Higher Risk Of Severe Illness Research Articles

Patient Perspective: Vaccines for Older People.

Pharmacists, as one of the most accessible health care professionals in the community, can educate, promote, and administer vaccinations. Immunizations are an important way to protect communities from potentially severe diseases, including COVID-19, influenza, pneumonia, shingles, hepatitis, and monkeypox. Though adults 65 years of age and older tend to have higher vaccination rates than other age groups, there are health care disparities that exist in relation to socioeconomic status, race, ethnicity, gender, and sexuality. Vaccine hesitancy and misconceptions cause concerns in older people that can challenge both vaccine administration and rates. Other concerns for older people are the cost, safety, and side effects of vaccines. In addition, updated vaccine guidelines were released by the Centers for Disease Control and Prevention (CDC) in early 2023 that affect recommendations for influenza, COVID-19, and pneumonia vaccines. Older people are at higher risk for severe illness, making immunizations especially important in this patient population. Pharmacists can play a pivotal role in health promotion by staying up to date on immunization guidelines and addressing barriers to vaccination.

The First Differentiated TB Care Model From India: Delays and Predictors of Losses in the Care Cascade.

To reduce TB deaths in resource-limited settings, a differentiated care strategy can be used to triage patients with high risk of severe illness (i.e., those with very severe undernutrition, respiratory insufficiency, or inability to stand without support) at diagnosis and refer them for comprehensive assessment and inpatient care. Globally, there are few examples of implementing this type of strategy in routine program settings. Beginning in April 2022, the Indian state of Tamil Nadu implemented a differentiated care strategy called Tamil Nadu-Kasanoi Erappila Thittam (TN-KET) for all adults aged 15 years and older with drug-susceptible TB notified by public facilities. Before evaluating the impact on TB deaths, we sought to understand the retention and delays in the care cascade as well as predictors of losses. During April-June 2022, 14,961 TB patients were notified and 11,599 (78%) were triaged. Of those triaged, 1,509 (13%) were at high risk of severe illness; of these, 1,128 (75%) were comprehensively assessed at a nodal inpatient care facility. Of 993 confirmed as severely ill, 909 (92%) were admitted, with 8% unfavorable admission outcomes (4% deaths). Median admission duration was 4 days. From diagnosis, the median delay in triaging and admission of severely ill patients was 1 day each. Likelihood of triaging decreased for people with extrapulmonary TB, those diagnosed in high-notification districts or teaching hospitals, and those transferred out of district. Predictors of not being comprehensively assessed included: aged 25-34 years, able to stand without support, and diagnosis at a primary or secondary-level facility. Inability to stand without support was a predictor of unfavorable admission outcomes. To conclude, the first quarter of implementation suggests that TN-KET was feasible to implement but could be improved by addressing predictors of losses in the care cascade and increasing admission duration.

Make No Apologies: Fear of Negative Evaluation, Depressive Symptoms, and the Mediating Role of Accounting for COVID-Safe Behavior Amongst People at High-Risk for Severe Illness

ABSTRACT With the goal of understanding unique and important threats to the mental health of people who are especially vulnerable to severe illness as a result of COVID-19, this study investigated associations between such individuals’ fear of negative evaluation, tendency to “account for” practicing COVID-safe behaviors, and depressive symptoms. Grounded in perspectives on self-presentation, normative influence, and cognitive dissonance, we hypothesized that fear of negative evaluation would relate positively to accounting for COVID-safe behaviors, which, in turn, would associate positively with increased depressive symptoms. The results showed that increased fear of negative evaluation predicted an increased use of apologies and excuses, which in turn were positively related to depressive symptoms. Justifications for COVID-safe behaviors were not significantly associated with either fear of evaluation or depressive symptoms. The practical and theoretical implications are discussed.

Impact of the COVID-19 Pandemic on Antihyperglycemic Prescriptions for Adults With Type 2 Diabetes in Canada: A Cross-sectional Study

ObjectivesDiabetes is a major public health problem in Canada and requires multifactorial, consistent clinical management. The COVID-19 pandemic has increased challenges in the management of many chronic ailments, including diabetes. Diabetes was associated with a higher risk of severe illness in the context of COVID-19. Pandemic restrictions also impacted diabetes care continuity, which may have contributed to an increased risk of diabetes-related complications and mortality. MethodsThis was a retrospective cross-sectional study of prescription patterns of antihyperglycemic medications claimed by individuals with type 2 diabetes (T2D) before and during the COVID-19 pandemic using the IQVIA Canada Longitudinal Prescription Claims database. The study period was from March 1, 2018, to February 28, 2021. The study outcomes are described on a monthly, quarterly, and yearly basis and overall, and by medication, medication class, and insurance coverage type. “New-to-molecule” patients were defined as those claiming a medication during the analysis period that they had no history of claiming in the database. Adults with at least 1 year of prescription history available and claiming their first prescription for an antihyperglycemic drug during the analysis period were classified as newly diagnosed with T2D. ResultsA similar number of people had at least 1 non-insulin antihyperglycemic prescription during the baseline, prepandemic, and pandemic periods in Canada (1,778,155, 1,822,403, and 1,797,272, respectively). However, the number of people initiating newer antihyperglycemic medications decreased at the beginning of the pandemic, in contrast to older medications, which remained consistent across the pandemic period. The number of people diagnosed with T2D decreased in the early months of the pandemic but recovered by October 2020. ConclusionThe COVID-19 epidemic in Canada impacted clinical care for at-risk Canadians, with fewer being prescribed newer antihyperglycemic drugs and a reduction in the number of diagnoses of T2D.

Prevalence of high-risk conditions for severe COVID-19 among Medicaid-enrolled children with autism and mental health diagnoses in the United States.

Children are at risk of varying severity of illness and even death from COVID-19. We aim to determine whether autistic children or children with mental health conditions have more underlying health conditions that put people at risk of severe illness from COVID-19. We use data from a national sample of Medicaid-enrolled children for the years 2008-2016. These data include children across the 50 states and the District of Columbia. We compare the prevalence of underlying conditions among autistic children and children with mental health condition to that of other children in Medicaid. This study included 888,487 autistic children, 423,397 with any mental health condition (but not autism), and 932,625 children without any of these diagnoses. We found 29.5% of autistic children and 25.2% of children with mental health conditions had an underlying condition with high risk for severe illness from COVID, compared to 14.1% of children without these diagnoses. Autistic children had over twice the odds of having any underlying conditions, when accounting for age, race, sex, and other characteristics. Children with mental health conditions had 70% higher odds of having these underlying conditions. Mitigation measures in schools and other areas could minimize risk of short- and long-term impacts from COVID for autistic and all children.

Assessment of the influence of ABO blood groups on oral cholera vaccine immunogenicity in a cholera endemic area in Zambia

BackgroundHisto-blood group antigens (HBGAs) which include the ABO and Lewis antigen systems have been known for determining predisposition to infections. For instance, blood group O individuals have a higher risk of severe illness due to V. cholerae compared to those with non-blood group O antigens. We set out to determine the influence that these HBGAs have on oral cholera vaccine immunogenicity and seroconversion in individuals residing within a cholera endemic area in Zambia.MethodologyWe conducted a longitudinal study nested under a clinical trial in which samples from a cohort of 223 adults who were vaccinated with two doses of Shanchol™ and followed up over 4 years were used. We measured serum vibriocidal geometric mean titers (GMTs) at Baseline, Day 28, Months 6, 12, 24, 30, 36 and 48 in response to the vaccine. Saliva obtained at 1 year post vaccination was tested for HBGA phenotypes and secretor status using an enzyme-linked immunosorbent assay (ELISA).ResultsOf the 133/223 participants included in the final analysis, the majority were above 34 years old (58%) and of these, 90% were males. Seroconversion rates to V. cholerae O1 Inaba with non-O (23%) and O (30%) blood types were comparable. The same pattern was observed against O1 Ogawa serotype between non-O (25%) and O (35%). This trend continued over the four-year follow-up period.Similarly, no significant differences were observed in seroconversion rates between the non-secretors (26%) and secretors (36%) against V. cholerae O1 Inaba. The same was observed for O1 Ogawa in non-secretors (22%) and the secretors (36%).ConclusionOur results do not support the idea that ABO blood grouping influence vaccine uptake and responses against cholera.

The Pandemic Special with a Side of Shut-Downs: A Note on NYC's Restaurants in the Age of COVID-19

SARS-CoV-2 is the virus causing the coronavirus disease (COVID-19). The World Health Organization (WHO) stated the virus originated in Wuhan, China. On March 11, 2020, the WHO declared COVID-19 a global pandemic. On the day of this declaration, New York City reported its first COVID-19 associated death. Three weeks after the discovery of the coronavirus, NYC accounted for 5% of the world’s confirmed cases, rendering the region a global epicenter. By May 2, 2020, New York City recorded 13,831 COVID-19 deaths, and estimated an additional 5,048 probable deaths. COVID-19 is infamous for its lethal effects: the Center for Disease Control listed COVID-19 symptoms that include “fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches . . . . ” For individuals who are at higher risk of severe illness (young children, the elderly, and those with compromised immune systems), COVID-19 is deadly. Globally, and as current as January, 2021, the WHO reported 93,611,355 confirmed cases, and over two million deaths. When the pandemic struck the State of New York in March 2020, Governor Cuomo signed Executive Order No. 202, declaring a state of emergency. Shortly after this declaration, the Governor signed the “New York on PAUSE” Executive Order which required all nonessential businesses to shut down. Subsequent guidance clarified the meaning of “essential businesses,” which did not include restaurants. The COVID-19 crisis in New York City eviscerated most restaurants’ capacities to conduct their ordinary business activities. Even when New York City began entering its reopening phases, the economic ramifications of COVID-19 and the Executive Orders continued to pose unprecedented hardships for restaurants. Despite the substantial health risks of resuming restaurant work amidst a global pandemic, many restaurant owners concluded that reopening their businesses would be an unprofitable and dangerous affair. Accordingly, many restaurant owners diligently, although with great sadness, elected to close shop permanently. Commercial rent in Midtown Manhattan and throughout New York City is expensive. Rent may be as high as thousands of dollars per square foot. As such, the pandemic understandably caused landlords anxiety about lost income. Yet some landlords began pestering small business owners for rent. Beyond mere pestering, such landlords have threatened to sue for damages to recover the rent owed. This crisis ended lengthy, harmonious, and profitable businesses ventures. Amongst the myraid, unfortunate results of this pandemic, a new looming threat of unjust enrichment emerges. If landlords threatening to sue small restaurant owners for rent owed succeed, such owners would suffer a burdensome economic harm, in addition to losing their businesses. This crisis raises complicated questions of contract and property law regarding commercial leases in the event of unforeseeable emergencies: should defendants in breach of contract lawsuits be required to pay rent when performance of the paramount contractual terms, i.e., operating the business safely, become no longer possible? Does a global pandemic constitute an “act of God” which triggers force majeure clauses? And in the absence of such clauses, can the common law doctrines of impossibility of performance or frustration of purpose rise up to the defense of the small business owner? Can the State and City of New York solve this matter through legislation and ordinances? This Note explores these questions, while prescribing the need for force majeure clauses that clearly define pandemics and other imminent natural disasters as triggering events as the most powerful prospective solution. This Note will first discuss COVID-19’s impact on New York City from public health, economic, and administrative perspectives. The next part will delve into relevant pending legislation and enacted NYC ordinances that respond directly to the issue of commercial rent in this crisis. Part III discusses the state of the common law of contracts with respect to force majeure and impossibility of performance doctrine. Part IV includes legal analysis of four major areas of contract law in New York: impossibility of performance doctrine, force majeure, landlord-tenant obligations, and remedies. Fifth, the note will propose solutions to this crisis. Retrospectively, considering that many contracts do not presently include “pandemics” in their clauses, the impossibility of performance doctrine in the absence of force majeure can serve to protect small business owners. Prospectively, force majeure and material adverse effect clauses should specify “pandemics,” by constituting the strongest form of protection for any party adversely affected by unforeseeable, catastrophic events. Finally, the Note will conclude by summarizing the major arguments and themes, and will reemphasize the policy considerations of protecting small restaurant owners from unjust enrichments in the COVID-19 context.

Associations of influenza and pneumococcal vaccinations with burdens of older family caregivers: The Japan Gerontological Evaluation study (JAGES) cross-sectional study.

Influenza and pneumonia tend to be severe in older adults; thus, vaccination is necessary to prevent these illnesses. Vaccination is especially important for older family caregivers (OFCs) not only to prevent them from becoming ill, but also to prevent secondary infections in the family care receivers (FCRs), who are mostly frail older adults and have a higher risk of severe illness. Thus, we investigated whether caregiving burdens were associated with the vaccinations among older adults. We used cross-sectional data from the Japan Gerontological Evaluation Study (JAGES), which was conducted in 64 Japanese municipalities from November 2019 to January 2020. The target population consisted of 26,177 individuals aged 65years or older who were independent and did not need public long-term care. The primary outcome was the uptakes of either or both influenza and pneumococcal vaccinations. Multinomial logistic regressions were performed, setting those who underwent neither vaccinations as the reference group. Among the participants, 23.3%, 25.8%, 9.4%, or 41.5% underwent neither, only influenza, only pneumococcal, or the both vaccinations, respectively. The caregiving frequency, time length in a day, or dementia of FCR were negatively associated with influenza vaccination (caregiving almost every day: relative risk ratio {RRR}: 0.39, 95% confident interval {95% CI} [0.24-0.63]; caregiving almost all day: 0.44, 95% CI: 0.23-0.85; caregiving for FCR: RRR:0.55, 95% CI: 0.34-0.91). On the other hand, those caregiving burdens were not associated with pneumococcal only or the both vaccinations. Having a family physician mitigated all the negative effect of the caregiving burdens on the vaccinations. Our results suggest that the caregiving burden is a barrier to influenza vaccination but not to pneumococcal vaccination and that having a physician mitigates the negative effect regardless of the burden kind.

CHANGES IN LIFE SATISFACTION DURING THE FIRST YEAR OF THE COVID-19 PANDEMIC: A LONGITUDINAL STUDY OF JAPANESE ADULTS

Abstract The outbreak of the novel coronavirus (COVID-19) has exerted a major impact on daily life. Despite older adults being at a higher risk of severe illness from COVID-19, research has indicated that older adults experienced the same or even higher levels of well-being during the early phase of the pandemic than younger adults. To investigate adverse long-term effects, we examined how individuals’ well-being changed during the first year of the pandemic. A total of 5,281 Japanese adults aged 15—89 years participated in an online survey in February 2020 (before the first state of emergency) and were followed up in March 2021 (during the second state of emergency; follow-up rate 54.7%). Well-being was assessed as a one-item indicator of life satisfaction, with a range of 0－10. Counterintuitively, results of a latent change score model demonstrated that life satisfaction increased over time (unstandardized coefficient of 1.17, SE = 0.16, standardized coefficient of 0.58). Individuals aged 64 years and below, with low levels of education, living alone, and perceiving worse health and economic status showed less increase in life satisfaction. In an additional analysis, those more concerned about the pandemic at follow-up displayed less increase. The findings suggest that most people did not exhibit a decrease in life satisfaction during the first year of the COVID-19 pandemic. However, certain individuals could be vulnerable to the outbreak due to the lack of resources. Researchers should better understand the factors that drive the resilience of older adults in the face of adversity.

LB1534. Cord blood and maternal cytokine levels following SARS-CoV-2 infection during pregnancy

Abstract Background Pregnant people and fetuses are uniquely vulnerable to SARS-CoV-2, a driver of inflammation and immune dysregulation. Prior investigations have shown that pregnant people with SARS-CoV-2 are at higher risk of severe illness, mortality, and obstetric complications. We investigated the impact of SARS-CoV-2 infection severity and latency on maternal and infant cytokine levels. Methods We collected maternal blood and cord blood at delivery from mother-infant dyads (Chicago, IL; 3/2020-1/2022). A multiplex cytokine panel (IsoPlexis) was run on plasma from 93 SARS-CoV-2 infected dyads and 32 matched controls. Clinical data was abstracted by chart review, including latency (acute being ≤14 days and distant >14 days from SARS-CoV-2 infection to delivery) and severity (NIH criteria: asymptomatic, mild, moderate, severe/critical). Kruskal-Wallis tests with post-hoc pairwise Dunn Tests were used (α=0.05). Results SARS-CoV-2 exposed infants had lower levels of MIP-1b (p=0.037) and PDGF (p=0.008) than controls [Fig 1]. There were no differences in maternal blood cytokines at time of delivery following SARS-CoV-2 infection during pregnancy (pooled analysis of all SARS-CoV-2). Stratifying by latency, acutely exposed infants showed higher levels of MCP-1 than controls or those with distant maternal SARS-CoV-2 (p=0.016). There were no significant differences in maternal cytokines between control, acute, and distant SARS-CoV-2. In mothers with acute SARS-CoV-2, differences in levels of IL-1B (p=0.011) and IL-10 (p=0.046) were observed across severity groups, with a significant linear trend for each among severity groups (p for trend < 0.001, respectively). Severe/critical acute infection resulted in higher maternal granzyme and IL-8 than mild infection (p=0.037 and 0.047) [Fig 2]. There were no differences across severity groups in 1) mothers with distant infection, 2) infants with acute maternal infection, or 3) infants with distant maternal infection. Maternal and infant cytokine levels in acute SARS-CoV-2 infection across severity Conclusion Cytokine levels in SARS-CoV-2 positive dyads were altered only in the setting of acute or more severe infection and demonstrated anti-inflammatory, anti-viral, and anti-angiogenic responses. In acute infection, greater severity drives higher levels of both a pro- and anti-inflammatory cytokine in pregnant people. Disclosures All Authors: No reported disclosures.

Outpatient Treatment with Anti-Sars-Cov-2 Monoclonal Antibodies and Remdesivir for COVID19 Infections Demonstrates Encouraging Outcomes in Hematopoietic Stem Cell Transplant Recipients: A Single-Center Experience

Introduction: Patients with hematologic malignancies are at high risk of severe illness and increased mortality from SARS-CoV-2 infection. Autologous (auto) and allogeneic (allo) hematopoietic stem cell transplant (HCT) recipients also have a higher likelihood of developing severe COVID-19 with increased risk of mortality as described in registry analysis (Sharma et al, Lancet Haematol 2021, Ljungman et al, Leukemia 2021). Several monoclonal antibody (MOAB) combinations, as well as the antiviral remdesivir (Rem) have been approved under an emergency use authorization (EUA) and for outpatients with mild to moderate COVID-19 at risk of progression. There is limited data on HCT patient outcomes in the era of novel COVID-19 directed treatments. The aim of this study is to describe the effectiveness of outpatient (OP) MOABs and Rem in HCT recipients at our institution. Methods: We conducted a retrospective analysis of HCT patients treated at H. Lee Moffitt Cancer Center who were COVID-19 PCR positive between June 2020 and February 2022. The primary endpoint was hospitalization related to severe SARS-CoV-2 infection. We used Fisher's exact test, the Wilcoxon test and the Chi-squared test to compare the characteristics of patients who progressed to severe COVID-19 requiring hospitalization and those who did not. Results: 150 HCT patients were PCR positive for COVID-19 thus were included in this analysis. Patient characteristics are described in Table 1. The mean age was 60 years old (interquartile range [IQR], 48-68 years old) with 61% males. The majority of patients (65%) were recipients of alloHCT, while 35% had autoHCT. Median time from cell therapy to COVID-19 diagnosis was 548 days (IQR 167-1368 days). Data on COVID-19 vaccinations was missing in the majority of patients and was not included in this analysis. At the time of diagnosis, 82% of alloHCT patients were on immunosuppressive therapy (IST) and 25% had received chemotherapy within the past 30 days prior to diagnosis. With a median follow up of 132 days (range 1-875 days), 32 patients (21%) required hospitalization with moderate to severe COVID-19 as primary diagnosis. A total of 89 subjects (59%) received MOABs active against circulating variants and/or Rem. Sixty-two (70%) were treated with only MOAB and 27 (30%) with Rem. Of those requiring hospitalization, eight (25%) had received OP treatment with MOAB or Rem in comparison to twenty-four patients (75%) who did not receive OP therapy (p-value<0.01). Hospitalized patients who received OP treatment were more likely to be older (median age 64 years [IQR 57-70] vs 56 years [IQR 47-64]; p-value=0.05), male (75% vs 44%; p-value = 0.45) and to have received chemotherapy in the preceding 30 days (50% vs 9%; p-value < 0.01). No differences in race, body mass index (BMI), type of transplant or conditioning were noted (Table 2). Overall, rates of COVID-19 related death were significantly lower in patients who had received OP therapy (N=2 [2.3%]) compared to those who had not (N=8 [13.1%]; p-value = 0.02). Of those admitted, 22 (69%) received inpatient Rem for five days with 59% and 27% receiving concurrent dexamethasone or tocilizumab respectively. Ten hospitalized patients died of COVID-19-related complications resulting in a mortality rate of 31.2% in patients requiring hospitalization. Conclusions: Treatment with anti-SARS-CoV-2 MOABs and Rem in 89 HCT patients at our institution demonstrated encouraging safety and efficacy in a high-risk population with an overall COVID-19 mortality rate of 2.3% which compares favorably to published data. Despite novel therapies for the treatment of COVID19, further studies are needed in HCT recipients as nearly one third of patients with severe disease requiring hospitalization died. While the study is limited by retrospective design and the presence of confounders, our findings support continued vigilance against COVID-19 in HCT recipients with early testing via PCR swabs and prompt outpatient therapy in mildly symptomatic patients. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Abstract 15282: COVID-19 Cases, Hospitalizations, and Vaccination Among Adults With Congenital Heart Disease

Background: There are conflicting data as to whether congenital heart disease (CHD) should be considered a condition that places a person at high risk of severe illness from COVID-19. The objective of our study was to compare COVID-19 cases, hospitalization rate, and vaccine uptake among adults with history of cardiac intervention vs. the general US adult population. Methods: We performed a cross-sectional study of adults using survey data from the Congenital Heart Disease Project to Understand Lifelong Survivor Experience (CHD PULSE). This survey, conducted in 2021-2022, queried CHD survivors regarding a variety of domains, including history of COVID-19 infection and vaccination. Adults with a history of surgical, catheter, or electrophysiologic intervention at 1 of 8 Pediatric Cardiac Care Consortium centers were eligible for inclusion. Results were limited to those aged 18-49 years to allow comparison to age-specific data from the US Centers for Disease Control and Prevention. Results: Among 1,277 respondents (20.2% response rate), the median age was 32 years (IQR: 27-38 years), the majority were female (55.6%), and the most common race/ethnicity was Non-Hispanic White (89.9%). There was no difference in history of a positive COVID-19 test in persons with CHD compared to adults of a similar age (26.8% vs 28.1%, p=0.86). However. those with CHD and COVID-19 were significantly more likely to require hospitalization than adults in the general population with COVID-19 (1.75% vs. 0.26%, p=0.004) (Figure). Regarding COVID-19 vaccination, 76.5% of CHD PULSE respondents reported a history of at least 1 COVID-19 vaccine, with no differences vs. the general population when compared by age (p=0.99). Conclusions: Given higher hospitalization rates among adults with CHD and COVID-19, CHD should be considered a medical condition that places one at increased risk of severe COVID-19. These findings underscore the importance of COVID-19 vaccination in this population.

Abstract 15507: The Role of Obesity in Covid-19 Pathogenesis and Inflammation

SARS-CoV-2 has caused a global pandemic unseen for nearly a century. To date hundreds of millions of people have been diagnosed and millions more have died from COVID-19 disease; many of which are in groups with comorbidities. Obesity is associated with a 3.07 times higher risk of hospitalization and a 1.42 times higher risk of severe illness. However, our understanding of obesity-accelerated severity of COVID-19 is limited. To model the increased disease severity of obese individuals with COVID-19, we used a humanized ACE2 (hACE2) transgenic mouse model, in which hACE2 is under the cytokeratin-18 promoter (K18). Modeling the effects of obesity on COVID-19 in K18-hACE2 mice will help us better understand the mechanisms underlying obesity-accelerated severity of COVID-19 disease and inflammation. We have developed a study in which K18 hACE2 mice infected with SARS-CoV-2 were fed both a normal standard diet as well as a western high fat and carbohydrate diet that causes them to gain excess weight and become obese over a period of 3 months. K18-hACE2 obese mice lose a signifyingly more percentage body weight over both a 7 (acute) 14 day (long-term) period than normal diet fed mice do after infection with SARS-CoV-2. H&amp;E staining analysis of lung histological changes indicated a dramatic increase in inflammation in our K18 hACE2 obese mice infected with SARS-CoV-2 . Subgenomic qPCR and IHC staining was used to quantify virus (viral titer) which indicated that in both of our diet groups after infection did not have a significantly different SARS-CoV-2 viral load. No significant difference in the SARS-CoV-2 viral load was detected at either 7 or 14 dpi with SARS-CoV-2 . We further measured adipokines with an ELISA on two of the most notable adipokines: leptin and adiponectin. Levels of leptin were significantly higher in our obese K18-hACE2 mice but not in our normal mice after infection. There was no difference however in the levels of adiponectin. Obese K18-hACE2 mice show a more severe COVID 19 phenotype than normal diet mice after infection and can be used to further study the underlying mechanism of how SARS-CoV-2 infection in obese individuals causes a more severe disease phenotype.

Understanding of COVID-19 vaccination in pregnant female – Hesitancy and acceptance: A prospective observational study

Background: India is one of the most severely affected countries due to the COVID-19 pandemic. A higher risk of severe illness and complications from COVID-19 had been observed in pregnant women as compared to nonpregnant women. The government of India on July 2, 2021, provided approval for the vaccination of pregnant women against COVID-19. A little data regarding the safety or harm during pregnancy of vaccination were available that time. Lack of safety data, fear, mistrust, underestimation of efficacy of vaccine, and chaos due to pandemic makes indecisive surrounding for pregnant women and this causes hesitancy with decision making about the COVID-19 vaccination. Aims and Objectives: This study aims to analyze the willingness and hesitancy of pregnant women to get vaccinated against COVID-19. Materials and Methods: This prospective study was conducted in a tertiary care institute in Northern India. Five hundred antenatal women who were eligible for COVID-19 vaccination were included in this study. Informed consent has been taken and data were analyzed after filling face to face questionnaire regarding vaccine acceptance or hesitancy. Results: The present study revealed low acceptance of COVID-19 vaccination in pregnancy. Prime reasons for the same are no allowance by the family and the possibility of vaccine harming the baby. Conclusion: Specific efforts should be directed toward high-risk populations including pregnant women and those who are planning for pregnancy. This will promote vaccination rates by increasing people’s trust in immunization and the health-care system.

Notes From the Field: Dispensing of Oral Antiviral Drugs for Treatment of COVID-19 by Zip Code-Level Social Vulnerability - United States, December 23, 2021-August 28, 2022.

Equitable access to COVID-19 therapeutics is a critical aspect of the distribution program led by the U.S. Department of Health and Human Services (HHS).* Two oral antiviral products, nirmatrelvir/ritonavir (Paxlovid)† and molnupiravir (Lagevrio),§ received emergency use authorization (EUA) from the Food and Drug Administration (FDA) in December 2021, to reduce the risk for COVID-19-associated hospitalization and death for those patients with mild to moderate COVID-19 who are at higher risk for severe illness (1,2). HHS has been distributing these medications at no cost to recipients since their authorization. Data collected from provider sites during December 23, 2021-May 21, 2022, indicated substantial disparities in the population-adjusted dispensing rates in high social vulnerability (high-vulnerability) zip codes compared with those in medium- and low-vulnerability zip codes (3). Specifically, dispensing rates for the 4-week period during April 24-May 21, 2022, were 122 per 100,000 residents (19% of overall population-adjusted dispensing rates) in high-vulnerability zip codes compared with 247 (42%) in medium-vulnerability and 274 (39%) in low-vulnerability zip codes. This report provides an updated analysis of dispensing rates by zip code-level social vulnerability and highlights important intervention strategies.

COVID-Washing in US Food and Beverage Marketing on Twitter: Content Analysis.

BackgroundFood companies have increased digital and social media ad expenditures during the COVID-19 pandemic, capitalizing on the coinciding increase in social media use during the pandemic. The extent of pandemic-related social media advertising and marketing tactics have been previously reported. No studies, however, have evaluated how food and beverage companies used COVID-washing on social media posts in the United States or analyzed the nutritional content of advertised food and beverage products. This study was designed to address these gaps by evaluating how food and beverage companies capitalize on the COVID-19 pandemic to promote unhealthy foods and sugary beverages.ObjectiveWe aimed to document the types and frequencies of COVID-19–related themes in US food and beverage companies’ Twitter posts during the first wave of the pandemic in the United States, and assess the nutritional quality of food and beverage products featured in these tweets.MethodsResearch assistants visited the Twitter accounts of the most-marketed food and beverage brands, and screen-captured all tweets posted between March 1 and May 31, 2020. Researchers documented the date of the tweet; the number of likes, views, comments, and “retweets”; and the type of food and beverage products. We coded tweets for the following 10 COVID-19 themes: (1) social distancing, staying home, or working remotely; (2) contactless delivery or pick-up; (3) handwashing or sanitizing; (4) masks; (5) safety or protection; (6) staying connected with others; (7) staying active; (8) frontline or essential workers; (9) monetary relief, donations, or unemployment; and (10) pandemic, unprecedented, or difficult times. Researchers calculated the nutrient profile index scores for featured foods and sorted beverages into categories based on sugar content.ResultsOur final sample included 874 COVID-19–themed tweets from 52 food and beverage brands. Social distancing themes appeared most frequently (n=367, 42%), followed by pandemic, unprecedented, or difficult times (n=246, 28.2%), and contactless delivery (n=237, 27.1%). The majority of tweets (n=682, 78%) promoted foods and beverages. Among those tweets featuring foods and beverages, 89.6% (n=611) promoted unhealthy products, whereas 17.2% (n=117) promoted healthy products.ConclusionsOur findings point to a concerning marketing tactic in which major food and beverage companies promote unhealthy foods and sugary beverages during the COVID-19 pandemic. Given that nutrition-related diseases such as obesity and diabetes are risk factors for COVID-19 morbidity and mortality, food and beverage companies should reduce the promotion of unhealthy products to help decrease the prevalence of health conditions that place people at higher risk for severe illness and death due to COVID-19.

The National COVID-19 Clinical Evidence Taskforce: pregnancy and perinatal guidelines.

IntroductionPregnant women are at higher risk of severe illness from coronavirus disease 2019 (COVID‐19) than non‐pregnant women of a similar age. Early in the COVID‐19 pandemic, it was clear that evidenced‐based guidance was needed, and that it would need to be updated rapidly. The National COVID‐19 Clinical Evidence Taskforce provided a resource to guide care for people with COVID‐19, including during pregnancy. Care for pregnant and breastfeeding women and their babies was included as a priority when the Taskforce was set up, with a Pregnancy and Perinatal Care Panel convened to guide clinical practice.Main recommendationsAs of May 2022, the Taskforce has made seven specific recommendations on care for pregnant women and those who have recently given birth. This includes supporting usual practices for the mode of birth, umbilical cord clamping, skin‐to‐skin contact, breastfeeding, rooming‐in, and using antenatal corticosteroids and magnesium sulfate as clinically indicated. There are 11 recommendations for COVID‐19‐specific treatments, including conditional recommendations for using remdesivir, tocilizumab and sotrovimab. Finally, there are recommendations not to use several disease‐modifying treatments for the treatment of COVID‐19, including hydroxychloroquine and ivermectin. The recommendations are continually updated to reflect new evidence, and the most up‐to‐date guidance is available online (https://covid19evidence.net.au).Changes in management resulting from the guidelinesThe National COVID‐19 Clinical Evidence Taskforce has been a critical component of the infrastructure to support Australian maternity care providers during the COVID‐19 pandemic. The Taskforce has shown that a rapid living guidelines approach is feasible and acceptable.

SOSIALISASI PENGENALAN VARIAN BARU VIRUS COVID-19 (OMICRON) GUNA MENINGKATKAN KESADARAN MASYARAKAT TENTANG PENTINGNYA VAKSINASI COVID-19

The virus that causes COVID-19, SARS-CoV-2 continues to undergo mutations forming new variants. The latest variant that has been detected, namely the Omicron variant known as the B.1.1.529 variant. The Omicron variant has a high transmission rate of up to 5 times that of the previous variant including the Delta variant. The speed of transmission that occurs in South Africa is still being carried out epidemiological studies to find out whether this is caused by Omicron or other factors. Transmission is easier to occur in individuals who have not received the vaccine and this can also cause complications in their treatment. Nonetheless, some countries are concerned about pressure on health systems due to the increased need for hospitalizations as the rate of transmission of this variant is much higher. Viral replication occurs 70 times faster in the respiratory tract, but 10 times slower when in human lung tissue. Because one of the efforts that can be done to avoid Covid-19 is to use a vaccine, it can help protect people around from the corona virus. Especially people who are at high risk of severe illness from COVID-19. By seeing these problems, it is necessary to have health counseling in getting to know the new variant of Covid-19 (omicron) and increasing public awareness of how important Covid-19 vaccination is

Summary of Guidance for Minimizing the Impact of COVID-19 on Individual Persons, Communities, and Health Care Systems - United States, August 2022.

As SARS-CoV-2, the virus that causes COVID-19, continues to circulate globally, high levels of vaccine- and infection-induced immunity and the availability of effective treatments and prevention tools have substantially reduced the risk for medically significant COVID-19 illness (severe acute illness and post-COVID-19 conditions) and associated hospitalization and death (1). These circumstances now allow public health efforts to minimize the individual and societal health impacts of COVID-19 by focusing on sustainable measures to further reduce medically significant illness as well as to minimize strain on the health care system, while reducing barriers to social, educational, and economic activity (2). Individual risk for medically significant COVID-19 depends on a person's risk for exposure to SARS-CoV-2 and their risk for developing severe illness if infected (3). Exposure risk can be mitigated through nonpharmaceutical interventions, including improving ventilation, use of masks or respirators indoors, and testing (4). The risk for medically significant illness increases with age, disability status, and underlying medical conditions but is considerably reduced by immunity derived from vaccination, previous infection, or both, as well as timely access to effective biomedical prevention measures and treatments (3,5). CDC's public health recommendations change in response to evolving science, the availability of biomedical and public health tools, and changes in context, such as levels of immunity in the population and currently circulating variants. CDC recommends a strategic approach to minimizing the impact of COVID-19 on health and society that relies on vaccination and therapeutics to prevent severe illness; use of multicomponent prevention measures where feasible; and particular emphasis on protecting persons at high risk for severe illness. Efforts to expand access to vaccination and therapeutics, including the use of preexposure prophylaxis for persons who are immunocompromised, antiviral agents, and therapeutic monoclonal antibodies, should be intensified to reduce the risk for medically significant illness and death. Efforts to protect persons at high risk for severe illness must ensure that all persons have access to information to understand their individual risk, as well as efficient and equitable access to vaccination, therapeutics, testing, and other prevention measures. Current priorities for preventing medically significant illness should focus on ensuring that persons 1) understand their risk, 2) take steps to protect themselves and others through vaccines, therapeutics, and nonpharmaceutical interventions when needed, 3) receive testing and wear masks if they have been exposed, and 4) receive testing if they are symptomatic, and isolate for ≥5 days if they are infected.

COVID-19 Incidence and Mortality in Long-Term Care Facilities in Tennessee.

Coronavirus Disease 2019, COVID-19, a viral infection, responsible for the latest pandemic has been shown to particularly affect the older population. Older adults, those aged 65 years and older, and individuals with serious underlying medical conditions are at a higher risk for severe illness from COVID-19 with a greater likelihood for hospitalization, admittance to the intensive care unit (ICU), and mortality. In this article, we describe the incidence and mortality rate found in Long Term Care facilities (LTCFs) and delineate any variations observed across varying types of LTCFs in the state of Tennessee (TN). Using aggregated data from the Tennessee (TN) Department of Health on COVID-19 Cases and Deaths from June 2020 to November 2021, we compare and contrast the incidence and fatality of COVID-19 among Long Term Care Facilities (LTCFs) in TN and describe the trends observed in these settings. Our study indicates that there were major variations in COVID-19 prevalence rates in Nursing Homes (NHs) - 49% versus Assisted Care Living Facilities (ACLFs) in TN -16%. Although COVID-19 prevalence rates differed for NH and ACLFs, 12% of infected residents died in NHs while 13% of infected residents died in ACLFs. (Odds Ratio [OR]: 1.08 95% Confidence Interval [CI]: 0.93 -1.3, z-score: 1.37, p value: 0.085). Cases were more prevalent in five counties namely Davidson, Shelby, Hamilton, Knox, and Rutherford, majority of which were Metropolitan. As new variants continue to appear, counties with higher prevalence of COVID-19 should take continued effort to protect both resident and staff members especially in NHs settings and Metropolitan cities, where prevalence rate of the illness is higher.