Low Fatality Rate Research Articles

Understanding varying COVID-19 mortality rates reported in Africa compared to Europe, Americas and Asia.

SummaryThe SARS‐CoV‐2 infection, which causes the COVID‐19 disease, has impacted every nation on the globe, albeit disproportionately. African countries have seen lower infection and mortality rates than most countries in the Americas Europe and Asia. In this commentary, we explore some of the factors purported to be responsible for the low COVID‐19 infection and case fatality rates in Africa: low testing rate, poor documentation of cause of death, younger age population, good vitamin D status as a result of exposure to sunlight, cross‐immunity from other viruses including coronaviruses, and lessons learnt from other infectious diseases such as HIV and Ebola. With the advent of a new variant of COVID‐19 and inadequate roll‐out of vaccines, an innovative and efficient response is needed to ramp up testing, contact tracing and accurate reporting of infection rates and cause of death in order to mitigate the spread of the infection.

Understanding the Differences in COVID-19 Case Fatality Rates Observed Across Alabama Counties.

To understand county-level variation in case fatality rates of COVID-19, a statewide analysis of COVID-19 incidence and fatality data was performed, using publicly available incidence and case fatality rate data of COVID-19 for all 67 Alabama counties and mapped with health disparities at the county level. A specific adaptation of the Shewhart p-chart, called a funnel chart, was used to compare case fatality rates. Important differences in case fatality rates across the counties did not appear to be reflective of differences in testing or incidence rates. Instead, a higher prevalence of comorbidities and vulnerabilities was observed in high fatality rate counties, while showing no differences in access to acute care. Funnel charts reliably identify counties with unexpected high and low COVID-19 case fatality rates. Social determinants of health are strongly associated with such differences. These data may assist in public health decisions including vaccination strategies, especially in southern states with similar demographics.

SARS-CoV-2 infection dynamics in Denmark, February through October 2020: Nature of the past epidemic and how it may develop in the future.

Initially, the relative sizes of the asymptomatic and the symptomatic infected populations were not known for the COVID-19 pandemic and neither was the actual fatality rate. Therefore it was not clear either how the pandemic would impact the healthcare system. As a result it was initially predicted that the COVID-19 epidemic in Denmark would overwhelm the healthcare system and thus both the diagnosis and treatment of other hospital patients were compromised for an extended period. To develop a mathematical model, which includes both asymptomatic and symptomatic infected persons, for early estimation of the epidemic's course, its Infection Fatality Rate and the healthcare system load in Denmark, both retrospectively and prospectively. The SEIRS (Susceptible-Exposed-Infected-Recovered-Susceptible) model including deaths outside hospitals and separate assessments of symptomatic and asymptomatic cases (based on seroprevalence) with different immunological memories. Optimal model parameters are in part identified by Monte Carlo based Least Square Error methods while micro-outbreaks are modeled by noise and explored in Monte Carlo simulations. Estimates for infected population sizes are obtained by using a quasi steady state method. The calculations and simulations made by the model were shown to fit with the observed development of the COVID-19 epidemic in Denmark. The antibody prevalence in the general population in May 2020 was 1.37%, which yields a relative frequency of symptomatic and asymptomatic cases of 1 to 5.2. Due to the large asymptomatic population, the Infection Mortality Rate was only 0.4%. However, with no non-pharmacological restrictions the COVID-19 death toll was calculated to have more than doubled the national average yearly deaths within a year. The transmission rate ℜ0 was 5.4 in the initial free epidemic period, 0.4 in the lock-down period and 0.8-1.0 in the successive re-opening periods through August 2020. The large asymptomatic population made the termination of the epidemic difficult and micro-outbreaks occurred when the country re-opened. The estimated infected population size July 15 to August 15 was 2,100 and 12,200 for October 1-20, 2020. The results of the model show, that COVID-19 has a low Infection Fatality Rate because the majority of infected persons are either asymptomatic or with few symptoms. A minority of the infected persons, therefore, requires hospitalization. That means that for a given infection pressure of both symptomatic and asymptomatic infected there will be a lower pressure on the capacity of the health care system than previously predicted. Further the epidemic will be difficult to terminate since about 84% of the infected individuals are asymptomatic but still contagious. The model may be useful if a major infection wave occurs in the autumn-winter season as it could make robust estimates both for the scale of an ongoing expanding epidemic and for the expected load on the healthcare system. The simulation may also be useful to evaluate different testing strategies based on estimated infected population sizes. The model can be adjusted and scaled to other regions and countries, which is illustrated with Spain and USA.

Death Rate in Lung Transplant Recipients during the COVID-19 Outbreak in France

PurposeData on outcomes in lung transplant recipients with SARS-CoV-2 infection remains limited. Given the potential higher COVID-19 severity in lung recipients, the Agence de la biomedecine has limited the transplant program to patients with high-urgency status during the first epidemic wave. The program has been fully restored where possible during the second epidemic wave. This study aimed to assess the impact of COVID-19 on lung recipient mortality in France.MethodsAll lung recipients with COVID-19 reported in the French national registry CRISTAL between February 1st and September 30th 2020 were included in the study. Patient characteristics were extracted from CRISTAL. Cumulative number of cases by month since February (Figure 1) and case fatality rate (CFR) were calculated. Mortality rates from February to September in the whole 2019 and 2020 recipient cohorts were compared. Survival curves were estimated using Kaplan-Meier method and compared using the log-rank test.ResultsOf the 46 patients (median age (IQR) 51 years (39-60), 54% female, median time from transplantation 3.5 years (0.8-7.1)) 88% required hospitalization including 21% in ICU. Eight patients died (CFR: 17.4%). No difference in 3-month survival was observed between 2020 and 2019 recipient cohorts (98.6% 95%CI [98.0%-99.0%] vs 98.4% [97.8%-98.8%], respectively) (Figure 2).ConclusionCOVID-19 was associated with lower fatality rate in lung recipients than in other organ transplant recipients and did not result in an excess mortality. These findings suggest that continuing lung transplant activity during the COVID-19 pandemic was a reasonable option.

COVID-19 in aged care homes: a comparison of effects initial government policies had in the UK (primarily focussing on England) and Australia during the first wave

BackgroundCOVID-19 pandemic has had a major impact globally, with older people living in aged care homes suffering high death rates.ObjectivesWe aimed to compare the impact of initial government policies on this vulnerable older population between the UK and Australia during the first wave of attack.MethodsWe searched websites of governments in the UK and Australia and media outlets. We examined the key policies including the national lockdown dates and the distribution of some important resources (personal protective equipment and testing) and the effects of these initial policies on the mortality rates in the aged care homes during the first wave of attack of COVID-19.ResultsWe found that both countries had prioritized resources to hospitals over aged care homes during the first wave of attack. Both countries had lower priority for aged care residents in hospitals (e.g. discharging without testing for COVID-19 or discouraging admissions). However, deaths in aged care homes were 270 times higher in the UK than in Australia as on 7 May 2020 (despite UK having a population only 2.5 times larger than Australia). The lower fatality rate in Australia may have been due to the earlier lockdown strategy when the total daily cases were low in Australia (118) compared to the UK (over 1000), as well as the better community viral testing regime in Australia.ConclusionIn conclusion, the public health policy in Australia aimed towards earlier intervention with earlier national lockdown and more viral testing to prevent new cases. This primary prevention could have resulted in more lives being saved. In contrast, the initial policy in the UK focussed mainly on protecting resources for hospitals, and there was a delay in national lockdown intervention and lower viral testing rate, resulting in more lives lost in the aged care sector.

Entry, egress and vertical transmission of SARS-CoV-2

The high infectivity and pathogenicity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have caused the COVID-19 outbreak, one of the most devastating pandemics in more than a century. This pandemic has already left a trail of destruction, including enormous loss of life, a global economic slump, and widespread psychological damage. Despite assiduous world-wide endeavors, an effective cure for COVID-19 is still lacking. Surprisingly, infected neonates and children have relatively mild clinical manifestations and a much lower fatality rate than elderly adults. Recent studies have unambiguously demonstrated the vertical transmission of SARS-CoV-2 from infected pregnant women to fetuses, which creates yet another challenge for disease prevention. In this review, we will summarize the molecular mechanism for entry of SARS-CoV-2 into host cells, the basis for the failure of the lungs and other organs in severe acute cases, and the evidence for congenital transmission.

Clinical Insights into SARS-COV-2 Infection in Rural Rajasthan, India

Background: This study aimed to highlight the primary endpoint of death and to understand the clinical andepidemiological characteristics of COVID-19 infection in the rural community of Chittorgarh, Rajasthan,India.Method: This was a retrospective, observational study of COVID-19 patients from March to June 2020 thatcollected and analysed epidemiological, clinical, laboratory, and radiological data.Results: In 353 patients, COVID-19 affected all age groups, mainly those aged 16–49 years, followed bythose aged 50–64 years; 82.43% were male; 68% of infected patients were asymptomatic at presentationand were incidentally positive on contact tracing. Among symptomatic cases, fever (88%) was the mostcommon symptom; of 14 severe COVID-19 patients with pneumonia, 8 died. Leukopenia, lymphopenia,thrombocytopenia, and abnormal liver function tests were common lab findings. Thirty patients hadradiographic evidence of pneumonia. The most common complications were acute respiratory distresssyndrome, multiple organ dysfunction syndrome, and kidney injury. The case fatality rate was 0.02%, andthe Sequential Organ Failure Assessment score>6 was a surrogate marker for admittance to the intensivecare unit.Conclusion: Low case fatality rate and SOFA score surrogate for ICU admittance

Clinical Characteristics and Mortality Profile of COVID-19 Patients Aged less than 20 years Old in Pernambuco - Brazil.

ABSTRACTCOVID-19 in children and adolescents has low frequency, severity, and fatality rate all over the world. A cross-sectional study was conducted to assess the epidemiological and clinical aspects of COVID-19 in patients younger than 20 years in Pernambuco (Brazil), with cases confirmed by reverse-transcriptase–PCR SARS-CoV-2 between 13 February and June 19, 2020, reported on information systems. Data regarding age (< 30 days, 1–11 months, 1–4 years, 5–9 years, 10–14 years, and 15–19 years), gender, color/race, symptoms, pregnancy or puerperium, comorbidities, hospitalization, and death were investigated. Fatality rate and mortality coefficient were calculated, and a multiple logistic regression analysis was performed to determine if gender, age, and comorbidities were factors associated with death. Of 682 pediatric cases, 52.8% were female, with a mean age of 9 ± 7.2 years. The most frequent symptoms were fever (64.4%), cough (52.4%), and respiratory distress (32.4%). Hospitalization was reported in 46.2% of cases, mainly among neonates (80.3%) and infants (73.8%). Thirty-eight deaths were notified, and a fatality rate of 5.6% (95% CI: 3.9–7.3) was found, with higher fatality rates among neonates 11.5% (7 of 61) and 9.5% (8 of 84) infants. The mortality coefficient was 10.9 per 100,000 inhabitants < 1 year of age, whereas comorbidities (Odds ratio [OR] = 14.13, 95% CI: 6.35–31.44), age < 30 days (OR = 5.17, 95% CI: 1.81–14.77), and age 1–11 months (OR = 3.28, 95% CI: 1.21–8.91) were independent factors associated with death. The results demonstrate the vulnerability of neonates and infants with severe conditions, need hospitalization, and high fatality rate, indicating the necessity to adapt public health policies for these age-groups.

SARS-Cov2 S Protein Features Potential Estrogen Binding Site.

SUMMARYResearch backgroundDuring the current SARS-CoV2 pandemic, as well as earlier SARS and MERS epidemics, it has been observed that COVID19-positive women on average tend to have milder symptoms and lower fatality rates than men. There is a number of differences between the sexes known to contribute to different immune responses and severity of the disease, one being the effect of estrogen via estrogen receptor signalling. We wondered if estrogen might also affect the SARS-CoV2 more directly, perhaps by binding to the surface glycoprotein (S protein), thus possibly reducing its infectivity.Experimental approachTo assess whether there is a possibility for estrogen binding on the SARS-CoV2 S protein, we used BLAST and HHpred to compare protein sequences of S protein and human estrogen receptor β, while 3D structures of a potential estrogen binding site and an active site of estrogen receptor β were visualized and compared using PyMOL.Results and conclusionsBy comparing the sequence of SARS-CoV2 S protein with the human estrogen receptor β, we identified a potential estrogen binding site on S protein and further determined that it also shares notable similarities with the active site of ER β when observed in 3D structure of their respective proteins. As a control, SARS-CoV2 S protein was compared with the human androgen receptor, and no such similarities were found. The potential estrogen binding site is part of coronavirus S2 superfamily domain, which is involved in host-virus membrane fusion during infection and appears to be conserved throughout the Coronaviridae family.Novelty and scientific contributionThis preliminary communication shows that SARS-CoV2 S protein features a potential estrogen binding site. Hopefully, this will prompt a more comprehensive study on the possibilities of estrogen binding on the S protein and the effect this might confer on the virus infectivity.

Majority world successes and European and American failure to contain COVID-19: Cultural collectivism and global leadership.

United Nations and World Health Organization data show a positive correlation, r = .53, p < .0001, N = 189, between COVID‐19 infection rates and the human development index (HDI). Less wealthy, less educated countries with lower life spans were also more successful in maintaining lower fatality rates, r = .46, p < .0001, N = 189 whereas 9 of the top‐10 countries in the world in per capita fatalities due to COVID‐19 were Western societies high in HDI. Similar positive correlations were found between COVID‐19 infection and fatality rates and a smaller sample of 76 countries measured on Schwartz intellectual autonomy (or individualism), and negative correlations of similar magnitude were found for embeddedness (or collectivism). East Asia was a global leader in preventing the spread of COVID‐19 because of a vigilant public concerned for public safety and compliant with public safety measures. African Union leaders coordinated their responses, and bought into a continent‐wide African Medical Supplies Platform that prevented panicked competition for scare supplies. Western global media and scholars have not paid attention to the successes of East Asia, Africa, and the South Pacific in fighting the pandemic. It is worth asking why this should be the case; understand the weaknesses of extreme individualism in fighting a pandemic requiring coordinated and unified public response, and consider the lessons for global scholars from the pandemic for doing research in the future.

Innovative approach for potential scale-up to jump-start simplified management of sick young infants with possible serious bacterial infection when a referral is not feasible: Findings from implementation research.

Neonatal bacterial infections are a common cause of death, which can be managed well with inpatient treatment. Unfortunately, many families in low resource settings do not accept referral to a hospital. The World Health Organization (WHO) developed a guideline for management of young infants up to 2 months of age with possible serious bacterial infection (PSBI) when referral is not feasible. Government of Ethiopia with WHO evaluated the feasibility of implementing this guideline to increase coverage of treatment. The objective of this study was to implement a simplified antibiotic regimen (2 days gentamicin injection and 7 days oral amoxicillin) for management of sick young infants with PSBI in a programme setting when referral was not feasible to identify at least 80% of PSBI cases, achieve an overall adequate treatment coverage of at least 80% and document the challenges and opportunities for implementation at the community level in two districts in Tigray, Ethiopia. Using implementation research, we applied the PSBI guideline in a programme setting from January 2016 to August 2017 in Raya Alamata and Raya Azebo Woredas (districts) in Southern Tigray, Ethiopia with a population of 260884. Policy dialogue was held with decision-makers, programme implementers and stakeholders at federal, regional and district levels, and a Technical Support Unit (TSU) was established. Health Extension Workers (HEWs) working at the health posts and supervisors working at the health centres were trained in WHO guideline to manage sick young infants when referral was not feasible. Communities were sensitized towards appropriate home care. We identified 854 young infants with any sign of PSBI in the study population of 7857 live births. The expected live births during the study period were 9821. Assuming 10% of neonates will have any sign of PSBI within the first 2 months of life (n = 982), the coverage of appropriate treatment of PSBI cases in our study area was 87% (854/982). Of the 854 sick young infants, 333 (39%) were taken directly to a hospital and 521 (61%) were identified by HEW at health posts. Of the 521 young infants, 27 (5.2%) had signs of critical illness, 181 (34.7%) had signs of clinical severe infection, whereas 313 (60.1%) young infants 7-59 days of age had only fast breathing pneumonia. All young infants with critical illness accepted referral to a hospital, while 117/181 (64.6%) infants with clinical severe infection accepted referral. Families of 64 (35.3%) infants with clinical severe infection refused referral and were treated at the health post with injectable gentamicin for 2 days plus oral amoxicillin for 7 days. All 64 completed recommended gentamicin doses and 63/64 (98%) completed recommended amoxicillin doses. Of 313 young infants, 7-59 days with pneumonia who were treated by the HEWs without referral with oral amoxicillin for 7 days, 310 (99%) received all 14 doses. No deaths were reported among those treated on an outpatient basis at health posts. But 35/477 (7%) deaths occurred among young infants treated at hospital. When referral is not feasible, young infants with PSBI can be managed appropriately at health posts by HEWs in the existing health system in Ethiopia with high coverage, low treatment failure and a low case fatality rate. Moreover, fast breathing pneumonia in infants 7-59 days of age can be successfully treated at the health post without referral. Relatively higher mortality in sick young infants at the referral level health facilities warrants further investigation.

In Silico Study of Polyunsaturated Fatty Acids as Potential SARS-CoV-2 Spike Protein Closed Conformation Stabilizers: Epidemiological and Computational Approaches.

SARS-CoV-2 infects host cells by interacting its spike protein with surface angiotensin-converting enzyme 2 (ACE2) receptors, expressed in lung and other cell types. Although several risk factors could explain why some countries have lower incidence and fatality rates than others, environmental factors such as diet should be considered. It has been described that countries with high polyunsaturated fatty acid (PUFA) intake have a lower number of COVID-19 victims and a higher rate of recovery from the disease. Moreover, it was found that linoleic acid, an omega-6 PUFA, could stabilize the spike protein in a closed conformation, blocking its interaction with ACE2. These facts prompted us to perform in silico simulations to determine if other PUFA could also stabilize the closed conformation of spike protein and potentially lead to a reduction in SARS-CoV-2 infection. We found that: (a) countries whose source of omega-3 is from marine origin have lower fatality rates; and (b) like linoleic acid, omega-3 PUFA could also bind to the closed conformation of spike protein and therefore, could help reduce COVID-19 complications by reducing viral entrance to cells, in addition to their known anti-inflammatory effects.

The good, the bad and the ugly of lockdowns during Covid-19.

Amidst the rapid global spread of Covid-19, many governments enforced country-wide lockdowns, with likely severe well-being consequences. In this regard, South Africa is an extreme case suffering from low levels of well-being, but at the same time enforcing very strict lockdown regulations. In this study, we analyse the causal effect of a lockdown and consequently, the determinants of happiness during the aforementioned. A difference-in-difference approach is used to make causal inferences on the lockdown effect on happiness, and an OLS estimation investigates the determinants of happiness after lockdown. The results show that the lockdown had a significant and negative impact on happiness. In analysing the determinants of happiness after lockdown, we found that stay-at-home orders have positively impacted happiness during this period. On the other hand, other lockdown regulations such as a ban on alcohol sales, a fear of becoming unemployed and a greater reliance on social media have negative effects, culminating in a net loss in happiness. Interestingly, Covid-19, proxied by new deaths per day, had an inverted U-shape relationship with happiness. Seemingly people were, at the onset of Covid-19 positive and optimistic about the low fatality rates and the high recovery rates. However, as the pandemic progressed, they became more concerned, and this relationship changed and became negative, with peoples' happiness decreasing as the number of new deaths increased.

Coronaviruses - a new old menace.

The current pandemic caused by novel coronavirus SARS-CoV-2 pandemic has been described as a global health emergency. The outbreak of this virus has raised a number of questions: what exactly is SARS-CoV-2? How transmissible the novel coronavirus is? How severely affected are patients infected with SARS-CoV-2? What are the risk factors for COVID-19? What are the differences between this novel coronavirus and other coronaviruses? To answer these questions, a comparative study of three pathogenic coronaviruses that primarily invade the human respiratory system and may cause death, namely, severe acute respiratory syndrome (SARS-CoV-1), Middle East respiratory syndrome (MERS-CoV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Middle East respiratory syndrome coronavirus (MERS-CoV). This review describes the source of origin, transmission, and pathogenicity of these viruses. Prevention of SARS-CoV-2 spreading entails home isolation of suspected cases and those with mild illnesses and strict infection control measures at hospitals that include contact and droplet precautions. The novel coronavirus spreads faster than its two predecessors - the SARS-CoV-1 and MERS-CoV - but has lower fatality rate. The global impact of this new pandemic is still uncertain, but it is a challenge to healthcare systems around the world.

Predictors of COVID-19 Case Fatality Rate in Highly Populated Developed Countries During the Emergence of the Delta Variant

By September 2021 the outbreak of the COVID-19 caused 228.19 million confirmed cases and 4.7 million deaths globally. Mortality measures are frequently used to estimate the severity of a pandemic. Among them is the Case Fatality Rate (CFR). Some mathematical models were developed to estimate the impact of specific factors on the disease’s mortality. These models were developed before the COVID-19 vaccines were administrated, and therefore did not consider the vaccines influence on COVID-19 fatality. Moreover, some other factors associated with COVID-19 mortality such as diabetes and cardiovascular mortality were not included in these models. This study offers a mathematical model with some potential predictors of COVID-19 CFR during the fourth pandemic wave caused by the Delta variant. To evaluate these predictors, demographic and clinical information for 10 highly populated developed countries was retrieved from a real-time available website. Demographic data included population density, percent of population above age 65, GDP per capita, and percent of smoking. Clinical data included diabetes prevalence, cardiovascular death rate, percent of fully vaccinated population, and CFR. Single linear regressions were conducted to assess the association of each potential predictor with CFR. A backward multiple linear regression was conducted to identify the most parsimonious combination of the independent variables of this study predicting CFR. The model developed in this study suggests that percent of population above age 65, and cardiovascular death rate have a positive effect on CFR, i.e., they are associated with increased COVID-19 fatality rate during the fourth wave. In addition, GDP per capita has a negative effect on CFR, i.e. – higher GDP per capita is associated with lower fatality rate during COVID-19 fourth wave. Moreover, single linear regressions show a strong negative association between percent of fully vaccinated people in each country and CFR. This model sheds light on several potential demographic and clinical factors which may predict CFR in highly populated developed countries during the emergence of the Delta variant. Vaccination in accordance with the recommendations is recommended to reduce COVID-19 mortality.

Post-Surgical Patient Education after Coronary Artery Bypass Graft Surgery: Recovery Treatments

The majority of coronary surgical procedures are conducted for multiple vessel disease, and coronary artery bypass surgery (CABG) remains an established form of treatment for coronary artery disease. Overall, coronary artery surgery has a low fatality rate. Post-surgical neurocognitive impairment is also a source of worry. Percutaneous coronary intervention has had a significant impact on CABG, halting the explosive rise of the procedure in the 1980’s and directing surgeons' attention to patients with severe coronary disease and several concomitant diseases. This has prompted surgeons to improve coronary revascularization techniques in order to improve clinical efficacy, lower costs, and decrease invasiveness. The current study shows that better discharge planning and home support services are needed. Further research should compare the experiences of cardiac patients and their caregivers to those of other surgical groups, as well as analyse methods of periodic follow-up and mechanisms for mutual support.

Configuration Analysis of Influencing Factors of Technical Efficiency Based on DEA and fsQCA: Evidence from China's Medical and Health Institutions.

PurposeThis paper aims to measure the technical efficiency of China’s medical and health institutions from 2012 to 2017 and outline the path to achieve high-quality development.MethodsThe DEA-Malmquist was used to evaluate the total factor productivity of medical and health institutions in 31 provinces. A fuzzy set Qualitative Comparative Analysis (fsQCA) was used for configuration analysis of determinants affecting technical efficiency.ResultsThe average total factor productivity (TFP) of those institutions was 0.965, namely TFP declined averagely by 3.5% annually. The efficiency change and the technical change were 0.998 and 0.967, respectively. The realization paths of high technical efficiency are composed of high fatality rate and high financial allocation-led, high population density and high GDP-led. Low dependency ratio and low financial allocation-led, low fatality rate and low financial allocation-led are the main reasons for low technical efficiency.ConclusionDue to advanced medical technology and economic development, major cities like Beijing, Shanghai, and Guangdong have attracted a large number of high-level health personnel, achieving long-term and stable health business growth. Hubei, Anhui, and Sichuan also have made rapid development of health care through appropriate financial subsidies and policy supports. The technical changes in Qinghai, Yunnan, and Inner Mongolia are higher than the national average, but the operation and management level of the medical and health institutions is relatively weak. Henan, Jiangxi, and Heilongjiang have a prominent performance in the efficiency change, but the technical change is weaker than the national average.

The Experience of Greece as a Model to Contain COVID-19 Infection Spread

The severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) emerged in late 2019 and has caused a pandemic known as corona virus disease 2019 (COVID-19), responsible for the death of more than 2 million people worldwide. The outbreak of COVID-19 has posed an unprecedented threat on human lives and public safety. The aim of this review is to describe key aspects of the bio-pathology of the novel disease, and discuss aspects of its spread, as well as targeted protective strategies that can help shape the outcome of the present and future health crises. Greece is used as a model to inhibit SARS-COV-2 spread, since it is one of the countries with the lowest fatality rates among nations of the European Union (E.U.), following two consecutive waves of COVID-19 pandemic. Furthermore, niche research technological approaches and scientific recommendations that emerged during the COVID-19 era are discussed.

Clinical Characteristics and Risk Factors for Severe Disease of Coronavirus Disease 2019 in a Low Case Fatality Rate Region in Korea.

BackgroundJeju island had the seventh highest incidence rate of coronavirus disease 2019 (COVID-19) but showed the lowest case fatality rate among 17 provinces of Korea, which may be associated with comorbidities and geographic differences. This study aimed to analyze the epidemiological and clinical characteristics of patients with COVID-19 and evaluate the risk factors for severe COVID-19 in Jeju island, Korea.Materials and MethodsAll patients with COVID-19 admitted between February 20, 2020, and June 19, 2021, at a single center were retrospectively enrolled in this study. The severity of illness was defined using five categories (asymptomatic, mild, moderate, severe, and critical) according to the National Institute of Health criteria. Then, patients with severe and critical illness were grouped into a severe group, whereas patients with asymptomatic, mild, and moderate illness were grouped into a non-severe group. Multivariate logistic regression analysis was performed using risk factors that were found to be significantly associated with the severe group.ResultsThis study included 348 patients with a median age was 57 years, and 37.5% were aged 60 or older. Among them, 43.4% were male and 10.9% were asymptomatic, whereas 41.4%, 33.9%, 12.9%, and 1.1% had mild, moderate, severe, and critical illness. The all-cause mortality of patients with COVID-19 was 0.28% (1/348). Among confirmed patients with COVID-19, exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was mainly within Jeju island (75.9%). The mean body mass index was 24.09 ± 4.04 kg/m2, the median comorbidity index score was low in each group (0 in asymptomatic; 1 in mild; 1 in moderate; 1 in severe; and 2 in critical group, P <0.548). In the multivariable analysis, male sex [odds ratio (OR), 6.37; 95% confidence interval (CI), 2.69 – 15.13; P <0.001], ≥65 years of age (OR, 2.68; 95% CI, 1.18 – 6.10; P <0.019), chronic pulmonary disease (OR, 6.10; 95% CI, 1.40 – 26.61; P = 0.016), and length of fever duration (OR, 1.33; 95% CI, 1.19 – 1.49; P <0.001) were independently associated with severe COVID-19.ConclusionThe most relevant risk factors of COVID-19 severity were male sex, older age, underlying chronic lung diseases, and duration of fever during hospitalization. The risk factors for severe COVID-19 were not significantly different from those reported in other studies. However, a lower proportion of the older population among confirmed SARS-CoV-2 cases might contribute to the lower fatality rate than the national rate.

An Evidence Base for School Health Policy during the COVID-19 Pandemic

Objective: Children represent a small fraction of confirmed COVID-19 cases, with a low case fatality rate (CFR). In this paper, we lay out an evidence-based policy for reopening schools. Methods: We gathered age-specific COVID-19 case counts and identified mortality data for 14 countries. Dose-response meta-analysis was used to examine the relationship of the incremental case fatality rate (CFR) to age. In addition, an evidence-to-decision framework (EtD) was used to correlate the dose-response data with other epidemiological characteristics of COVID-19 in childhood. Results: In the dose-response analysis, we found that there was an almost negligible fatality below age 18. CFR rose little between ages 5 to 50 years. The confidence intervals were narrow, suggesting relative homogeneity across countries. Further data suggested decreased childhood transmission from respiratory droplets and a low viral load among children. Conclusions: Opening up schools and kindergartens is unlikely to impact COVID-19 case or mortality rates in both the child and adult populations. We outline a robust plan for schools that recommends that general principles not be micromanaged, with authority left to schools and monitored by public health authorities.