High Risk For Serious Illness Research Articles

Surveillance of Infections and Antibiotic Use in 21 Nursing Home Wards during the COVID-19 Pandemic: A Systematic Assessment.

Residents in nursing homes are fragile and at high risk of serious illness or death from healthcare-associated infections. The COVID-19 pandemic posed a significant risk of suffering and mortality for residents of nursing homes. Surveillance of infections is essential for infection prevention and is missing in many countries. The aim of this study is to explore infection rates and antibiotic use in nursing homes during the COVID-19 pandemic. Data collection was conducted from February to September 2021. Each week, healthcare workers at 21 nursing home wards answered a questionnaire on infections, antibiotic use, deaths, and hospital admissions related to infections. A total of 495 infections were reported, and 97.6% were treated with antibiotics. The total infection rate was 5.37 per 1000 bed days, and there were reported 53 hospital admissions and 11 deaths related to or caused by infections. The infection rate and high use of antibiotics found in this study indicated that it is difficult to treat infections in residents in nursing homes and make it difficult to achieve the global goal of reducing infections and antibiotic resistance rates. This emphasizes the need for stricter infection control programs to reduce antibiotic use and patient suffering.

Characteristics and Outcomes of COVID-19 Patients with Diabetes Mellitus at the University of Muhammadiyah Malang General Hospital

The number of confirmed cases of COVID-19 in East Java is 590,531 (9,41% of total national confirmed cases)\. The death toll in the province is 31,774. Diabetes Mellitus (DM) can cause systemic complications such that COVID-19 patients with DM have a high risk of serious illness and mortality. The characteristics and outcomes of COVID-19 patients with DM at the University of Muhammadiyah Malang General Hospital have never been reported before. Data were taken from medical records at the University of Muhammadiyah Malang General Hospital. The diagnosis of COVID-19 was obtained from a positive PCR swab. DM diagnosis was made by studying the patient history of DM or Random Blood Glucose (RBG) >200 mg/dL or HbA1c >7% sampling. Characteristics of the patients were age, gender, length of treatment, history of DM, and adherence to DM control. The supporting examinations were leukocytes, platelets, O2 saturation, RBG, HbA1c, CRP, and D-dimer, which were grouped into two groups: recovered and dead. Data were analyzed with the SPSS version 28. COVID-19 patients with DM from June 2020 to May 2021 were 206 (23.09%) out of 892 confirmed COVID-19. The majority of cases occurred in men (51.5%) and occurred in the age range of 51-60 years (38.3%). The number of patients who died was 38 (18.4%). The average platelet value was 286,191, the average leukocyte value was 7804, the average oxygen saturation was 90%, the average HbA1c value was 9.4%, the average CRP value was 68.99mg/L, and the average D-dimer value is 13,39ng/mL There was a significant difference in oxygen saturation and D-Dimer between recovered and dead patients. There were no significant differences in the results of other investigations.
 Keywords: COVID-19, DM, mortality, University of Muhammadiyah Malang General Hospital

Singing Interventions in Pulmonary Rehabilitation: A Scoping Review.

(1) Background: Individuals with pulmonary disease need intensive and consistent rehabilitation due to their high risk for serious illness and long-term complications. The purpose of this scoping review was to provide a comprehensive analysis of relevant research regarding the use of singing in pulmonary rehabilitation. (2) Methods: A systematic literature search was performed using the PsycINFO, CINAHL, PubMed, and Web of Science databases. A search for studies that employed singing in pulmonary rehabilitation for patients with pulmonary disease was conducted. (3) Results: Studies that met the selection criteria were summarized and analyzed. Twenty-seven studies were included in the final analysis. Results showed that research using singing in pulmonary rehabilitation generally employed an intervention with structured tasks and additional home practice or socialization time. However, the singing procedure in each intervention was not always specifically described and the findings were inconsistent. (4) Conclusions: Programmed singing interventions can support lung health and be an effective component of pulmonary rehabilitation. The therapeutic singing method in relation to respiratory exercises should be integrated into the main activity in the intervention. Overall, singing has physical and psychosocial effects, leading to improvements in symptoms, but more research is necessary to ensure that the respiratory needs of people with pulmonary disease are adequately met.

Severe COVID-19 outcomes after full vaccination of primary schedule and initial boosters: pooled analysis of national prospective cohort studies of 30 million individuals in England, Northern Ireland, Scotland, and Wales

BackgroundCurrent UK vaccination policy is to offer future COVID-19 booster doses to individuals at high risk of serious illness from COVID-19, but it is still uncertain which groups of the population could benefit most. In response to an urgent request from the UK Joint Committee on Vaccination and Immunisation, we aimed to identify risk factors for severe COVID-19 outcomes (ie, COVID-19-related hospitalisation or death) in individuals who had completed their primary COVID-19 vaccination schedule and had received the first booster vaccine.MethodsWe constructed prospective cohorts across all four UK nations through linkages of primary care, RT-PCR testing, vaccination, hospitalisation, and mortality data on 30 million people. We included individuals who received primary vaccine doses of BNT162b2 (tozinameran; Pfizer–BioNTech) or ChAdOx1 nCoV-19 (Oxford–AstraZeneca) vaccines in our initial analyses. We then restricted analyses to those given a BNT162b2 or mRNA-1273 (elasomeran; Moderna) booster and had a severe COVID-19 outcome between Dec 20, 2021, and Feb 28, 2022 (when the omicron (B.1.1.529) variant was dominant). We fitted time-dependent Poisson regression models and calculated adjusted rate ratios (aRRs) and 95% CIs for the associations between risk factors and COVID-19-related hospitalisation or death. We adjusted for a range of potential covariates, including age, sex, comorbidities, and previous SARS-CoV-2 infection. Stratified analyses were conducted by vaccine type. We then did pooled analyses across UK nations using fixed-effect meta-analyses.FindingsBetween Dec 8, 2020, and Feb 28, 2022, 16 208 600 individuals completed their primary vaccine schedule and 13 836 390 individuals received a booster dose. Between Dec 20, 2021, and Feb 28, 2022, 59 510 (0·4%) of the primary vaccine group and 26 100 (0·2%) of those who received their booster had severe COVID-19 outcomes. The risk of severe COVID-19 outcomes reduced after receiving the booster (rate change: 8·8 events per 1000 person-years to 7·6 events per 1000 person-years). Older adults (≥80 years vs 18–49 years; aRR 3·60 [95% CI 3·45–3·75]), those with comorbidities (≥5 comorbidities vs none; 9·51 [9·07–9·97]), being male (male vs female; 1·23 [1·20–1·26]), and those with certain underlying health conditions—in particular, individuals receiving immunosuppressants (yes vs no; 5·80 [5·53–6·09])—and those with chronic kidney disease (stage 5 vs no; 3·71 [2·90–4·74]) remained at high risk despite the initial booster. Individuals with a history of COVID-19 infection were at reduced risk (infected ≥9 months before booster dose vs no previous infection; aRR 0·41 [95% CI 0·29–0·58]).InterpretationOlder people, those with multimorbidity, and those with specific underlying health conditions remain at increased risk of COVID-19 hospitalisation and death after the initial vaccine booster and should, therefore, be prioritised for additional boosters, including novel optimised versions, and the increasing array of COVID-19 therapeutics.FundingNational Core Studies–Immunity, UK Research and Innovation (Medical Research Council), Health Data Research UK, the Scottish Government, and the University of Edinburgh.

Prevalence of chronic conditions and influenza vaccination coverage rates in Germany: Results of a health insurance claims data analysis.

The significant annual burden caused by seasonal influenza has led to global calls for increased influenza vaccination coverage rates (VCRs). We aimed to estimate the proportion of the German population at high risk of serious illness from influenza due to chronic conditions and to estimate age-specific VCRs of people with/without chronic conditions. Using health insurance claims data covering nine influenza seasons (2010-2019), we assessed up to 7 million insured individuals per season across all German regions. Individuals were classified according to age and presence of chronic health conditions. VCRs were estimated using outpatient healthcare utilization documentation. In the 2018-2019 influenza season, 47.3% of individuals had ≥1 chronic condition. Most common were circulatory disorders, accounting for more than a third of individuals with ≥1 condition. Prevalence of chronic diseases, and therefore the proportion of high-risk individuals, increased slightly over time across most age groups. A downward trend in influenza VCRs was observed in all age groups until the 2017-2018 season, followed by a noticeable increase in the 2018-2019 season. Highest VCRs occurred among individuals of ≥60 years, with a 38.5% VCR for this age group in the 2018-2019 season. Several factors, including age, chronic condition type, and geographical location, affected VCRs. Influenza VCRs in individuals at high risk of severe complications from influenza infection are insufficient. Our results suggest that intensified public health efforts are necessary to reach the World Health Organization vaccination coverage target of 75%.

Telerehabilitation of Post-Stroke Patients with Motor Function Disorders: A Review

Stroke is the main reason for disabilities of increasing geriatric population. It affects brain and motor function domains significantly reducing the life quality. Recent coronavirus pandemic raised a question on changing approaches to deliver post-stroke rehabilitation services to geriatric patients due to their high risk of serious illness. This paper presents an overview of current telerehabilitation approaches for motor function recovery and balance training of post-stroke patients. We used papers from peer-reviewed medical journals on stroke telerehabilitation. The review showed exergames, virtual reality (VR), web-platforms, and applications are extensively used in rehabilitation programs to gain clinical outcomes among geriatric stroke patients. Findings indicate telerehabilitation improves older patients’ functional ability via systematic training, positively affecting their life quality. The treatment therapy of older adults using telerehabilitation can be organized synchronously and asynchronously in home-based environment or in-clinic conditions. Telerehabilitation can be used as complementary therapy or as an alternative to conventional treatment. However, further research is required to test a variety of telerehabilitation systems using larger samples of post-stroke geriatric patients.

P16.32: COVID-19 Clinical Outcomes, Coinfection and Secondary Infections in Solid Organ Transplant Recipients

Introduction: The COVID-19 pandemic is still affecting the World. According to the Centers for Disease Control and Prevention, solid organ transplant (SOT) recipients are among those at high risk of serious illness from SARS-CoV-2. Because of the virus’s novelty, there is still a lack of information on topics such as how it behaves in immunocompromised hosts, how it affects immunosuppression, how it affects rejection, and whether it increases the incidence of opportunistic infections. In this study, we aimed to evaluate the clinical course of SOT recipients with COVID-19 over a one year follow-up period and to evaluate co- infections or secondary infections. Method: Data from SOT patients diagnosed with COVID-19 has been retrieved retrospectively from the hospital information management system since March 2020. Demographic characteristics, examinations during hospitalization and admissions to outpatient clinics after illness were screened in detail. Results: There were 53 SOT patients recorded. The median age was 49, the median time post-transplant was 11 years, thirty-four (71.7 %) were men. The kidney was the most frequently transplanted organ (75.5 %). Severe/critical COVID-19 was diagnosed within 11 (20.8%) patients. The most common symptoms were fever (49.1%) and cough (39.6%). Thirty-nine (73.6 %) of the patients were hospitalized. Among those 14 (26.4%) required mechanical ventilation, 8 (15%) required renal replacement therapy, and five (9.4%) died 7 days after diagnosis, 10 (18.8%) patients died 30 days after diagnosis. Co-infections occurred in 15 patients; there were six urinary tract infections, four bacteremia, two Cytomegalovirus (CMV), and one both with CMV and a urinary tract infection. During the follow-up, CMV and Aspergillosis were both detected in three patients, only CMV in one, only Aspergillosis in one, a healthcare-associated infection in one, and pancreatitis in one. All patients who developed CMV and/or aspergillosis had been given high dose steroid during their COVID-19 treatment. Two (3.7%) patients had acute rejection during this period. Conclusion: The impact of immunosuppression on COVID-19 disease severity remains unclear. We believe that high-dose steroid therapy aids SOT patients who develop opportunistic infections such as CMV and aspergillosis. According to some studies, high-dose steroid therapy used to treat COVID-19 can cause opportunistic infections. In our study, we believe that the mortality rates were high due to our patients’ long post-transplantation period and, as a result, their chronic immunosuppression status. Wide-range studies are required to assess the long-term outcomes including allograft rejection, co-infections and secondary infections in SOT patients.

SARS-CoV-2 Antibody Seroprevalence in Patients With Cancer on Systemic Antineoplastic Treatment in the First Wave of the COVID-19 Pandemic in Portugal.

At the time of the first wave of the COVID-19 pandemic, patients with cancer were considered to be at high risk of serious illness and had a higher exposure risk since they needed frequent and nondeferrable hospital visits. Serological tests were not routinely used, and seroprevalence in this population was unknown.A single-center, cross-sectional study was developed to determine the seroprevalence of anti-SARS-CoV-2 antibodies (Abs) in patients with cancer undergoing systemic antineoplastic treatment. One hundred patients were consecutively recruited in a two-week period (6th-20th May 2020), and serum samples were tested for the presence of immunoglobulin M (IgM) and immunoglobulin G (IgG) Abs directed against both spike (S) and nucleocapsid (N) SARS-CoV-2 proteins in two distinct time points (at recruitment and 4-8 weeks later). IgG-positive results were subject to confirmation, in the same serum sample, using two distinct assays.At the time of the first study visit, no patient had a previously confirmed diagnosis of COVID-19, one reported previous contact with a COVID-19 patient, and all had a baseline SARS-CoV-2-negative RT-PCR. Two patients tested positive for SARS-CoV-2 IgG in the first study visit, which was not confirmed in either of the two confirmatory assays. Seventy-two patients were tested at the second study visit, all with negative IgG tests. IgM was persistently positive at both study visits in one patient and was positive in another patient at the second study visit, both with negative RT-PCR and serum IgG. No patient tested positive for RT-PCR within the study timeframe.No evidence of prior or acute SARS-CoV-2 infection was documented in this cohort of patients with cancer undergoing systemic treatment, and no additional exposure risk was documented compared to general population seroprevalence studies. The study was inconclusive regarding the role of SARS-CoV-2 serology in patients with cancer in the early phase of the pandemic. This study did show that, with adherence to recommended preventive measures, it was safe to maintain systemic cancer therapy.

Blood biomarkers in early bacterial infection and sepsis diagnostics in feverish young children.

Background and objectives: While most feverish children have self-limiting diseases, 5-10% develop a serious and potentially life-threatening bacterial infection (BI). Due to potential risk, prompt recognition of BI and sepsis in the pediatric emergency department (PED) remains a clinical priority. The aim of the study was to evaluate the role of certain cytokines and chemokines separately and in combination with routine blood tests in early BI and sepsis diagnostics at PED. Materials and methods: We prospectively studied children younger than 5 presenting to the PED with fever lasting for under 12 hours with high risk for serious illness. Clinical data, routine blood analysis, and inflammatory cytokine and chemokine panels were evaluated for their diagnostic abilities. Two separate analyses were carried out on the patients' data: one contrasting BI and viral infection (VI) groups, the other comparing septic and non-septic patients. Results: The sample comprised 70 patients (40% with BI). IL-2 was found to be the most specific biomarker to identify BI with specificity of 100%. The best discriminative ability was demonstrated by combining IL-2, IL-6, CRP, WBC, and neutrophil count: AUC 0.942 (95% Cl 0.859-0.984). IL-10 exhibited a greater AUC (0.837. 95% CI: 0.730-0.915 p<0.05) than CRP (0.807. 95% CI: 0.695-0.895 p<0.05) when predicting sepsis and showed high specificity (98%) and moderate sensitivity (75%). Conclusions: IL-6 and IL-2 could increase the diagnostic ability of routine blood tests for predicting BI, as IL-10 raises specificity for recognizing sepsis in the early hours of disease onset.

Let them go! Compassionate release for disabled prisoners with chronic health conditions during the COVID-19 public health emergency

Inmates with disabilities are at high risk of serious illness and death from COVID-19 due to crowded and unsanitary conditions. The punishment for serious crimes is incarceration—not exposure to a dangerous, contagious virus. Prisoners have human rights, notwithstanding the loss of most of their civic rights. Critical Disability Studies draws attention to multiple and overlapping injustices and oppressions. Prisoners with disabilities often suffer from race and ethnic discrimination, poverty, trauma, multiple physical impairments, mental illness, and/or cognitive limitations. This essay calls for action to accelerate compassionate release of disabled inmates, many of whom are at high risk for COVID-19, and offers recommendations for improving conditions of confinement for disabled inmates who remain incarcerated.

#12: The Safety and antibody kinetics of COVID-19 Convalescent Plasma for the Treatment of Moderate to Severe Cases of SARS-CoV-2 Infection in Pediatric Patients

Abstract Introduction A novel Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the pathogen responsible for a serious, life threatening respiratory infection (COVID-19) initially reported in Wuhan, China which rapidly spread worldwide resulting in global pandemic. Multiple immunological and pharmacological therapies have been evaluated with variable results. Convalescent plasma has been used in previous outbreaks such as Influenza 1918 and 2009, Ebola, MERS and SARS with good efficacy and safety reported. There have been multiple large reports on the safety of COVID-19 convalescent plasma (CCP) for the treatment of this serious infection in the adults; controversy has ensued regarding its efficacy. Pediatric data on CCP use are limited. Methods We conducted a prospective, open label treatment trial using CCP (10 ml/kg up to 1 unit) for the treatment of COVID-19 in pediatric patients with moderate to severe disease or high risk for serious illness. Safety and antibody kinetics and outcome data were collected. Results Eighteen moderate to severe COVID19 pediatric patients were enrolled and received CCP early in their illness (median days of symptoms XX). We observed no infusion related adverse events, no hematological or metabolic adverse events were noted during the hospitalization and at 3 weeks after infusion follow up. Sixteen patients demonstrated significant clinical improvement by day seven post infusion, as measured by the WHO eight-category ordinal severity scale for COVID-19. Presence of SARS-COV-2 anti-nucleocapsid IgG was demonstrated in all CCP specimens, a significant increase in antibodies was demonstrated in CCP recipients 24 hours after receiving CCP. Sustained high levels of anti- SARS-COV-2 anti-nucleocapsid IgG was demonstrated at 7- and 21-days post-transfusion. A transient IgM response not associated with CCP was noted. Eleven (61.1%) patients were discharge to home by day 7 post CCP infusion. One patient remained on invasive ventilatory support 21 days after CCP infusion and was eventually discharged to an intermediate care facility, one patient died retrospectively confirmed to have been brain death before receiving CCP. Conclusion We conclude that CCP was well tolerated in pediatric patients. CCP resulted in rapid increase of antibodies and sustained levels 21 days after infusion suggesting that CCP did not interfere with patients own immune response. More data are necessary to establish efficacy of this intervention in children, but our patients clinical course suggests benefit of CCP. Pediatric patients with moderate to severe COVID-19 may benefit of CCP when used early in the course of illness in conjunction with other immunological or antiviral interventions as needed.

Japan\u2019s voluntary lockdown: further evidence based on age-specific mobile location data

Changes in people’s behavior during the COVID-19 pandemic can be regarded as the result of two types of effects: the “intervention effect” (changes resulting from government orders for people to change their behavior) and the “information effect” (voluntary changes in people’s behavior based on information about the pandemic). Using age-specific mobile location data, we examine how the intervention and information effects differ across age groups. Our main findings are as follows. First, the age profile of the intervention effect shows that the degree to which people refrained from going out was smaller for older age groups, who are at a higher risk of serious illness and death, than for younger age groups. Second, the age profile of the information effect shows that the degree to which people stayed at home tended to increase with age for weekends and holidays. Thus, while Acemoglu et al. (2020) proposed targeted lockdowns requiring stricter lockdown policies for the oldest group in order to protect those at a high risk of serious illness and death, our findings suggest that Japan’s government intervention had a very different effect in that it primarily reduced outings by the young, and what led to the quarantining of older groups at higher risk instead was people’s voluntary response to information about the pandemic. Third, the information effect has been on a downward trend since the summer of 2020. It is relatively more pronounced among the young, so that the age profile of the information effect remains upward sloping.

Descriptive Analysis of a Telephone Based Community Monitoring Service for COVID-19.

The coronavirus disease (COVID-19) pandemic has required health services to rapidly respond to the needs of people diagnosed with the virus. Over 80% of people diagnosed with COVID-19 experience a mild illness and there is a need for community management to support these people in their home. In this paper we present, a telephone based COVID-19 community monitoring service developed in an Australian public health network, and we describe the rapid implementation of the service and the demographic and clinical characteristics of those enrolled. A retrospective mixed methods evaluation of the COVID-19 community monitoring service using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Eight hundred and fifty COVID-19 positive patients were enrolled, 54% female, 45% male, mean age 34 years SD 17. Four hundred and nine (48%) patients were born outside Australia. Among the 850 patients, 305 (36%) were classified as having a high risk of serious illness from COVID-19. The most prevalent risk factors were cardiovascular disease (37%), lung disease (30%) and age over 60 years (26%). The most common reported ongoing symptoms were fatigue (55%), breathing issues (26%) and mental health issues such as low mood (19%). There were no deaths in patients that participated in the service. The process of risk stratification undertaken with telephone triage was effective in determining risk of prolonged illness from COVID-19. Telephone monitoring by trained health professionals has a strong potential in the effective management of patients with a mild COVID-19 illness.

Management of acute fever in children: Consensus recommendations for community and primary healthcare providers in sub-Saharan Africa.

Fever is one of the most common reasons for unwell children presenting to pharmacists and primary healthcare practitioners. Currently there are no guidelines for assessment and management of fever specifically for community and primary healthcare workers in the sub-Saharan Africa region. This multidisciplinary consensus guide was developed to assist pharmacists and primary healthcare workers in sub-Saharan Africa to risk stratify and manage children who present with fever, decide when to refer, and how to advise parents and caregivers.Fever is defined as body temperature ≥ 37.5 °C and is a normal physiological response to illness that facilitates and accelerates recovery. Although it is often associated with self-limiting illness, it causes significant concern to both parents and attending healthcare workers. Clinical signs may be used by pharmacy staff and primary healthcare workers to determine level of distress and to distinguish between a child with fever who is at high risk of serious illness and who requires specific treatment, hospitalisation or specialist care, and those at low risk who could be managed conservatively at home. In children with warning signs, serious causes of fever that may need to be excluded include infections (including malaria), non-infective inflammatory conditions and malignancy. Simple febrile convulsions are not in themselves harmful, and are not necessarily indicative of serious infection. In the absence of illness requiring specific treatment, relief from distress is the primary indication for prescribing pharmacotherapy, and antipyretics should not be administered with the sole intention of reducing body temperature. Care must be taken not to overdose medications and clear instructions should be given to parents/caregivers on managing the child at home and when to seek further medical care.

In emergencies, Howard University student pharmacists answer the call.

When public health officials in Washington, DC, needed medication management help for homeless residents during the early weeks of the COVID-19 pandemic, the city turned to Howard University’s Capitol City Pharmacy Medical Reserve Corps (CCPMRC) unit. For about a month, 8 student volunteers and 3 pharmacists helped homeless people obtain necessary medications and supplies to treat chronic conditions. The group worked out of a hotel that the city used to isolate homeless people whose age and health status put them at high risk for serious illness or death from COVID-19. CCPMRC faculty director Tamara McCants said the unit assisted as many as 20–30 patients per day at the height of the deployment. “It was a good experience, and it was good for the students,” said McCants, who is also executive director of the college of pharmacy’s experiential programs. “It was really meeting the patients where they are and ensuring all...

Clinical Profile of Child COVID-19 Patients of Bangladesh

<i>Background</i>: Millions of people worldwide have been affected by the COVID-19 pandemic. Due to the prevalence of malnutrition, refusal of immunization during a pandemic, nutritional anemia, air pollution, poverty, poor parental education, inadequate access to high-quality acute healthcare, the clinical characteristics and outcomes of children in Bangladesh may vary from other countries. Information on clinical presentations, outcomes, the relationship between disease incidence and the prevalence of associated disease in Bangladeshi children affected by COVID-19 are scarce. <i>Objective</i>: In this study, our main goal was to evaluate the clinical profile of pediatric COVID-19 patients in child corona unit of Dhaka Medical College Hospital, Bangladesh. <i>Method</i>: This single center observational study was conducted in Child Corona Unit of Dhaka Medical College Hospital (DMCH). A total of 1020 COVID-19 positive pediatric patients were included in this study. <i>Results</i>: In our study, 89.1% of patients had fever, 80.8% had a cough, 23.1% had diarrhea, and 70.8% had myalgia. According to CXR reports, 2.1% patients had ground-glass opacity, 38% had local patchy shadowing, 31.8% patients had bilateral patchy shadowing and 27.9% patients had interstitial abnormalities. Correlation of disease severity between without co-morbidity and with co-morbidity is statistically significant (p=0.01). <i>Conclusion</i>: This research revealed a variable range of presentations. This sheds light on the cases of COVID-19 in the pediatric population. Children with COVID-19 normally present with or are asymptomatic with different symptoms; infants may have a high risk of serious illness. However, most cases were reported in children 11-15 years of age and fever, cough, nasal congestion and dyspnoea were typical symptoms. Serious cases were those with co-morbidity and in order to save them additional attention during home care and prompt hospitalization therapy are needed.

Why Are Patients With COVID-19 at Risk for Drug-Drug Interactions?

The goal of this column is to provide information to health care professionals about drug-drug interactions (DDIs) and why DDIs are important to consider in those at serious risk of illness with Coronavirus Disease 2019 (COVID-19). Important considerations discussed in this column include the frequency and complexity of multiple medication use, particularly important for the older patient who often has multiple comorbid illnesses. The column covers the following issues: (1) Why patients at high risk for serious illness from COVID-19 are also at high risk for DDIs. (2) Application of results of pharmacoepidemiological studies to the population at risk for serious COVID-19 illness. (3) Mechanisms underlying DDIs, frequency and potential complexity of DDIs, and how DDIs can present clinically. (4) Methods for preventing or mitigating DDIs. (5) An introduction to the University of Liverpool drug interaction checker as a tool to reduce the risk of adverse DDIs while treating patients for COVID-19. Commentary is also provided on issues related to specific psychiatric and nonpsychiatric medications a patient may be taking. A subsequent column will focus on DDIs between psychiatric medications and emerging COVID-19 treatments, as a detailed discussion of that topic is beyond the scope of this column.

Walk At Least 10 Minutes a Day for Adults With Knee Osteoarthritis: Recommendation for Minimal Activity During the COVID-19 Pandemic

The emergence of the coronavirus disease 2019 (COVID-19) has resulted in unprecedented changes in how the world socially interacts. Limits on contact with others, whether by social distancing or shelter-at-home recommendations, have negatively affected physical activity (PA); this is especially true for adults over the age of 60 who are at high risk of serious illness from COVID-19.

Half of Rural Residents at High Risk of Serious Illness Due to COVID-19, Creating Stress on Rural Hospitals.

PurposeDuring the COVID‐19 epidemic, it is critical to understand how the need for hospital care in rural areas aligns with the capacity across states.MethodsWe analyzed data from the 2018 Behavioral Risk Factor Surveillance System to estimate the number of adults who have an elevated risk of serious illness if they are infected with coronavirus in metropolitan, micropolitan, and rural areas for each state. Study data included 430,949 survey responses representing over 255.2 million noninstitutionalized US adults. For data on hospital beds, aggregate survey data were linked to data from the 2017 Area Health Resource Files by state and metropolitan status.FindingsAbout 50% of rural residents are at high risk for hospitalization and serious illness if they are infected with COVID‐19, compared to 46.9% and 40.0% in micropolitan and metropolitan areas, respectively. In 19 states, more than 50% of rural populations are at high risk for serious illness if infected. Rural residents will generate an estimated 10% more hospitalizations for COVID‐19 per capita than urban residents given equal infection rates.ConclusionMore than half of rural residents are at increased risk of hospitalization and death if infected with COVID‐19. Experts expect COVID‐19 burden to outpace hospital capacity across the country, and rural areas are no exception. Policy makers need to consider supply chain modifications, regulatory changes, and financial assistance policies to assist rural communities in caring for people affected by COVID‐19.

Summary of international recommendations in 23 languages for patients with cancer during the COVID-19 pandemic

Patients with cancer are at high risk for serious illness and death from COVID-19. The pandemic has altered the routine for oncology patients. Their lives depend on their ability to receive medical care, but every visit to a health-care facility exposes them to the risk of contracting the virus; therefore, concerns about getting infected might interfere with their continuity of care. Does oncology treatment outweigh the risk of infection? The psychological pressure of uncertainty for patients with cancer is particularly high.