Higher COVID-19 Mortality Research Articles

The Impact of Greenspace, Walking, and Cycling on the Health of Urban Residents during the COVID-19 Pandemic: A Study of London.

Vulnerability to COVID-19 has been linked to public health issues like obesity and physical fitness, which consecutively can be linked to access to urban greenspace. However, the value of greenspaces remains contentious in the literature and unclear in practice. In view of very high COVID-19 mortality rates, we use data from London boroughs to explore the impact of green infrastructure in terms of the size, accessibility, and support of physical activity and healthy lifestyles (e.g., walking and cycling). Results show no significant relationship between the availability of greenspace and the probability of being obese or dying from COVID-19. Cycling once, thrice, or five times weekly was found to improve healthy weight, as does cycling once a month. However, the probability of dying from COVID-19 during lockdowns is correlated to the frequency of walking or cycling as a result of decreased social distancing, while the frequency of walking and cycling is determined by availability and access to greenspace.

COVID-19 vaccination, incidence, and mortality rates among individuals with mental disorders in South Korea: A nationwide retrospective study.

We examined COVID-19 vaccination, incidence, and mortality rates among patients with mental health disorders in South Korea from 1 January 2020 to 31 December 2021. The study found that individuals with mental disorders had higher COVID-19 incidence and mortality than those without. Patients with mood disorders had higher vaccination rates and COVID-19 incidence and mortality than those without mental disorders. In contrast, patients with schizophrenia had lower vaccination rates, slightly lower COVID-19 incidence, and higher COVID-19 mortality. Patients with mental health disorders have been vulnerable to COVID-19, and more attention should be paid to their vaccination and health needs.

Impaired pathogen-specific CD4 +T cell functionality in patients with CLL

Abstract Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in adults and remains an incurable disease. Many patients with CLL are affected by non-malignant complications, including infectious diseases, as witnessed during the past years, with very high COVID-19 mortality rates. Accumulating data indicate that T cells might become exhausted in patients with CLL, which might be a contributing factor to poor control of pathogenic infections. Here we developed flow cytometry protocols to combine activation-induced molecule (AIM) assessment and functional read-outs to understand if bacteria- and virus-specific CD4 +T cell responses are impaired in patients with CLL. PBMCs were collected from indolent CLL patients (n=23) and age and gender-matched blood donors (n=17) to assess CD4 +T cell dysfunction against pathogenic bacteria (S. Pneumonia, H. Influenzae, M. Catarrhalis, K. Pneumoniae) and viruses (CMV, EBV, IAV). We show that the frequency of CD4 +T cell responses against most assessed bacterial species was of lower frequencies in CLL patients compared to matched control groups. Both bacteria- and virus-specific CD4 +T cells experienced, in general, signs of functional exhaustion, including diminished capacity to produce IFN-γ, TNF, IL-2, IL-17, and/or IL-21, during indolent CLL. Functional exhaustion was not coupled to increased expression of inhibitory receptors but instead reduced stem-like phenotypes of CD4 +T cells. These data indicate that untreated CLL is coupled to impaired functional capacity of bacteria and virus-specific CD4 +T cells, which might lead to poor pathogen control. Swedish Cancer Foundation(Cancerfonden)

Dynamics of factors associated with rates of COVID-19 cases and deaths in African countries

BackgroundAfrican countries have not had the high case and death rates from COVID-19 as was predicted early in the pandemic. It is not well understood what factors modulated the rate of COVID-19 cases and death on the continent.MethodsWe collated data from the World Bank data site, Our World in Data and Freedom House for African for 54 African countries who are members of the African Union. We used them as explanatory variables in two general linear model regression analyses. COVID cases and deaths per 100,000 obtained from WHO COVID-19 dashboard on August 12, 2021, as outcome variables in two prediction models.ResultsGDP, percentage of population under 14 years of age, Maternal Mortality Ratio, number of international tourists visiting per year and public transportation closures were not significant in predicting COVID-19 cases. Higher percentage of unemployed adults in the population, lower percentage of the population over 25 years of age with secondary education, internal travel restrictions increased spread of COVID-19 while international travel restrictions were associated with lower COVID-19 cases per 100,000 population. Higher levels of democratization results in higher cases of COVID-19. Unemployment, education and democratization were still significant for COVID-19 death in the same direction as they were for COVID-19 cases. Number of tourism visitors per year was also associated with higher COVID-19 death rates but not with case rates.ConclusionIn African countries, internal movement restrictions enacted to inhibit COVID-19, had the opposite effect and enabled COVID-19 spread. Low Education levels and high unemployment were associated with having higher death rates from COVID-19. More studies are needed to understand the impact of tourism on COVID-19 and other infectious diseases arising from other regions on African countries, in order to put in place adequate control protocols.

COVID-19 fatalities and internal conflict: Does government economic support matter?

This study examines the association between COVID-19 mortality rates and internal conflict and investigates the possible moderating role of government economic support during the pandemic years of 2020 and 2021. Our main hypothesis suggests that countries with lower levels of government economic support are more likely to experience a positive correlation between higher COVID-19 mortality rates and the emergence of internal conflict. Using cross-country data from over 100 countries and controlling for various factors that may influence internal conflict, our analysis provides some support for this hypothesis. The results suggest a possible moderating role for government economic support, with the evidence indicating a weakening or elimination of the association between COVID-19 mortality rates and internal conflict when government economic support is adequate. However, the moderating effect of government economic support is not always significant, and caution is needed when interpreting the results. Our analysis also highlights the potential risks associated with low levels of government economic support during the pandemic. Specifically, we find that in countries where the government's macro-financial package in response to the pandemic is less than approximately 25% of GDP, there is a possible risk of growth in civil disorder resulting from increased COVID-19 deaths per million.

COVID-19 Incidence and Mortality Among Unvaccinated and Vaccinated Persons Aged ≥12 Years by Receipt of Bivalent Booster Doses and Time Since Vaccination - 24 U.S. Jurisdictions, October 3, 2021-December 24, 2022.

On September 1, 2022, CDC recommended an updated (bivalent) COVID-19 vaccine booster to help restore waning protection conferred by previous vaccination and broaden protection against emerging variants for persons aged ≥12 years (subsequently extended to persons aged ≥6 months).* To assess the impact of original (monovalent) COVID-19 vaccines and bivalent boosters, case and mortality rate ratios (RRs) were estimated comparing unvaccinated and vaccinated persons aged ≥12 years by overall receipt of and by time since booster vaccination (monovalent or bivalent) during Delta variant and Omicron sublineage (BA.1, BA.2, early BA.4/BA.5, and late BA.4/BA.5) predominance.† During the late BA.4/BA.5 period, unvaccinated persons had higher COVID-19 mortality and infection rates than persons receiving bivalent doses (mortality RR = 14.1 and infection RR = 2.8) and to a lesser extent persons vaccinated with only monovalent doses (mortality RR = 5.4 and infection RR = 2.5). Among older adults, mortality rates among unvaccinated persons were significantly higher than among those who had received a bivalent booster (65-79 years; RR = 23.7 and ≥80 years; 10.3) or a monovalent booster (65-79 years; 8.3 and ≥80 years; 4.2). In a second analysis stratified by time since booster vaccination, there was a progressive decline from the Delta period (RR = 50.7) to the early BA.4/BA.5 period (7.4) in relative COVID-19 mortality rates among unvaccinated persons compared with persons receiving who had received a monovalent booster within 2 weeks-2 months. During the early BA.4/BA.5 period, declines in relative mortality rates were observed at 6-8 (RR = 4.6), 9-11 (4.5), and ≥12 (2.5) months after receiving a monovalent booster. In contrast, bivalent boosters received during the preceding 2 weeks-2 months improved protection against death (RR=15.2) during the late BA.4/BA.5 period. In both analyses, when compared with unvaccinated persons, persons who had received bivalent boosters were provided additional protection against death over monovalent doses or monovalent boosters. Restored protection was highest in older adults. All persons should stay up to date with COVID-19 vaccination, including receipt of a bivalent booster by eligible persons, to reduce the risk for severe COVID-19.

Neighborhood Condition Prevalence Rates Correlate With COVID-19 Mortality in Milwaukee County, Wisconsin.

We sought to determine if census tract-level (ie, neighborhood) COVID-19 death rates in Milwaukee County correlated with the census tract-level condition prevalence rates (CPRs) for individual COVID-19 mortality risk. This study used Milwaukee County-reported COVID-19 death rates per 100,000 lives for the 296 census tracts within the county to perform a linear regression with individual COVID-19 mortality risk CPR, mean age, racial composition of census tract (by percentage of non-White residents), and poverty (by percentage within census tract), followed by multiple regression with all 7 CPRs as well as the 7 CPRs combined with the additional demographic variables. CPR estimates were accessed from the Centers for Disease Control and Prevention 500 Cities Project. Demographics were accessed from the U.S. Census. The Milwaukee County Medical Examiner's office identified 898 deaths from COVID-19 in Milwaukee County from March 2020 to June 2021. Among the variables included, crude death rate demonstrated a statistically significant association with the 7 COVID-19 mortality risk CPRs (as analyzed collectively), census tract mean age, and several of the CPRs individually. The addition of census tract age, race, and poverty in multiple regression did not improve the association of the 7 CPRs with crude death rate. Results from this population-level study indicated that census tracts with high COVID-19 mortality correlated with high-risk condition prevalence estimates within those census tracts, illustrating how health data collection and analysis at a census tract level could be helpful when planning pandemic-mitigating public health efforts.

A multisite exploration of the association between critical care implementation factors and clinical outcomes during the COVID-19 pandemic.

Little is known about strategies to implement new critical care practices in response to COVID-19. Moreover, the association between differing implementation climates and COVID-19 clinical outcomes has not been examined. The purpose of this study was to evaluate the relationship between implementation determinants and COVID-19 mortality rates. We used mixed methods guided by the Consolidated Framework for Implementation Research (CFIR). Semi-structured qualitative interviews were conducted with critical care leaders and analyzed to rate the influence of CFIR constructs on the implementation of new care practices. Qualitative and quantitative comparisons of CFIR construct ratings were performed between hospital groups with low- versus high-mortality rates. We found associations between various implementation factors and clinical outcomes of critically ill COVID-19 patients. Three CFIR constructs (implementation climate, leadership engagement, and engaging staff) had both qualitative and statistically significant quantitative correlations with mortality outcomes. An implementation climate governed by a trial-and-error approach was correlated with high COVID-19 mortality, while leadership engagement and engaging staff were correlated with low mortality. Another three constructs (needs of patient; organizational incentives and rewards; and engaging implementation leaders) were qualitatively different across mortality outcome groups, but these differences were not statistically significant. Improving clinical outcomes during future public health emergencies will require reducing identified barriers associated with high mortality and harnessing salient facilitators associated with low mortality. Our findings suggest that collaborative and engaged leadership styles that promote the integration of new yet evidence-based critical care practices best support COVID-19 patients and contribute to lower mortality.

Somali experiences of first wave Caabuqa-corona: an analysis of high COVID-19 mortality and infection levels in London�s East End, 2020

This article focuses on the experiences of a minoritised black Muslim community in London during the first wave of the COVID-19 pandemic, 2020. It shows that many Somali families, living in a high-density area of the East End, experienced acutely high infection and death rates from late March. The reasons for this were found to be late lockdown, a top-down community-insensitive public health approach, and the way that many of the work force were in highly vulnerable occupations. However, high rates were then prolonged due to the legacy of historic poverty, housing density and institutional racism. Culture and locally specific responses were less significant factors but overall had a positive impact in mitigation. However, the situation with regard to mental health remains bleak. This research suggests more trained Somali health experts, community sensitive data, trauma informed care, and use of local networks could help reduce future vulnerabilities and health poverty.

Risk and Preferences for Government Healthcare Spending: Evidence from the UK COVID-19 Crisis

AbstractThe onset of the COVID-19 pandemic constituted a large shock to the risk of acquiring a disease that represents a meaningful threat to health. We investigate whether individuals subject to larger increases in objective health risk – operationalized by occupation-based measures of proximity to other people – became more supportive of increased government healthcare spending during the crisis. Using panel data that track UK individuals before (May 2018–December 2019) and after (June 2020) the outbreak of the pandemic, we implement a fixed-effect design that was pre-registered before the key treatment variable was available to us. While individuals in high-risk occupations were more worried about their personal risk of infection and had higher COVID-19 death rates, there is no evidence that increased health risks during COVID-19 shifted either attitudes on government spending on healthcare or broader attitudes relating to redistribution. Our findings are consistent with recent research demonstrating the limited effects of the pandemic on political attitudes.

Identifying age- and sex-specific COVID-19 mortality trends over time in six countries

ObjectivesThe COVID-19 pandemic is characterized by successive waves that each developed differently over time and through space. We aim to provide an in-depth analysis of the evolution of COVID-19 mortality during 2020 and 2021 in a selection of countries. MethodsWe focus on five European countries and the United States. Using standardized and age-specific mortality rates, we address variations in COVID-19 mortality within and between countries, and demographic characteristics and seasonality patterns. ResultsOur results highlight periods of acceleration and deceleration in the pace of COVID-19 mortality, with substantial differences across countries. Periods of stabilization were identified during summer (especially in 2020) among the European countries analyzed but not in the United States. The latter stands out as the study population with the highest COVID-19 mortality at young ages. In general, COVID-19 mortality is highest at old ages, particularly during winter. Compared with women, men have higher COVID-19 mortality rates at most ages and in most seasons. ConclusionThere is seasonality in COVID-19 mortality for both sexes at all ages, characterized by higher rates during winter. In 2021, the highest COVID-19 mortality rates continued to be observed at ages 75+, despite vaccinations having targeted those ages specifically.

The Clinical Characteristics and Outcomes of COVID-19 Patients with Pre-Existing Thyroid Dysfunction: A Nationwide Study.

To which extent the pre-existing hypothyroidism or hyperthyroidism has an impact on coronavirus infection 2019 (COVID-19) outcomes remains unclear. The objective of this study was to evaluate COVID-19 morbidity and mortality in patients with pre-existing thyroid dysfunction. A retrospective cohort of patients with a polymerase chain reaction (PCR)-confirmed COVID-19 infection (n=14 966) from March 11 to May 30, 2020, was established using the database of the Turkish Ministry of Health. We compared the morbidity and mortality rates of COVID-19 patients with pre-existing hypothyroidism (n=8813) and hyperthyroidism (n=1822) to those patients with normal thyroid function (n=4331). Univariate and multivariate regression analyses were performed to identify the factors associated with mortality. Mortality rates were higher in patients with hyperthyroidism (7.7%) and hypothyroidism (4.4%) than those with normal thyroid function (3.4%) (p<0.001 and p=0.008, respectively). Pre-existing hyperthyroidism was significantly associated with an increased risk of mortality (OR 1.54; 95% CI, 1.02-2.33; p=0.042) along with advanced age, male gender, lymphopenia and chronic kidney disease (p<0.001 for all). Although a potential trend was noted, the association between pre-existing hypothyroidism and mortality was not significant (OR 1.36; 95% CI, 0.99-1.86; p=0.055). In conclusion, this study showed an association between pre-existing hyperthyroidism with higher COVID-19 mortality. A potential trend towards increased mortality was also observed for hypothyroidism. The risk was more pronounced in patients with hyperthyroidism.

NCOG-27. A SINGLE-INSTITUTION RETROSPECTIVE SERIES OF SARS-COV-2 INFECTION IN ADULT GLIOMA PATIENTS

Abstract A subset of cancer patients is particularly vulnerable to SARS-Cov-2 infection; however, real-world outcomes-based data on primary central nervous system tumor patients is sparse. This retrospective case series describes a cohort of adult glioma patients seen at Stanford Cancer Center between 1/20/2020 through 5/24/2022 who contracted SARS-Cov-2. We identified 18 patients with a diagnosis of glioma, with a median age of 54 years, who were infected with Covid-19. One patient contracted Covid-19 twice during this two-year period. Of these patients, four had pathology confirmed low-grade glioma, defined as oligodendroglioma or astrocytoma WHO grade 2, and 14 patients had high-grade glioma, defined as astrocytoma or glioblastoma WHO grade 4. Median KPS at time of infection was 70. Six individuals had notable cardiovascular comorbidities including coronary artery disease, obesity, and/or diabetes. All but one patient was vaccinated against Covid-19, and 6 were taking dexamethasone at the time of infection. Three patients required hospital admission for management of Covid-19 symptoms, although none required ICU-level of care. None died from Covid-related complications; however, two died from complications of their underlying cancer at the end of study. Our data suggest that glioma patients seen at Stanford Cancer Center do not experience an exceptionally high Covid-19 infectivity, hospitalization, or mortality rate, especially when compared to other vulnerable populations such as lung cancer patients. High vaccination rates, fairly low prevalence of cardiovascular comorbidities, and adherence to pandemic precautions among this cohort may have contributed to these results.

Is there an association between hospital staffing levels and inpatient-COVID-19 mortality rates?

ObjectiveThis study aims to investigate the relationship between RNs and hospital-based medical specialties staffing levels with inpatient COVID-19 mortality rates.MethodsWe relied on data from AHA Annual Survey Database, Area Health Resource File, and UnitedHealth Group Clinical Discovery Database. In phase 1 of the analysis, we estimated the risk-standardized event rates (RSERs) based on 95,915 patients in the UnitedHealth Group Database 1,398 hospitals. We then used beta regression to analyze the association between hospital- and county- level factors with risk-standardized inpatient COVID-19 mortality rates from March 1, 2020, through December 31, 2020.ResultsHigher staffing levels of RNs and emergency medicine physicians were associated with lower COVID-19 mortality rates. Moreover, larger teaching hospitals located in urban settings had higher COVID-19 mortality rates. Finally, counties with greater social vulnerability, specifically in terms of housing type and transportation, and those with high infection rates had the worst patient mortality rates.ConclusionHigher staffing levels are associated with lower inpatient mortality rates for COVID-19 patients. More research is needed to determine appropriate staffing levels and how staffing levels interact with other factors such as teams, leadership, and culture to impact patient care during pandemics.

Massachusetts flu vaccination and application for COVID-19 routine vaccination planning

BackgroundSARS-CoV-2 has affected communities of color at disproportionate rates. In particular, Black Americans have higher COVID-19 mortality rates, rooted in health disparities and institutionalized racism. We describe Massachusetts (MA) influenza (flu) vaccination data by race and vaccination location to inform yearly COVID-19 vaccination plans. MethodsWe analyzed self-reported, pooled data from the 2017, 2018, and 2019 Massachusetts Behavioral Risk Factor Surveillance System (MA-BRFSS) of adults. Using the questions around race and ethnicity and flu vaccination, we calculated location types most visited as a percent of people receiving flu vaccine, stratified by race. ResultsThe 3 years combined yielded 6031 completed surveys. Compared to White non-Hispanics, Black non-Hispanics, Hispanics, and other non-White adults combined reported flu vaccination less frequently (p < 0.01). Doctor’s office or a health maintenance organization (HMO) were the primary flu vaccination locations among all race subcategories. Within each race category, the top three locations covered 82.7 % of White respondents, while covering only 75.9 % of Hispanic respondents, and 71.0 % of Black respondents. Fewer Hispanic (16.1 %) and Black respondents (13.8 %) were vaccinated at supermarkets or drug stores compared to White respondents (25.2 %). ConclusionAs COVID-19 vaccination will likely be a yearly occurrence, the above findings can help support future COVID-19 vaccination plans. Since the frequency and location of receipt of flu vaccination varied by race/ethnicity in Massachusetts, the state should ensure specific COVID-19 vaccination locations are available going forward.

COVID-19, Non-Communicable Diseases, and Behavioral Factors in the Peruvian Population ≥ 15 Years: An Ecological Study during the First and Second Year of the COVID-19 Pandemic.

A range of health-related and behavioral risk factors are associated with COVID-19 incidence and mortality. In the present study, we assess the association between incidence, mortality, and case fatality rate due to COVID-19 and the prevalence of hypertension, obesity, overweight, tobacco and alcohol use in the Peruvian population aged ≥15 years during the first and second year of the COVID-19 pandemic. In this ecological study, we used the prevalence rates of hypertension, overweight, obesity, tobacco, and alcohol use obtained from the Encuesta Demográfica y de Salud Familiar (ENDES) 2020 and 2021. We estimated the crude incidence and mortality rates (per 100,000 habitants) and case fatality rate (%) of COVID-19 in 25 Peruvian regions using data from the Peruvian Ministry of Health that were accurate as of 31 December 2021. Spearman correlation and lineal regression analysis was applied to assess the correlations between the study variables as well as multivariable regression analysis adjusted by confounding factors affecting the incidence and mortality rate and case fatality rate of COVID-19. In 2020, adjusted by confounding factors, the prevalence rate of obesity (β = 0.582; p = 0.037) was found to be associated with the COVID-19 mortality rate (per 100,000 habitants). There was also an association between obesity and the COVID-19 case fatality rate (β = 0.993; p = 0.014). In 2021, the prevalence of obesity was also found to be associated with the COVID-19 mortality rate (β = 0.713; p = 0.028); however, adjusted by confounding factors, including COVID-19 vaccination coverage rates, no association was found between the obesity prevalence and the COVID-19 mortality rate (β = 0.031; p = 0.895). In summary, Peruvian regions with higher obesity prevalence rates had higher COVID-19 mortality and case fatality rates during the first year of the COVID-19 pandemic. However, adjusted by the COVID-19 vaccination coverage, no association between the obesity prevalence rate and the COVID-19 mortality rate was found during the second year of the COVID-19 pandemic.

Long-Term Care Home Size Association with COVID-19 Infection and Mortality in Catalonia in March and April 2020.

We aim to assess how COVID-19 infection and mortality varied according to facility size in 965 long-term care homes (LTCHs) in Catalonia during March and April 2020. We measured LTCH size by the number of authorised beds. Outcomes were COVID-19 infection (at least one COVID-19 case in an LTCH) and COVID-19 mortality. Risks of these were estimated with logistic regression and hurdle models. Models were adjusted for county COVID-19 incidence and population, and LTCH types. Sixty-five per cent of the LTCHs were infected by COVID-19. We found a strong association between COVID-19 infection and LTCH size in the adjusted analysis (from 45% in 10-bed homes to 97.5% in those with over 150 places). The average COVID-19 mortality in all LTCHs was 6.8% (3887 deaths) and 9.2% among the COVID-19-infected LTCHs. Very small and large homes had higher COVID-19 mortality, whereas LTCHs with 30 to 70 places had the lowest level. COVID-19 mortality sharply increased with LTCH size in counties with a cumulative incidence of COVID-19 which was higher than 250/100,000, except for very small homes, but slightly decreased with LTCH size when the cumulative incidence of COVID-19 was lower. To prevent infection and preserve life, the optimal size of an LTCH should be between 30 and 70 places.

COVID-19 mortality and excess mortality among working-age residents in California, USA, by occupational sector: a longitudinal cohort analysis of mortality surveillance data

BackgroundDuring the first year of the COVID-19 pandemic, workers in essential sectors had higher rates of SARS-CoV-2 infection and COVID-19 mortality than those in non-essential sectors. It is unknown whether disparities in pandemic-related mortality across occupational sectors have continued to occur during the periods of SARS-CoV-2 variants and vaccine availability.MethodsIn this longitudinal cohort study, we obtained data from the California Department of Public Health on all deaths occurring in the state of California, USA, from Jan 1, 2016, to Dec 31, 2021. We restricted our analysis to residents of California who were aged 18–65 years at time of death and died of natural causes. We classified the occupational sector into nine essential sectors; non-essential; or unemployed or without an occupation provided on the death certificate. We calculated the number of COVID-19 deaths in total and per capita that occurred in each occupational sector. Separately, using autoregressive integrated moving average models, we estimated total, per-capita, and relative excess natural-cause mortality by week between March 1, 2020, and Nov 30, 2021, stratifying by occupational sector. We additionally stratified analyses of occupational risk into counties with high versus low vaccine uptake, categorising high-uptake regions as counties where at least 50% of the population were fully vaccinated according to US guidelines by Aug 1, 2021.FindingsFrom March 1, 2020, to Nov 30, 2021, 24 799 COVID-19 deaths were reported in residents of California aged 18–65 years and an estimated 28 751 (95% prediction interval 27 853–29 653) excess deaths. People working in essential sectors were associated with higher COVID-19 deaths and excess deaths than were those working in non-essential sectors, with the highest per-capita COVID-19 mortality in the agriculture (131·8 per 100 000 people), transportation or logistics (107·1 per 100 000), manufacturing (103·3 per 100 000), facilities (101·1 per 100 000), and emergency (87·8 per 100 000) sectors. Disparities were wider during periods of increased infections, including during the Nov 29, 2020, to Feb 27, 2021, surge in infections, which was driven by the delta variant (B.1.617.2) and occurred during vaccine uptake. During the June 27 to Nov 27, 2021 surge, emergency workers had higher COVID-19 mortality (113·7 per 100 000) than workers from any other sector. Workers in essential sectors had the highest COVID-19 mortality in counties with low vaccination uptake, a difference that was more pronounced during the period of the delta infection surge during Nov 29, 2020, to Feb 27, 2021.InterpretationWorkers in essential sectors have continued to bear the brunt of high COVID-19 and excess mortality throughout the pandemic, particularly in the agriculture, emergency, manufacturing, facilities, and transportation or logistics sectors. This high death toll has continued during periods of vaccine availability and the delta surge. In an ongoing pandemic without widespread vaccine coverage and with anticipated threats of new variants, the USA must actively adopt policies to more adequately protect workers in essential sectors.FundingUS National Institute on Aging, Swiss National Science Foundation, and US National Institute on Drug Abuse.

The Association of High COVID-19 Cases and Mortality with Anomalous High Surface Ozone Concentration in Moscow City in Summer 2021

Aim: to compare statistical data on the frequency of COVID-19 and deaths from it with the ozone content in the surface atmosphere of Moscow in the summer of 2021.Materials and methods. We used data on the frequency of daily COVID-19 cases and mortality from COVID-19 in Moscow in 2020–2021 published by Rospotrebnadzor. Data on the ozone content in the surface layer of the atmosphere were obtained by an automatic monitoring station using a chemiluminescent analyzer.Results. The waves of high frequency of COVID-19 cases and mortality from COVID-19 in Moscow in the summer of 2021 were compared with abnormally high concentrations of ozone in the surface atmosphere of the megalopolis. Variations of these parameters were found to be markedly correlated. The coefficients of correlation of the COVID-19 cases and mortality with the concentration of ground-level ozone were 0,59 (p &lt; 0.01) and 0.60 (p &lt; 0.01), respectively.Conclusion. The observed noticeable relationship may be due to the combined pathological effect of high concentrations of ozone and the SARS-CoV-2 on the respiratory and circulatory organs, which can lead to both easier transmission of infection and a more severe course of the disease with increased mortality.

Vitamin D Status and Mortality from SARS CoV-2: A Prospective Study of Unvaccinated Caucasian Adults.

COVID-19 and a low vitamin D state share common risk factors, which might explain why vitamin D deficiency has been linked with higher COVID-19 mortality. Moreover, measures of serum vitamin D may become lower during systemic inflammatory responses, further confounding the association via reverse causality. In this prospective study (recruited over 12 months), we examined whether the association between a low vitamin D state and in-hospital mortality due to SARS-CoV-2 pneumonia in unvaccinated subjects is explained by (i) the presence of shared risk factors (e.g., obesity, advanced age) or (ii) a reduction in serum 25(OH)D due to COVID-19 (i.e., reverse causality). In this cohort of 232 (mean age = 56 years) patients (all had SARS-CoV-2 diagnosed via PCR AND required supplemental oxygen therapy), we failed to find an association between serum vitamin D and levels of CRP, or other inflammatory markers. However, the hazard ratio for mortality for subjects over 70 years of age (13.2) and for subjects with a serum 25(OH)D level less than 30 nmol·L−1 (4.6) remained significantly elevated even after adjustment for gender, obesity and the presence of diabetes mellitus. Subjects <70 years and >70 years had significantly higher mortality with a serum 25(OH)D less than 30 nmol·L−1 (11.8% and 55%), than with a serum 25(OH)D greater than 30 nmol·L−1 (2.2% and 25%). Unvaccinated Caucasian adults with a low vitamin D state have higher mortality due to SARS CoV-2 pneumonia, which is not explained by confounders and is not closely linked with elevated serum CRP.