Higher COVID-19 Mortality Research Articles

Abstract P92: Higher Risk of Covid-19 Mortality Among Patients With Preexisting Neurological Disease

Introduction: Neurotropism of the SARS-CoV-2 has been reported. We evaluated the risk of poor outcomes associated with preexisting neurological disease (PEND) among COVID-19 patients. Methods: We analyzed data from COVID-19 Outcomes Registry (CURATOR) at Houston Methodist. All adult (≥ 18 years) patients tested for SARS-CoV-2 RNA in nasopharyngeal specimens were included. Utilizing ICD-10 diagnoses codes, we classified PEND patients as those with documented history of ischemic or hemorrhagic stroke, transient ischemic attack, mild cognitive impairment, Alzheimer’s disease and related dementias including vascular dementia, primary and metastatic brain tumors, epilepsy, motor neuron disease, amyotrophic lateral sclerosis, multiple sclerosis, Parkinson’s disease, spinal cord injury, and traumatic brain injury. Logistic regression models were fitted to assess the odds of COVID-19 mortality associated with PEND. Odds ratios (OR) and 95% Confidence Intervals (CI) are reported. Results: Between March 3 and August 10, 2020, 86,614 individuals were tested for SARS-CoV-2, of whom 14,233 (16.4%) tested positive, with 4,473 (31.4%) hospitalizations, and 431 (9.6%) deaths. Overall 11,473 (13.2%) individuals had PEND, of whom 1,458 (12.7%) tested positive, 966 (66.3%) were hospitalized and 165 (17.1%) died. Among positive cases, PEND (vs. non-PEND) patients were older (67.1 vs. 46.4 years) and had a higher overall comorbidity burden (median Charlson Comorbidity Index: 6 vs. 1). The proportion of PEND patients was significantly higher among COVID-19 patients who died (vs. those who were discharged alive) (38.3% vs. 19.8%, crude OR, CI: 2.51, 2.03 - 3.09). In the fully adjusted model for socio-demographic, comorbidity and clinical factors, PEND was independently associated with higher risk of COVID-19 mortality OR (CI): 1.42 (1.04, 1.95) (graphic). Conclusions: Biological mechanisms of higher COVID-19 mortality among patients with PEND need to be evaluated.

N-acetylcysteine as a part of complex treatment of moderate COVID-associated pneumonia

The need for safe and effective treatment is becoming increasingly urgent due to the high COVID-19 mortality rates observed worldwide. The choice of drug products for COVID-19 treatment regimens is based on the efficacy and safety data, the mechanism of action, and potential interactions. N-acetylcysteine's (NAC) pharmacological activity and its potential to suppress the progression of COVID-19 make it a promising therapeutic agent for COVID-19.Aimof the study was to evaluate the efficacy of NAC in the complex treatment of moderate COVID-associated pneumonia.Methods. The study included adult patients (n= 46) with moderate COVID-associated (the 2nddegree on CT) pneumonia (age 57 (51; 71) years, body mass index - 30 (27.1; 32.3) kg/m2, duration of the disease before hospitalization - 7 (6; 8) days, body temperature at the admission - 37.5 (37.1; 37.8)°С). The patients were randomized into two study groups. The 1stgroup (n= 22) received standard COVID-19 treatment [1]. The 2ndgroup (n= 24) additionally received NAC 1,200 - 1,500 mg/day intravenously. Treatment with NAC was started together with the standard therapy.Results. Our study showed that the inclusion of NAC in the complex treatment of moderate COVID-associated pneumonia led to a statistically significant increase in blood oxygen saturation, oxygenation index, the difference in delta increase in oxygenation index, a quicker reduction in the volume of lung damage and the difference between the groups in delta reduction of this index. Also, the rate of reduction of C-reactive protein and reduction of the duration of hospitalization in the group of patients who received NAC was statistically significantly more profound than in the standard treatment group.Conclusion. The study confirmed the effectiveness of NAC as a part of the complex treatment of moderate COVID-associated pneumonia.

Migration, ethnicity, racism and the COVID-19 pandemic: A conference marking the launch of a new Global Society

The inaugural conference of the Global Society on Migration, Ethnicity, Race and Health COVID-19 examined the impact of the COVID-19 pandemic on migrants and ethnic minorities and the role of racism. Migrants everywhere have faced tightening immigration restrictions, more obstacles to healthcare, increased racism and worsening poverty. Higher COVID-19 mortality rates have been otbserved in ethnic/racial minorities in the United Kingdom and the United States. Structural racism has been implicated, operating, for example, through more crowded living conditions and higher-risk occupations. In Brazil, good data are lacking but a seroprevalence survey suggested higher rates of infection among ethnic minorities and slum dwellers. Considerable disruption of services for migrants at the border with Venezuela have occurred. National policy responses to protect vulnerable groups have been lacking. In Australia, with strict COVID-19 control metrtrun 0asures and inclusive policies, there have been few cases and deaths reported in Indigenous communities so far. In most countries, the lack of COVID-19 data by ethnic/racial group or migrant status should be addressed. Otherwise, racism and consequent inequalities will go undetected.

Visualizing COVID-19 Mortality Rates and African-American Populations in the USA and Pennsylvania.

The Centers for Disease Control and Prevention has identified African-Americans as having increased risk of COVID-19-associated mortality. Access to healthcare and related social determinants of health are at the core of this disparity. To explore the geographical links between race and COVID-19 mortality, we created descriptive maps of COVID-19 mortality rates in relation to the percentage of populations self-identifying as African-American across the USA, by state, and Pennsylvania (PA), by county. In addition, we used bivariate and logistic regression analyses to quantify the statistical relationship between these variables, and control for area-level demographic, healthcare access, and comorbidity risk factors. We found that COVID-19 mortality rates were generally higher in areas that had higher African-American populations, particularly in the northeast USA and eastern PA. These relationships were quantified through Pearson correlations showing significant positive associations at the state and county level. At the US state-level, percent African-American population was the only significant correlate of COVID-19 mortality rate. In PA at the county-level, higher percent African-American population was associated with higher COVID-19 mortality rate even after controlling for area-level confounders. More resources should be allocated to address high COVID-19 mortality rates among African-American populations.

Clinical Characteristics of Hospitalized Individuals Dying with COVID-19 in Ulin Regional Hospital Banjarmasin

Background: Corona Virus Disease (COVID-19) has become a global pandemic and has spread to more than 200 countries including Indonesia. South Kalimantan is one of the provinces in Indonesia that has a high COVID-19 mortality rate (case fatality rate 4.1%). Information about characteristic of mortality patients with SARS-CoV-2 infection in Indonesia was limited. The objective of this study to describe clinical characteristics of COVID-19-confirmed deaths at Ulin Regional Hospital Banjarmasin, as a referral hospital in South KalimantanMethods: Medical records of 108 hospitalized patients dying with COVID-19 between March until August 2020 were collected. The recorded information included gender, age, onset and severity of disease, comorbidities, symptoms, signs, and laboratory findingsResults: The 108 confirmed cases of COVID-19 deaths were mostly male (73.1%) aged <65 years old (85.2%). About 84% of the cases had at least one comorbidity or more, like hypertension (44.4%), obesity (38%), and diabetes mellitus (32.4%). Common early symptoms were fever (91.7%) and shortness of breath (89.8%). Laboratory findings included lympocytopenia and eosinophilopenia (80.6% and 72.2%), increased neutrophil lymphocyte ratio (NLR; 86.1%), decreased absolute lymphocyte count (ALC; 72.2%), and hyponatremia (55.6%). Elevated C-reactive protein (CRP; 92.6%), lactate dehydrogenase (LDH; 91.7%), serum glutamic oxaloacetic transaminases (SGOT; 82.4%), and creatinine levels (57.4%). The majority of non survivors were severe-critical stage with severe acute respiratory distress syndrome (ARDS).Conclusion: In this depictive study, patients with comorbidities and severe-critical stage are at risk of death. Laboratory abnormalities were common in non survivors. Shortness of breath may indicate poor prognosis of COVID-19.

Lymphopenia as a Biological Predictor of Outcomes in COVID-19 Patients: A Nationwide Cohort Study.

Simple SummaryThe coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a major global health crisis. Owing to the rising number of cases and limited global resources, being able to predict patients with a severe disease course is crucial for the initial allocation of the limited medical resources. This study aimed to identify whether lymphopenia is a reliable prognostic marker for COVID-19 using Korean nationwide cohort. Lymphopenia and its severity levels may serve as reliable predictive factors for COVID-19 clinical outcomes including mortality, needs for intensive care, and oxygen requirements. Current study suggests that lymphopenia at the initial presentation of COVID-19 is associated with poor prognosis.We aimed to identify whether lymphopenia is a reliable prognostic marker for COVID-19. Using data derived from a Korean nationwide longitudinal cohort of 5628 COVID-19 patients, we identified propensity-matched cohorts (n = 770) with group I of severe lymphopenia (absolute lymphocyte counts [ALC]: <500/mm3, n = 110), group II of mild-to-moderate lymphopenia (ALC: ≥500–<1000/mm3, n = 330), and group III, no lymphopenia (ALC: ≥1000/mm3, n = 330). A significantly higher mortality rate was associated with lymphopenia severity: 40% in group I, 22.7% in group II, and 13.0% in group III (p < 0.001). At 28 days, the estimated inferior overall survival associated with intensified lymphopenia: 62.7% in group I, 79.9% in group II, and 89.0% in group III (p < 0.001). Lymphopenia contributed significantly toward a greater need for interventions in all groups but at varying degrees: requirements of invasive ventilation, intensive oxygen supply, or adequate oxygen supply, respectively (p < 0.001). The lymphopenia intensity was independently associated with higher COVID-19 mortality in multivariable analysis; adjusted odds ratios of 5.63 (95% CI, 3.0–10.72), and 2.47 (95% CI, 1.5–4.13) for group I and group II, respectively. Lymphopenia and its severity levels may serve as reliable predictive factors for COVID-19 clinical outcomes; thus, lymphopenia may provide the prognostic granularity required for clinical use in the management of patients with COVID-19.

High COVID-19 morbidity and mortality risk among smoked drug users in Brazil.

In much of the West, including Brazil, drug use has increased since social distancing began in response to the pandemic. Use of smoked and modified drugs, and their impacts on health, may contribute to aggravate the effects of the pandemic. However, studies on the relationship between use of smoked drugs and the new coronavirus are still scarce and have not received enough attention in global health recommendations. This paper aims to briefly review the relationship between use of smoked drugs and acute respiratory syndrome coronavirus 2 [SARS-CoV-2]. Recent studies also suggest that drug consumption increases the risk of contamination by SARS-CoV-2 and leads to worse prognosis, particularly consumption of drugs that affect lung function. Use of smoked drugs, especially tobacco, is strongly associated with lung diseases that are risk factors for contamination by SARS-CoV-2. It is essential to develop strategies based on specific characteristics of drug users and for mental health professionals to be included in strategic teams. It is also necessary to invest in information campaigns regarding risks and prevention of harm caused by smoked drugs as well as to design strategies that facilitate access to psychosocial treatment during the pandemic.

Low COVID-19 vaccination coverage and high COVID-19 mortality rates in Brazilian elderly

ABSTRACT Objective: To investigate the relation between COVID-19 vaccine coverage and COVID-19-related mortality by age groups in Brazil in 2021. Methods: Secondary data on COVID-19 deaths and vaccination coverage were retrieved to investigate COVID-19 mortality rate (MR) evolution as the vaccination against COVID-19 advanced in Brazil in 2021. Poisson regression with adjustment for age and Brazilian states was used to calculate the MR. Results: By mid-April 2021, MR increased 2 – 3 times compared with the already high level in January for people aged 60 years or older, reaching the highest epidemic level of 5 – 15 per 100,000 inhabitants in this age group. Despite the following decline trend, by the end of May, the MR level was still about 50% and 80% higher for the age groups of 40 – 79 years and 80 years or older. The coverage concerning the first dose of COVID-19 vaccine reached 80% for people aged 60 – 69 years and exceeded 95% for those aged 70 years or older, but the second dose was only given to 26, 76 and 64% of the age groups of 60 – 69, 70 – 79, and 80 years or older, respectively. The age-standardized average MR over the study period was the highest in northern Brazilian states of Rondônia, Amazonas, Acre, and Roraima (range 6-8.4 per 100,000 inhabitants). Conclusions: COVID-19 vaccination coverage was below the level necessary to protect Brazilians from rising MR between January and May 2021. Urgent measures are necessary to increase the vaccine supply and the adherence to non-pharmacological protective measures.

Abstract PO-004: Association between county-level socioeconomic characteristics and health indicators with COVID-19 deaths in Florida

Abstract COVID-19 has exposed the long standing racial health disparities and social inequities in the United States. It has also brought into focus the need of the vulnerable communities including racial and ethnic minority groups. health care reforms. The purpose of this analysis is to investigate county-level COVID-19 death rates with key socioeconomic and health indicators using correlation analysis. Death rates are calculated using deaths that occurred in Florida (n = 7,022 deaths) between March 1, 2020 and July 31, 2020. We hypothesize that counties with higher uninsured and older people have higher COVID-19 death rates. Data on COVID-19 county statistics is obtained from Florida Department of Health. County-level health indicators are obtained from Florida Health Community Health Assessment Resource Tool Set (CHARTS) and the County Health Rankings and Roadmap program of the Robert Wood Johnson Foundation. Spearman rank correlation, a non-parametric method, is applied to measure associations. We find that higher share of uninsured adults in a county is significantly associated with higher death rates from COVID-19. In addition, percent older than 65 is correlated death rates. However, contrary to other previous studies, we do not find a correlation between share of African Americans and death rates in Florida counties. Further, we do not find that death rates are correlated with measures of diabetes, smoking, and obesity. The policy implication of this investigation points to the vulnerability of communities without health insurance to the COVID-19 pandemic and the urgent need for health care reform. This research was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under the Award Number U54 MD007582. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This research was also made possible by Grant Numbers U54CA233396, U54CA233444, &amp; U54CA233465 from the National Institutes of Health (NIH), National Cancer Institute (NCI). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NCI. Citation Format: Gebre-Egziabher Kiros, Kira Gaddis. Association between county-level socioeconomic characteristics and health indicators with COVID-19 deaths in Florida [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-004.

Malaria Elimination Date Correlation to COVID-19 Mortality: New Evidence

Background: Literatures have already shown that malaria can elicit a non-specific immune response against viral, bacterial and other malarial and non-malarial infections. Possible role of heterogeneous immunity generated by previous malaria infection was suggested explaining part of diversity in COVID-19 mortality among various countries. This study is done to examine this hypotheses by testing correlation between COVID-19 mortality with duration of time since malaria was eliminated.Methods: 69 malaria free countries with a total population of 1 million or more were enrolled in this study using robust statistical tests which include: Mann-Whitney Test, Kendall's-τ coefficient test and receiver operation characteristic - (ROC)] curve analyses.Results: There was significant positive association between COVID-19 mortality and duration of time since date of malaria elimination. With cutoff point of 15, countries that eliminate malaria during last 15 years had reduced COVID-19 mortality, while countries that eliminate malaria more than 15 years ago there is high COVID-19 mortality. Conclusions: The author of this article suggests that a correlation exists between malaria elimination duration and mortality due to COVID-19. Further, clinical trials are suggested.

Evaluating the Effects of SARS-CoV-2 Spike Mutation D614G on Transmissibility and Pathogenicity

SummaryGlobal dispersal and increasing frequency of the SARS-CoV-2 spike protein variant D614G are suggestive of a selective advantage but may also be due to a random founder effect. We investigate the hypothesis for positive selection of spike D614G in the United Kingdom using more than 25,000 whole genome SARS-CoV-2 sequences. Despite the availability of a large dataset, well represented by both spike 614 variants, not all approaches showed a conclusive signal of positive selection. Population genetic analysis indicates that 614G increases in frequency relative to 614D in a manner consistent with a selective advantage. We do not find any indication that patients infected with the spike 614G variant have higher COVID-19 mortality or clinical severity, but 614G is associated with higher viral load and younger age of patients. Significant differences in growth and size of 614G phylogenetic clusters indicate a need for continued study of this variant.

All-cause mortality supports the COVID-19 mortality in Belgium and comparison with major fatal events of the last century

BackgroundThe COVID-19 mortality rate in Belgium has been ranked among the highest in the world. To assess the appropriateness of the country’s COVID-19 mortality surveillance, that includes long-term care facilities deaths and deaths in possible cases, the number of COVID-19 deaths was compared with the number of deaths from all-cause mortality. Mortality during the COVID-19 pandemic was also compared with historical mortality rates from the last century including those of the Spanish influenza pandemic.MethodsExcess mortality predictions and COVID-19 mortality data were analysed for the period March 10th to June 21st 2020. The number of COVID-19 deaths and the COVID-19 mortality rate per million were calculated for hospitals, nursing homes and other places of death, according to diagnostic status (confirmed/possible infection). To evaluate historical mortality, monthly mortality rates were calculated from January 1900 to June 2020.ResultsNine thousand five hundred ninety-one COVID-19 deaths and 39,076 deaths from all-causes were recorded, with a correlation of 94% (Spearman’s rho, p < 0,01). During the period with statistically significant excess mortality (March 20th to April 28th; total excess mortality 64.7%), 7917 excess deaths were observed among the 20,159 deaths from all-causes. In the same period, 7576 COVID-19 deaths were notified, indicating that 96% of the excess mortality were likely attributable to COVID-19. The inclusion of deaths in nursing homes doubled the COVID-19 mortality rate, while adding deaths in possible cases increased it by 27%. Deaths in laboratory-confirmed cases accounted for 69% of total COVID-19-related deaths and 43% of in-hospital deaths. Although the number of deaths was historically high, the monthly mortality rate was lower in April 2020 compared to the major fatal events of the last century.ConclusionsTrends in all-cause mortality during the first wave of the epidemic was a key indicator to validate the Belgium’s high COVID-19 mortality figures. A COVID-19 mortality surveillance limited to deaths from hospitalised and selected laboratory-confirmed cases would have underestimated the magnitude of the epidemic. Excess mortality, daily and monthly number of deaths in Belgium were historically high classifying undeniably the first wave of the COVID-19 epidemic as a fatal event.

Ageing Society and SARS-CoV-2 Mortality: Does the Healthcare Absorptive Capacity Matter?

This study examines the effect of the elderly population on SARS-CoV-2 Disease (COVID-19) mortality for a sample of 146 countries. It shows that the elderly population is robustly associated with higher COVID-19 mortality. This effect, however, decreases significantly in countries with higher health care absorptive capacity. The results are robust to control for a set of economic, institutional and regional variables.

Ambient PM2.5 exposure and rapid spread of COVID-19 in the United States

It has been posited that populations being exposed to long-term air pollution are more susceptible to COVID-19. Evidence is emerging that long-term exposure to ambient PM2.5 (particulate matter with aerodynamic diameter 2.5 μm or less) associates with higher COVID-19 mortality rates, but whether it also associates with the speed at which the disease is capable of spreading in a population is unknown. Here, we establish the association between long-term exposure to ambient PM2.5 in the United States (US) and COVID-19 basic reproduction ratio R0– a dimensionless epidemic measure of the rapidity of disease spread through a population. We inferred state-level R0 values using a state-of-the-art susceptible, exposed, infected, and recovered (SEIR) model initialized with COVID-19 epidemiological data corresponding to the period March 2–April 30. This period was characterized by a rapid surge in COVID-19 cases across the US states, implementation of strict social distancing measures, and a significant drop in outdoor air pollution. We find that an increase of 1 μg/m3 in PM2.5 levels below current national ambient air quality standards associates with an increase of 0.25 in R0 (95% CI: 0.048–0.447). A 10% increase in secondary inorganic composition, sulfate-nitrate-ammonium, in PM2.5 associates with ≈10% increase in R0 by 0.22 (95% CI: 0.083–0.352), and presence of black carbon (soot) in the ambient environment moderates this relationship. We considered several potential confounding factors in our analysis, including gaseous air pollutants and socio-economical and meteorological conditions. Our results underscore two policy implications – first, regulatory standards need to be better guided by exploring the concentration-response relationships near the lower end of the PM2.5 air quality distribution; and second, pollution regulations need to be continually enforced for combustion emissions that largely determine secondary inorganic aerosol formation.

Residential context and COVID-19 mortality among adults aged 70 years and older in Stockholm: a population-based, observational study using individual-level data

BackgroundHousing characteristics and neighbourhood context are considered risk factors for COVID-19 mortality among older adults. The aim of this study was to investigate how individual-level housing and neighbourhood characteristics are associated with COVID-19 mortality in older adults.MethodsFor this population-based, observational study, we used data from the cause-of-death register held by the Swedish National Board of Health and Welfare to identify recorded COVID-19 mortality and mortality from other causes among individuals (aged ≥70 years) in Stockholm county, Sweden, between March 12 and May 8, 2020. This information was linked to population-register data from December, 2019, including socioeconomic, demographic, and residential characteristics. We ran Cox proportional hazards regressions for the risk of dying from COVID-19 and from all other causes. The independent variables were area (m2) per individual in the household, the age structure of the household, type of housing, confirmed cases of COVID-19 in the borough, and neighbourhood population density. All models were adjusted for individual age, sex, country of birth, income, and education.FindingsOf 279 961 individuals identified to be aged 70 years or older on March 12, 2020, and residing in Stockholm in December, 2019, 274 712 met the eligibility criteria and were included in the study population. Between March 12 and May 8, 2020, 3386 deaths occurred, of which 1301 were reported as COVID-19 deaths. In fully adjusted models, household and neighbourhood characteristics were independently associated with COVID-19 mortality among older adults. Compared with living in a household with individuals aged 66 years or older, living with someone of working age (<66 years) was associated with increased COVID-19 mortality (hazard ratio 1·6; 95% CI 1·3–2·0). Living in a care home was associated with an increased risk of COVID-19 mortality (4·1; 3·5–4·9) compared with living in independent housing. Living in neighbourhoods with the highest population density (≥5000 individuals per km2) was associated with higher COVID-19 mortality (1·7; 1·1–2·4) compared with living in the least densely populated neighbourhoods (0 to <150 individuals per km2).InterpretationClose exposure to working-age household members and neighbours is associated with increased COVID-19 mortality among older adults. Similarly, living in a care home is associated with increased mortality, potentially through exposure to visitors and care workers, but also due to poor underlying health among care-home residents. These factors should be considered when developing strategies to protect this group.FundingSwedish Research Council for Health, Working Life and Welfare (FORTE), Swedish Foundation for Humanities and Social Sciences.

A well-being champion and the role of self-reflective practice for ICU nurses during COVID-19 and beyond.

A well-being champion and the role of self-reflective practice for ICU nurses during COVID-19 and beyond.

COVID-19: prevention and future initiative within nursing homes

The high COVID-19 mortality rate in nursing homes in the United States and internationally prompted a comprehensive mini literature review concerning the prevalence, preventative protocol, and proactive initiatives against the highly infectious COVID-19. PubMed articles published between January and June 2020 and data sourced from government ministries of health concerning COVID-19 in nursing homes were used for this review. The prevalence and mortality rate in seven countries were compared. The underlying theme of the articles reviewed addressed four focus areas for the prevention of infectious disease spread: diagnostics, protection of residents in nursing facilities, administration and staff protection, and legislative advocacy. Adaptations and solutions may reduce the current transmission of COVID-19 within nursing homes, as well as in the future.

Racial Disparities in Air Pollution Burden and COVID-19 Deaths in Louisiana, USA, in the Context of Long-Term Changes in Fine Particulate Pollution

Black Americans in Louisiana are disproportionately dying from COVID-19, and environmental disparities may be contributing to this injustice. While Black communities in Louisiana's industrialized regions (e.g., Cancer Alley, Calcasieu Parish) have been overburdened with pollution for decades, this disparity has not been evaluated by using recent data. Here, we explore statewide relationships among air pollution burden, race, COVID-19 death rates, and other health/socioeconomic factors. Measures of pollution burden included satellite-derived particulate matter (PM2.5) concentrations and health risks from toxic air pollution (i.e., respiratory hazard [RH] and immunological hazard [IH], estimated by the Environmental Protection Agency). In addition, we evaluate changes in emissions and ambient concentrations of fine PM2.5 in Louisiana over the past few decades. Our overall goal was to better understand Louisiana's burden of air pollution in the context of COVID-19. By all measures, a higher burden of air pollution was associated with larger percentages of Black residents and increased unemployment across Louisiana census tracts. Across parishes, higher COVID-19 death rates were associated with increased RH and IH and larger percentages of Black residents. These associations were not driven by diabetes, obesity, smoking, age, or poverty. Industrial sources comprised more of Louisiana's PM2.5 in 2017 versus 1990, as vehicle contributions declined 75% whereas industrial emissions remained about the same overall (despite variation in the interim). Ambient concentrations of PM2.5 decreased statewide from 2000 to 2015, but subsequently increased in south Louisiana, concurrent with an upward trend in industrial emissions. Our findings highlight the critical need to address Louisiana's pollution disparities and to recognize air pollution exposure as a risk factor for COVID-19.

High COVID-19 mortality in the UK: lessons to be learnt from Hubei province: are under-detected 'silent hypoxia' and subsequently low admission rate to blame?

High COVID-19 mortality in the UK: lessons to be learnt from Hubei province: are under-detected 'silent hypoxia' and subsequently low admission rate to blame?

Is Tirschenreuth the Colorado of Germany linking high COVID-19 mortality and low magnesium in drinking water?

Is Tirschenreuth the Colorado of Germany linking high COVID-19 mortality and low magnesium in drinking water?