Early COVID-19 Research Articles

Continued decline in the incidence of myocardial infarction beyond the COVID-19 pandemic: a nationwide study of the Swedish population aged 60 and older during 2015–2022

The number of myocardial infarctions declined during the early COVID-19 pandemic but mechanisms behind these declines are poorly understood. COVID-19 infection is also associated with an increased risk of myocardial infarction which could lead to higher incidence rates in the population. This study aims to shed light on the seemingly paradoxical relationship between COVID-19 and myocardial infarction occurrence on the population level by exploring long-term trends in incidence rates, case fatality, and proportion of patients dying before reaching a hospital. Our work is based on a linkage of administrative registers covering the entire population aged 60 + in Sweden. Considering both long-term trends since 2015 and seasonal variability, we compared observed incidence, case fatality, and proportions of patients hospitalized to expected values during 2020–2022. Despite more than 200 laboratory-confirmed COVID-19 cases per 1000 inhabitants by the end of 2022, incidence rates of myocardial infarction continued to decline, thus following the long-term trend observed already before 2020. During the first pandemic wave there was an additional incidence decline corresponding to 13% fewer myocardial infarctions than expected. This decline was neither accompanied by increasing case fatality nor by lower shares of patients being hospitalized. We found no increase in the population-level incidence of myocardial infarction despite large-scale exposure to COVID-19, which suggests that the effect of COVID-19 on myocardial infarction risk is not substantial. Increased pressure on the Swedish health care system has not led to increased risks or poorer outcomes for patients presenting with acute myocardial infarction.

Impact of financial support expansion on restaurant entries and exits during the COVID-19 pandemic

AbstractThis study examines the impact of an expansion of financial support to compensate for the business hour restrictions during the early COVID-19 pandemic on the entry of dine-in restaurants in the market. During this period, the local governments provided financial support to all restaurants to alleviate the urgent need for relief. This support was given regardless of their past performance, and it coincidentally provided an opportunity for new entrants that met certain criteria to receive support. Based on Japanese administrative data and a difference-in-differences estimation, our study shows that the expansion of financial support led to an increase in the number of dine-in restaurants. We also observed that the impact is more significant in areas with lower opening and operating costs, but it does not vary based on an index of potential sales. These results confirm that indiscriminate reduction of entry barriers could lead to the entry of less profitable and marginal new firms. Moreover, financial support led to a decrease in restaurant exits, especially of low-productive ones.

Public engagement through public service advertisements for health care awareness during early COVID-19 in Pakistan

The way information disseminated in the early period of COVID-19 led the world to confusion and an unprecedented public health crisis. This paper examines the relationships between public engagement through public service advertisements (PSA) and the effectiveness of health care awareness during early COVID-19. To explore such a relationship and mainly public perceptions, we conducted a very early survey (n = 200) using an online convenience sampling procedure with different age groups in Sahiwal, Pakistan. Data were analyzed using the PLS-SEM software to measure such a relationship. We find that PSA were perceived as a vital platform, which has an impact on public perceptions towards taking precautionary measures during the early pandemic. Importantly, PSA have a strong impact on spreading health awareness in Pakistan. Policymakers and health care professionals should grasp and acknowledge the significance of media content influence to enhance health awareness including the role of PSAs in health care. This comprehension may motivate the adoption of practices and policies in the health sector, contributing to the known ‘new normal’, ensuring their continuity even beyond the COVID-19 era.

Training strategies of 10,074 athletes from 121 countries based on human development index in early COVID-19 lockdown

The aim of this study was to investigate relationships between changes in training practices and human development index (HDI) levels, and identify strategies employed by athletes who consistently maintained their training quantity during the first 100 days of the COVID-19 pandemic. A total of 10,074 athletes (5290 amateur and 4787 professional athletes from 121 countries) completed an online survey between 17 May to 5 July 2020. We explored their training practices, including specific questions on training frequency, duration and quantity before and during lockdown (March–June 2020), stratified according to the human development index (HDI): low-medium, high, or very high HDI. During the COVID-19 lockdown, athletes in low-medium HDI countries focused on innovative training. Nevertheless, women and amateur athletes experienced a substantial reduction in training activity. Performance-driven athletes and athletes from higher HDI indexed countries, were likely to have more opportunities to diversify training activities during lockdowns, facilitated by the flexibility to perform training away from home. Factors such as lockdown rules, socioeconomic environment, and training education limited training diversification and approaches, particularly in low-medium and high HDI countries. Athletes (amateurs and professionals) who maintained the quantity of training during lockdown appeared to prioritize basic cardiovascular and strength training, irrespective of HDI level. Modifying training and fitness programs may help mitigate the decrease in training activities during lockdowns. Customized training prescriptions based on gender, performance, and HDI level will assist individuals to effectively perform and maintain training activities during lockdowns, or other challenging (lockdown-like) situations.

Fair or biased? A corpus-based study of Australia’s early COVID-19 media representation of China

ABSTRACT Given the surge in xenophobia faced by Chinese communities during the pandemic, there is a pressing need to delve into the concealed ideologies within public discourse that fuel discrimination. Against this backdrop, this study employs Critical Discourse Analysis and Corpus Linguistics to scrutinise the discursive construction and communication of China’s image in Australian print media during the early outbreak of COVID-19. The analysis uncovered recurrent negative depictions of the Chinese government, associating it with authoritarianism and responsibility for the pandemic. In the context of blame attribution and racialisation of COVID-19 terms, a counter-narrative was observed in Australian newspapers, reflecting journalistic efforts to present a balanced perception of China and to challenge the prevailing racialisation and discrimination. Furthermore, the study revealed Australian media’s focus on economic consequences over human losses during the early outbreak of this pandemic. That underscores China’s role as Australia’s indispensable economic partner. This research contends that the depiction of China in Australian news discourses during the COVID-19 pandemic is intertwined with historical tensions, bilateral relations, and journalistic efforts to counter prevailing biases.

Inhaled beclomethasone in the treatment of early COVID-19: a phase 2, double-blind, placebo-controlled, randomised trial

Inhaled beclomethasone in the treatment of early COVID-19: a phase 2, double-blind, placebo-controlled, randomised trial

COVID-19 critical care triage across Canada: a narrative synthesis and ethical analysis of early provincial triage protocols.

The COVID-19 pandemic created conditions of scarcity that led many provinces within Canada to develop triage protocols for critical care resources. In this study, we sought to undertake a narrative synthesis and ethical analysis of early provincial pandemic triage protocols. We collected provincial triage protocols through personal correspondence with academic and political stakeholders between June and August 2020. Protocol data were extracted independently by two researchers and compared for accuracy and agreement. We separated data into three categories for comparative content analysis: protocol development, ethical framework, and protocol content. Our ethical analysis was informed by a procedural justice framework. We obtained a total of eight provincial triage protocols. Protocols were similar in content, although age, physiologic scores, and functional status were variably incorporated. Most protocols were developed through a multidisciplinary, expert-driven, consensus process, and many were informed by influenza pandemic guidelines previously developed in Ontario. All protocols employed tiered morality-focused exclusion criteria to determine scarce resource allocation at the level of regional health care systems. None included a public engagement phase, although targeted consultation with public advocacy groups and relevant stakeholders was undertaken in select provinces. Most protocols were not publicly available in 2020. Early provincial COVID-19 triage protocols were developed by dedicated expert committees under challenging circumstances. Nonetheless, few were publicly available, and public consultation was limited. No protocols were ever implemented, including during periods of extreme critical care surge. A national approach to pandemic triage that incorporates additional aspects of procedural justice should be considered in preparation for future pandemics.

Impact of the COVID-19 Pandemic on Blood Lead Testing in Children in the United States.

The study objective was to evaluate the impact of the coronavirus disease (COVID-19) pandemic on pediatric blood lead testing in the United States. Clinical laboratory pediatric (ages <6 years) blood lead level (BLL) tests performed by Quest Diagnostics, January 2019-March 2022, were analyzed. Patients were categorized by age, by sex, and, through matching by ZIP code with US Census data, for race, ethnicity, pre-1950 housing, and poverty estimates. Over 2.8 million results from children (<6 years old) from all 50 states and the District of Columbia were included. Compared to March-May 2019, BLL testing was lower by 53.6% in March-May 2020 and lower by 14.6% in March-May 2021. Testing rebounded more for children in predominantly White non-Hispanic communities and among children living in communities, based on ZIP codes, with the least pre-1950 housing stock and lowest poverty rates. The proportion of children with BLL at or above the United States Centers for Disease Control and Prevention reference values of 3.5 and 5.0 µg/dL fell by 19% and 24%, respectively, in 2021 versus 2019. In conclusion, pediatric BLL testing has rebounded from sharp declines during the early pandemic period but unevenly. Declines in the proportion of children with elevated BLL should be interpreted with caution, as testing rebounds were less robust among communities with the highest risk of lead poisoning, notably communities with the oldest housing stock and higher poverty rates. More public health efforts are needed to address lead toxicity throughout the United States, especially in communities that did not experience a full rebound subsequent to the early COVID-19 pandemic period.

Use of artificial intelligence to develop predictive algorithms of cough and PCR-confirmed COVID-19 infections based on inputs from clinical-grade wearable sensors

There have been over 769 million cases of COVID-19, and up to 50% of infected individuals are asymptomatic. The purpose of this study aimed to assess the use of a clinical-grade physiological wearable monitoring system, ANNE One, to develop an artificial intelligence algorithm for (1) cough detection and (2) early detection of COVID-19, through the retrospective analysis of prospectively collected physiological data from longitudinal wear of ANNE sensors in a multicenter single arm study of subjects at high risk for COVID-19 due to occupational or home exposures. The study employed a two-fold approach: cough detection algorithm development and COVID-19 detection algorithm development. For cough detection, healthy individuals wore an ANNE One chest sensor during scripted activity. The final performance of the algorithm achieved an F-1 score of 83.3% in twenty-seven healthy subjects during biomarker validation. In the COVID-19 detection algorithm, individuals at high-risk for developing COVID-19 because of recent exposures received ANNE One sensors and completed daily symptom surveys. An algorithm analyzing vital parameters (heart rate, respiratory rate, cough count, etc.) for early COVID-19 detection was developed. The COVID-19 detection algorithm exhibited a sensitivity of 0.47 and specificity of 0.72 for detecting COVID-19 in 325 individuals with recent exposures. Participants demonstrated high adherence (≥ 4 days of wear per week). ANNE One shows promise for detection of COVID-19. Inclusion of respiratory biomarkers (e.g., cough count) enhanced the algorithm's predictive ability. These findings highlight the potential value of wearable devices in early disease detection and monitoring.

A measles-vectored vaccine candidate expressing prefusion-stabilized SARS-CoV-2 spike protein brought to phase I/II clinical trials: candidate selection in a preclinical murine model.

In the early COVID-19 pandemic with urgent need for countermeasures, we aimed at developing a replicating viral vaccine using the highly efficacious measles vaccine as vector, a promising technology with prior clinical proof of concept. Building on our successful pre-clinical development of a measles virus (MV)-based vaccine candidate against the related SARS-CoV, we evaluated several recombinant MV expressing codon-optimized SARS-CoV-2 spike glycoprotein. Candidate V591 expressing a prefusion-stabilized spike through introduction of two proline residues in HR1 hinge loop, together with deleted S1/S2 furin cleavage site and additional inactivation of the endoplasmic reticulum retrieval signal, was the most potent in eliciting neutralizing antibodies in mice. After single immunization, V591 induced similar neutralization titers as observed in sera of convalescent patients. The cellular immune response was confirmed to be Th1 skewed. V591 conferred long-lasting protection against SARS-CoV-2 challenge in a murine model with marked decrease in viral RNA load, absence of detectable infectious virus loads, and reduced lesions in the lungs. V591 was furthermore efficacious in an established non-human primate model of disease (see companion article [S. Nambulli, N. Escriou, L. J. Rennick, M. J. Demers, N. L. Tilston-Lunel et al., J Virol 98:e01762-23, 2024, https://doi.org/10.1128/jvi.01762-23]). Thus, V591 was taken forward into phase I/II clinical trials in August 2020. Unexpected low immunogenicity in humans (O. Launay, C. Artaud, M. Lachâtre, M. Ait-Ahmed, J. Klein et al., eBioMedicine 75:103810, 2022, https://doi.org/10.1016/j.ebiom.2021.103810) revealed that the underlying mechanisms for resistance or sensitivity to pre-existing anti-measles immunity are not yet understood. Different hypotheses are discussed here, which will be important to investigate for further development of the measles-vectored vaccine platform.IMPORTANCESARS-CoV-2 emerged at the end of 2019 and rapidly spread worldwide causing the COVID-19 pandemic that urgently called for vaccines. We developed a vaccine candidate using the highly efficacious measles vaccine as vector, a technology which has proved highly promising in clinical trials for other pathogens. We report here and in the companion article by Nambulli et al. (J Virol 98:e01762-23, 2024, https://doi.org/10.1128/jvi.01762-23) the design, selection, and preclinical efficacy of the V591 vaccine candidate that was moved into clinical development in August 2020, 7 months after the identification of SARS-CoV-2 in Wuhan. These unique in-human trials of a measles vector-based COVID-19 vaccine revealed insufficient immunogenicity, which may be the consequence of previous exposure to the pediatric measles vaccine. The three studies together in mice, primates, and humans provide a unique insight into the measles-vectored vaccine platform, raising potential limitations of surrogate preclinical models and calling for further refinement of the platform.

Program Director Reports of COVID-19 Lockdown-Driven Service Changes in Community-Based STI Clinics and Syringe Services Programs in the Southeastern U.S.

The COVID-19 pandemic strained the U.S. health care system, posing logistical challenges for community-based programs. This study surveyed 11 program directors in sexually transmitted infection (STI) clinics and syringe services programs (SSPs) that served people who use substances and are at risk for HIV in five southeastern U.S. states. Brief survey questions asked about programs' use of in-person and telehealth services. Results indicated widespread reduction of in-person services and concomitant adoption of telehealth services. In STI clinics, telehealth replaced in-person visits for all but urgent treatment of active symptoms. In SSPs, in-person contact continued or increased from pre-pandemic volumes. In both programs, the most salient telehealth use barrier was limited device or internet access and limited technological ease. Services were sustained through innovative adaptations. This snapshot of response to the early COVID-19 lockdown phase offers actionable guidance about service preparedness for future public health catastrophes in community-based programs serving vulnerable populations.

Investigation on the relationship between serum periostin, MMP-7, TGF-β, and IL-18 levels and the clinical course and prognosis of COVID-19.

Cytokines are involved in the inflammatory/anti-inflammatory balance and have been shown to play an important role in the course of COVID-19. This study aimed to evaluate the relationship of periostin, transforming growth factor-beta (TGF-β), interleukin-18 (IL-18), and matrix metalloproteinase 7 (MMP-7) levels with clinical course and mortality in patients with early COVID-19 pneumonia. A total of 150 hospitalized patients were diagnosed with COVID-19 between June and October 2021, and a control group of 30 healthy individuals were included in our study. The COVID-19 patients were divided into those who developed macrophage activation syndrome (MAS) in Group 1 and those who did not in Group 2. Serum periostin, MMP-7, TGF-β, and IL-18 levels were measured from blood samples obtained at admission using enzyme-linked immunosorbent assay (ELISA). Periostin, MMP-7, and IL-18 levels were significantly higher in COVID-19 patients compared to the control group (p<0.001 for all). Periostin and MMP-7 levels were also significantly higher in Group 1 than in Group 2 (p<0.001 for both). Periostin, MMP-7, IL-18, and TGF-β levels were significantly higher in non-surviving patients compared to survivors (p=0.04, p<0.001, p<0.001, and p<0.001, respectively). In the receiver operating characteristic (ROC) curve analysis, MMP-7 was found to have high sensitivity (90%) at a predictive value of 2.66 ng/mL. It is still not possible to predict which patients with early COVID-19 pneumonia will go on to develop MAS despite receiving standard treatment. The results of our study suggest that elevation of periostin and MMP-7 levels in the early period may predict the development of macrophage activation syndrome.

Comparative effectiveness of sotrovimab versus no treatment in non-hospitalised high-risk COVID-19 patients in north west London: a retrospective cohort study

BackgroundWe assessed the effectiveness of sotrovimab vs no early COVID-19 treatment in highest-risk COVID-19 patients during Omicron predominance.MethodsRetrospective cohort study using the Discover dataset in North West London. Included patients...

Role of Agriculture on Rural Household Food Security: A Systematic Review from Indonesia

Rural areas are crucial for agriculture in Indonesia, particularly in local rice production. However, many rural communities face challenges accessing safe and nutritious food due to limited transportation infrastructure, restricted local markets, and low incomes. The COVID-19 pandemic exacerbated these issues by disrupting food supply chains and worsening food insecurity. This systematic review examines how local food production, including agriculture, contributed to food security in early COVID-19 rural Indonesia following the PRISMA procedure. The author uses five databases including, EBSCO Host, ScienceDirect, Taylor & Francis, Wiley, and GARUDA. Search using keywords food security, access, local production, rural, agriculture, pandemic COVID-19, and Indonesia. Fifteen studies showed most rural communities faced food insecurity at the start of the pandemic due to lockdowns and higher non-household expenses. Nevertheless, some villages remained food secure, relying on local agriculture and plantations. The findings of this review can provide valuable direction for implementing focused mitigation plans in particular areas to reduce the effects of the ongoing COVID-19 pandemic and future global events on rural food security.

Impact of the early COVID-19 pandemic on adult mental health-related dispensed medications, hospitalizations and specialist outpatient visits in Norway and Sweden: Interrupted time series analysis.

Norway and Sweden had different early pandemic responses that may have impacted mental health management. The aim was to assess the impact of the early COVID-19 pandemic on mental health-related care. We used national registries in Norway and Sweden (1 January 2018-31 December 2020) to define 2 cohorts: (i) general adult population; and (ii) mental health adult population. Interrupted times series regression analyses evaluated step and slope changes compared to prepandemic levels for monthly rates of medications (antidepressants, antipsychotics, anxiolytics, hypnotics/sedatives, lithium, opioid analgesics, psychostimulants), hospitalizations (for anxiety, bipolar, depressive/mood, eating and schizophrenia/delusional disorders) and specialist outpatient visits. In Norway, immediate reductions occurred in the general population for medications (-12% antidepressants to -7% hypnotics/sedatives) except for antipsychotics; and hospitalizations (-33% anxiety disorders to -17% bipolar disorders). Increasing slope change occurred for all medications except psychostimulants (+1.1%/month hypnotics/sedatives to +1.7%/month antidepressants); and hospitalization for anxiety disorders (+5.5%/month), depressive/mood disorders (+1.7%/month) and schizophrenia/delusional disorders (+2%/month). In Sweden, immediate reductions occurred for antidepressants (-7%) and opioids (-10%) and depressive/mood disorder hospitalizations (-11%) only with increasing slope change in psychostimulant prescribing of (0.9%/month). In contrast to Norway, increasing slope changes occurred in specialist outpatient visits for depressive/mood disorders, eating disorders and schizophrenia/delusional disorders (+1.5, +1.9 and +2.3%/month, respectively). Similar changes occurred in the pre-existing mental health cohorts. Differences in early COVID-19 policy response may have contributed to differences in adult mental healthcare provision in Norway and Sweden.

Phase II Trial of the Impact 0.5% Povidone-Iodine Nasal Spray (Nasodine®) on Shedding of SARS-CoV-2.

A Phase II trial was conducted to determine if nasal disinfection with a commercial Good Manufacturing Practice-manufactured 0.5% povidone-iodine nasal spray (Nasodine®) may be a useful adjunct in the management of COVID-19 by reducing viral shedding and prevention of transmission of SARS-CoV-2. The aim was to confirm the results from a human single-dose pilot study by assessing repeated and frequent doses on nasal shedding of SARS-CoV-2 from adult subjects with confirmed COVID-19. A multicenter, randomized, double-blinded, placebo-controlled Phase II clinical trial involving adults with early COVID-19 symptoms. Baseline nasal swabs were collected to quantify pretreatment SARS-CoV-2 nasal viral load, followed by Nasodine treatment eight times daily over 3 calendar days. Daily nasal swabs were collected post-dose to assess the impact of treatment on nasal viral load, measured by log10 TCID50 in quantitative culture. Nasodine subjects exhibited significantly improved reduction in viral load (log10 TCID50) on Days 2-4 compared to placebo recipients (p = 0.028), rate of nasal clearance of viable virus (p = 0.032), and complete (100%) nasal and throat clearance of the virus by Day 5. No difference was seen in antigen shedding as measured by time transition from Rapid Antigen Test (RAT) positivity to RAT negativity. A total of 20 doses of Nasodine® nasal spray administered over 2.5 days significantly reduced the titers of viable SARS-CoV-2 virus in the nasal passages of COVID-19 subjects. This is the first study demonstrating the efficacy of a tolerable intranasal formulation of povidone-iodine on viral shedding in COVID-19 subjects. Nasal disinfection may diminish viral transmission to others. 2 Laryngoscope, 134:3947-3952, 2024.

Correction to “An Exploration of Journals Requested by Health Sciences Libraries through DOCLINE Interlibrary Loan During the Early COVID-19 Pandemic”

In the article “An exploration of journals requested by health sciences libraries through DOCLINE interlibrary loan during the early COVID-19 pandemic” by Caitlin J. Bakker, Jessica A. Koos, Margaret A. Hoogland, Debra Rand, and Kristine M. Alpi (ISTL issue no. 103), there was one error in Table 1 and three errors in Table 4.

Correction to “An Exploration of Journals Requested by Health Sciences Libraries through DOCLINE Interlibrary Loan During the Early COVID-19 Pandemic”

In the article “An exploration of journals requested by health sciences libraries through DOCLINE interlibrary loan during the early COVID-19 pandemic” by Caitlin J. Bakker, Jessica A. Koos, Margaret A. Hoogland, Debra Rand, and Kristine M. Alpi (ISTL issue no. 103), there was one error in Table 1 and three errors in Table 4.

Predicting COVID-19 Cough Sounds Using Spectrogram Analysis Across Multiple Classes

The COVID-19 pandemic has underscored the need for effective diagnostic tools. One promising avenue involves analyzing cough sounds to glean insights into respiratory health. This study presents a new method for predicting COVID-19 cough sounds using spectrogram analysis across various classes. We leverage advanced deep learning models such as DenseNet121, VGG16, ResNet50, and Inception Net, alongside our novel CNN architecture, to extract pertinent features from cough sound spectrograms. We use a diverse dataset encompassing cough sounds from COVID-19 positive and negative cases, as well as other respiratory conditions, for model training and assessment. Our results demonstrate the effectiveness of our approach in accurately categorizing COVID-19 cough sounds, outperforming existing models. This methodology shows promise as a non-invasive, scalable, and economical tool for early COVID-19 detection and monitoring, aiding public health efforts during the pandemic.

Coronaphobia or sinophobia: How journalistic practices in early COVID-19 coverage and online commentary affect anti-Chinese sentiment in the U.S.

Historically, pandemics have spurred an influx of disorganized information and escalated intergroup animosity, and COVID-19 is no exception. Pandemic reporting often features cues and testimonials to mark the distinction between “us” versus “them”; however, the influence of such journalistic practices on intergroup animosity remains largely unexplored during public health crises, let alone their potential interplay with ubiquitous user-generated comments that often accompany pandemic news stories in the digital era. We conducted an online survey experiment with a sample of U.S. participants ( N = 1428) during the early phase of the COVID-19 pandemic, systematically varying the presence of stigmatizing outgroup cues, testimonials from in-versus outgroups, and social media comments either predominantly endorsing or condemning xenophobia. Our findings reveal that stigmatizing outgroup cues amplified the effects of testimonials detailing ingroup suffering, thus heightening anti-Chinese sentiment. These results underscore the importance of evaluating the implications of journalistic practices in public health reporting on intergroup dynamics and social solidarity. Additionally, we found that online comments predominantly condemning xenophobia moderated the effects of ingroup testimonials in the direction of inducing more positive sentiments, highlighting the vital role of an engaged audience in moderating the influences of public health news coverage.