Herzegovina (FB&amp;H) have been significantly affected by the pandemic, leading to a need for a thorough analysis of the elements that contribute to this phenomenon. Mortality in Federation of Bosnia and Herzegovina age 15 - 44 Methods The objective of this study was to quantitatively assess the rise in overall excess mortality rates in the FB&amp;H region for the years 2020, 2021, and 2022. We employed data from the FB&amp;H mortality record, along with population statistics and official COVID-19 death counts, to emphasize the often underestimated number of deaths. Our objective was to offer a thorough comprehension of the actual scale of the pandemic. Mortality in Federation of Bosnia and Herzegovina age above 65 Results During the initial three years of the pandemic, FB&amp;H encountered three separate instances of heightened mortality from any cause, accounting for 18 % of the overall excess mortality during the period of 2020–2022. The biggest burden was recorded among adults aged 45–74, with 22.4% falling within the 45–64 age group, 22.1% within the 65–74 age group, and 19.4% within the 75–84 age group. Children under 15 years old did not exhibit any excess mortality. Conclusion COVID-19-related mortality in FB&amp;H are significantly underreported, especially among younger persons. This statement highlights the pressing necessity to enhance civil registration and vital statistics, while pushing for the implementation of comprehensive surveillance systems for all causes of mortality. These measures are of utmost importance in improving the surveillance of forthcoming pandemics and effectively addressing other significant public health occurrences. Disclosures Sinisa Skocibusic, Medicopharmacia: Travel grant to ECCMIDs

COVID-19 and Myocarditis: Pathogenetic Mechanisms and Histological Features

The COVID-19 pandemic has highlighted several cardiovascular complications, including myocarditis, which can be a significant cause of sudden cardiac death in young people. SARS-CoV-2 infection can cause cardiac muscle inflammation through direct mechanisms, such as viral invasion of myocardial cells, and indirect mechanisms, such as the systemic inflammatory response. Myocarditis can lead to life-threatening electrical dysfunctions and arrhythmias. Although post-infection myocarditis is more common, rare cases of post-vaccination myocarditis have also been reported, especially with mRNA vaccines. However, these post-vaccination cases tend to be mild and self-limiting, with a good response to treatment. Despite the associated risks, the benefits of vaccination far outweigh the risks, significantly reducing the incidence and severity of COVID-19 infections and related heart complications. It is crucial to continue surveillance and research to better understand the association between COVID-19, myocarditis and sudden cardiac death in the young and improve prevention and intervention strategies. In this literature review, we analyzed the pathogenetic mechanisms and histological features of myocarditis associated with COVID-19 and its vaccination, and focused on the correlation with sudden cardiac death.

Disparities in COVID-19 Cases, Deaths, and Vaccination, by Race and Ethnicity and Asian Ethnic Groups, Santa Clara County, California, 2020-2021.

Disaggregated data on Asian ethnic groups are needed to identify health disparities among Asian people. We examined COVID-19 incidence, deaths, and vaccinations among Asian ethnic groups in Santa Clara County, California. We extracted data on SARS-CoV-2 infections and COVID-19 vaccinations from December 15, 2020, through August 6, 2021, from the California Reportable Diseases Information Exchange and the California Immunization Registry. We assigned Asian ethnic group based on name for missing self-reported information. We calculated age-adjusted rates and rate ratios of infections and deaths and percentages of vaccinations by race and ethnicity and Asian ethnic group. We conducted multivariable logistic regression to examine factors associated with COVID-19 deaths. Although Asian residents had the lowest rate of SARS-CoV-2 infections per 100 000 people (1801.9; 95% CI, 1771.5-1832.7) among all racial and ethnic groups, when disaggregated by Asian ethnicity, Filipino (3169.0; 95% CI, 3049.1-3292.4) and Vietnamese (3008.4; 95% CI, 2916.9-3102.1) residents had the highest age-adjusted rates. Asian (38.7; 95% CI, 33.7-44.3) and non-Hispanic White (42.3; 95% CI, 37.5-47.5) residents had the lowest rate of COVID-19 deaths compared with all other racial and ethnic groups; however, Filipino (67.6; 95% CI, 49.1-90.8) and Vietnamese (63.7; 97% CI, 48.9-81.6) residents had significantly higher rates than the aforementioned groups did. Among all racial and ethnic groups, Asian residents had the highest completion rate of primary COVID-19 vaccine series by August 6, 2021 (87.0%; 95% CI, 86.8%-87.3%). Within Asian ethnic groups, Filipino residents had the lowest vaccination rate (65.0%; 95% CI, 64.4%-65.6%). Differences in COVID-19 incidence, deaths, and vaccinations among Asian ethnic groups highlight the importance of data collection of ethnic groups as a standard practice.

The association of the four social vulnerability themes and COVID-19 mortality rates in U.S. Counties

ABSTRACT The purpose of this study was to examine the relationship between social vulnerability and COVID-19 mortality rates during the whole outbreak in U.S. counties. COVID-19 deaths were gleaned from the USA Facts. Independent variables were gleaned from the CDC’s Social Vulnerability Index. Spatial autoregressive models were used for data analysis. Results show that counties with more social vulnerability (socioeconomic) were positively associated with higher COVID-19 mortality rates. Counties with more social vulnerability (household composition & disability) were positively associated with higher COVID-19 mortality rates. Counties with more social vulnerability (minority status & language) were negatively associated with higher COVID-19 mortality rates. Counties with more social vulnerability (housing type & transportation) were negatively associated with higher COVID-19 mortality rates. In conclusion, county-level social vulnerability provides an useful framework for identifying unequal distribution of deaths from COVID-19 in the United States.

Role of regular medical visits in mitigating increased suicide risk during the early COVID-19 pandemic in Kobe, Japan

BackgroundJapan has one of the lowest COVID-19 death rates, while the annual suicide rate in 2020 has risen for the first time since 2007. This study aimed to identify high-risk populations and assess the impact of medical visits on suicide trends post-COVID-19 pandemic in Japan.MethodThis quasi-experimental study analyzed a population-based database from Hyogo Prefecture (2012–2022). Interrupted time-series analyses identified level and trend changes in monthly suicide rates per 1 million population during the exposure period (2020–2022) versus the control period (2012–2019). Regular visits to primary care and psychiatry stratified analysis.Results2181 cases were analyzed, with two-thirds male and a median age of 54. Primary care physicians and psychiatric history were present in 69% and 40% of patients. The study found significant level changes in suicide rates overall (4.14, 95% CI: 1.70, 6.58) among individuals without regular primary care physician visits (2.83, 95% CI: 1.35, 4.32) and without psychiatric visits (2.85, 95% CI: 0.56, 5.14). In contrast, no significant changes were observed in individuals with regular primary care (0.99, 95% CI: -0.78, 2.76) or regular psychiatric visits (0.59, 95% CI: -0.98, 2.16). The trend changes were not significant in any of the groups.ConclusionThis study suggests that a history of attending a medical institution may have prevented the rapid increase in suicides during the early stages of the COVID-19 pandemic.

Population Attributable Fraction of Non-Vaccination and Under-Vaccination of COVID-19 Due to Vaccine Hesitancy, 2022.

Non-vaccination and under-vaccination with the COVID-19 vaccine may be attributed to multifaceted barriers including hesitancy and access issues. Using data from the CDC's Research and Development Survey, a nationally representative survey fielded from November 3, 2022 - December 12, 2022 (n=6,821), we examined the adjusted population attribution fraction (PAF) of COVID-19 non-vaccination and under-vaccination attributed to vaccine hesitancy by sociodemographic characteristics. Overall, the adjusted PAF of non-vaccination attributed to vaccine hesitancy was 84.8%, and the adjusted PAF of under-vaccination attributed to vaccine hesitancy decreased with increasing COVID-19 vaccine doses (76.0%, 41.0%, and 16.9% for ≥2, ≥3, and ≥4 doses, respectively). The proportion of adults who considered the social benefit of the vaccine, risk of contracting COVID-19, and information received from a medical provider increased with greater number of COVID-19 vaccine doses received. In contrast, the proportion of adults who were concerned about long-term impacts, speed of vaccine development and personal risk of getting vaccinated decreased with greater number of COVID-19 vaccine doses received. Understanding the PAF estimates from the acute phase of the pandemic serves as an important comparison for post-pandemic vaccination estimates, and is needed for messaging as COVID-19 cases, hospitalizations, and deaths resurge in the fall of 2024.

Attendance of Underserved Populations at Field-Based Health Services Events: Application of Quasi-Experimental Methods that Accommodate the COVID-19 Pandemic.

The COVID-19 pandemic disrupted the ability to receive health care services. Field-based health services became a logistically feasible alternative to medical center-based care. We compared two different field-based approaches to the delivery of SARS-CoV-2 testing and health education services for Latine communities using a quasi-experimental design that included propensity score matching to accommodate the challenges posed to research by the pandemic. From September 2021 through October 2022, we held 434 testing events, of which 234 used a geolocation approach and 200 used a partner-located approach to determine the location of the health services (n = 68 field sites in Oregon). We hypothesized that partner-located sites would obtain higher numbers of tests collected relative to geolocated sites, and that longer drive times to testing sites would be associated with lower testing rates. There were no differences in the number of tests collected by geolocated versus partner-located sites, controlling for population size and time-varying pandemic vulnerabilities measured as COVID-19 cases and deaths. Prior to propensity score weighting, a longer drive time to the testing site (both site types) was associated with a lower likelihood of total tests (IRR = .87, p < .01, CI [0.54, 0.92]), of Latine tests (IRR = .69, p < .001, CI [0.56, 0.84]), and of male tests collected (IRR = .67, p < .05, CI [0.47, 0.94]). The site's number of prior tests was associated with a significant 2% increase in tests collected and the prior week's number of county deaths was associated with a roughly 30% decrease in the likelihood of tests collected. However, the reduced testing rate when the death rate was higher was less likely in geolocated sites (IRR = 1.55, p < .001, CI [1.20, 2.01]). Implications for the utility of propensity score matching and time-varying covariates to accommodate pandemic challenges posed to research are discussed. Clinicaltrials.gov registration number: NCT05082935. Date of registration: 10/15/2021.

Analysis of consular assistance provided to Irish citizens abroad, 2014-2023.

There has been limited literature reporting the nature of the consular assistance provided to travellers. This study aimed to describe the consular assistance activity of the Irish Department of Foreign Affairs. Publicly available consular assistance data (2014-2023) were analysed descriptively. Consular missions were listed under 16-19 categories. A total of 26,378 consular assistance missions were recorded. The greatest proportion of missions related to COVID-19 repatriations (26.9%, n=7097), deaths overseas (10%, n=2650), and medical illness/mental health emergency abroad (11.6%, n=3047). Forensic incidents (arrests/victims of crime) accounted for 12.9% (n=3392) of consular assistance episodes. This study highlights the characteristics and trends of consular assistance requests received by a national governmental agency. Future studies should explore traveller awareness of consular procedures and the extent to which they are addressed in travel medicine consultations.