Lower Fatality Research Articles

COVID-19 clinical outcomes in patients with and without ongoing therapy with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers

Background: The are conflicting reports on the effects of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) continued treatment on clinical outcomes in COVID-19 patients. Material and methods: Patients presented with symptoms suggestive of COVID-19 infection were enrolled between 5 April 2021,and 5 June 2021. Patients who survived acute stage of the disease were asked to attend out-patient clinic after six months following COVID-19 infection diagnosis. Results : A total of 162 patients were enrolled in this study. ARB users showed significant independent association with lower fatality rate as compared to ACEI/ARB-naïve patients [OR (CI) = 0.1(0.0–0.5), p = 0.01]. The prevalence of respiratory support use and intensive care unit (ICU) admission was numerically, but not statically significant, lower among ARB users than non-ARB users. The distribution of in-hospital adverse outcome was numerically lower among ACEI users than in non ACEI users, though the association did not reach statistical significance. ARB users showed significant independent association with persistent cough [OR (CI) = 2 (1.1–10), p = 0.02]. No significant differences in other long term symptoms were found between ARB users and nonusers. On the other hand, chest pain showed higher prevalence among ACEI users than in non-ACEI users. After adjusting for baseline comorbidities, chest pain association with ACEI user was not persisted. No significant differences in other long term symptoms were found between ACEI users and nonusers. Conclusion: ARB and ACEI users showed low prevalence of in-hospital adverse outcome compared to ARB/ACEI nonusers. ARB showed significant and independent association with persistent cough.

Reduction of Midline Shift and Short-Term Mortality Following Minimal Invasive Surgery for Spontaneous Supratentorial Intracerebral Hemorrhage: A Retrospective and Case-Control Series

Currently, the treatment of spontaneous intracerebral hemorrhage (sICH) is limiting, especially in patients with midline shift and supratentorial hemorrhage. Here, we investigated the clinical value of minimally invasive surgery (MIS) in patients with midline shift and supratentorial sICH by observing the consciousness state, midline shift, and short-term mortality. A total of 124 supratentorial sICH patients with midline shift, hematoma volume >30 mL and <150 mL were included in this study. Based on treatment methods, the enrolled patients were divided into minimally invasive surgical (MIS) (group 1, n= 61) and conservative (group 2, n= 63) treatment groups. Measurements of midline shift and state of consciousness using the Glasgow Coma Scale (GCS) score were performed on day 2 following treatment. Additionally, mortality, adverse events, and neurologic recovery (modified Rankin Scale score) in each group were observed after 1 month. On postoperative day 2, the recovery rates of midline shift and consciousness state in group 1 patients were 59.02% and 50.82%, respectively, significantly higher than group 2, 26.98% and 25.40% (P < 0.01). By comparing death, adverse events, and neurologic function recovery of the 2 groups within 1 month postoperative, we observed a significantly lower fatality rate in group 1 (16.39%; 10 cases) than group 2 (33.33%; 21 cases) (P < 0.05). No significant difference of the adverse event rates was observed between groups 1 and 2 (19.67% [12 cases] vs. 19.05% [12 cases]). In addition, neurologic function recovery also had no significant difference between the 2 groups (P > 0.05). MIS could reduce early-stage midline shift, improve consciousness state and reduce short-term mortality in patients with supratentorial sICH.

Children Naturally Evading COVID-19—Why Children Differ from Adults

Coronavirus Disease 2019 (COVID-19) has spread across the world, caused lockdowns, and has had serious economic and social consequences. COVID-19 manifests differently in children than adults, as children usually have a milder course of disease, mild symptoms if any, and lower fatality rates are recorded among children. SARS-CoV-2 transmission also seems to be different between children and adults. Many factors are proposed to explain the milder outcome in children, e.g., a more appropriate immune response (especially active innate response), trained immunity, a lack of immunosenescence, and the reduced prevalence of comorbidities. A better understanding of the differences in susceptibility and outcome in children compared with adults could lead to greater knowledge of risk factors for complicated COVID-19 cases and potential treatment targets. We highlight proposed reasons as to why children are less affected by COVID-19 than adults.

COVID-19 in healthcare workers in the state of Espírito Santo, Brazil: clinical and sociodemographic characteristics associated with death and hospitalization.

ABSTRACTObjective To analyze clinical and sociodemographic characteristics associated with death and hospitalization of healthcare workers due to COVID-19, in addition to calculating the incidence rates per profession.Methods A cross-sectional observational study using secondary open data from the State Health Department of Espírito Santo (ES), Brazil. The cases of COVID-19 in healthcare workers were recorded between February 27 and August 17, 2020, in Espírito Santo, excluding cases with missing information.Results Of the confirmed cases, 75.6% (n=9,191) were female. The overall case fatality rate was 0.27% and the general hospitalization rate was 0.99%. The clinical outcome of death and the occurrence of hospitalization were associated with male sex, age ≥50 years, higher education, fever, difficulty breathing, cough, cardiac comorbidity, diabetes and obesity (p<0.05). Only the occurrence of hospitalization was associated with case reported in the metropolitan region of Vitória, runny nose, sore throat, headache and renal comorbidity (p<0.05). The profession with the highest incidence rate was nurse (16,053.2 cases/100,000 nurses).Conclusion The study demonstrated high frequency of cases among women, low overall case fatality rate, and high incidence in nurses.

Assessing the impact of temperature and humidity exposures during early infection stages on case-fatality of COVID-19: A modelling study in Europe

Background Although associations between key weather indicators (i.e. temperature and humidity) and COVID-19 mortality have been reported, the relationship between these exposures at different timings in early infection stages (from virus exposure up to a few days after symptom onset) and the probability of death after infection (also called case fatality rate, CFR) has yet to be determined.Methods We estimated the instantaneous CFR of eight European countries using Bayesian inference in conjunction with stochastic transmission models, taking account of delays in reporting the number of newly confirmed cases and deaths. The exposure-lag-response associations between fatality rate and weather conditions to which patients were exposed at different timings were obtained using distributed lag nonlinear models coupled with mixed-effect models.Results Our results show that the Odds Ratio (OR) of death is negatively associated with the temperature, with two maxima (OR = 1.29 (95% CI: 1.23, 1.35) at −0.1°C; OR = 1.12 (95% CI: 1.08, 1.16) at 0.1°C) occurring at the time of virus exposure and after symptom onset. Two minima (OR = 0.81 (95% CI: 0.71, 0.92) at 23.2°C; OR = 0.71 (95% CI: 0.63, 0.80) at 21.7°C) also occurred at these two distinct periods correspondingly. Low humidity (below 50%) during the early stages and high humidity (approximately 89%) after symptom onset were related to the lower fatality.Conclusion Environmental conditions may affect not only the initial viral load when patients are exposed to the virus, but also individuals’ immune response around symptom onset. Warmer temperatures and higher humidity after symptom onset were linked to lower fatality.

Social and Policy Determinants of COVID-19 Infection Across 23 Countries: An Ecological Study.

ObjectivesThis study aimed to identify the social and policy determinants of coronavirus disease 2019 (COVID-19) infection across 23 countries.MethodsCOVID-19 indicators (incidence, mortality, and fatality) for each country were calculated by direct and indirect standardization. Multivariable regression analyses were used to identify the social and policy determinants of COVID-19 infection.ResultsA higher number of doctors per population was related to lower incidence, mortality, and fatality rates of COVID-19 in 23 countries (β=−0.672, −0.445, and −0.564, respectively). The number of nurses/midwives per population was associated with lower mortality and fatality rates of COVID-19 in 23 countries (β=−0.215 and −0.372, respectively). Strengthening of policy restriction indicators, such as restrictions of public gatherings, was related to lower COVID-19 incidence (β=−0.423). A national Bacillus Calmette–Guérin vaccination policy conducted among special groups or in the past was associated with a higher incidence of COVID-19 in 23 countries (β=0.341). The proportion of the elderly population (aged over 70 years) was related to higher mortality and fatality rates (β=0.209 and 0.350, respectively), and income support was associated with mortality and fatality rates (β=−0.362 and −0.449, respectively).ConclusionsThese findings do not imply causality because this was a country-based correlation study. However, COVID-19 transmission can be influenced by social and policy determinants such as integrated health systems and policy responses to COVID-19. Various social and policy determinants should be considered when planning responses to COVID-19.

Commentary on “Different roles of interpersonal trust and institutional trust in COVID-19 pandemic control”

An increasing number of epidemiologic studies have identified trust as a social determinant of COVID-19 mortality. Trust influences public compliance with policies aimed at containing the pandemic through physical distancing, wearing masks, and vaccine uptake. However, whilst some forms of trust are public assets (e.g., trust in government), others might be liabilities (e.g., trust in close friends and family members). Contributing to this body of work, Lou et al. (2022) examined associations of trust with COVID-19 fatality rates and willingness to get tested for COVID-19. Using correlation analyses, behavioral experiments, and agent-based modeling, they found institutional trust predicted lower COVID-19 fatality rates and greater willingness to get tested. In contrast, interpersonal trust predicted the speed with which COVID-19 was controlled in the early stages of the pandemic and people's willingness to obey norms preventing the spread of the virus (e.g., decreased nonessential outdoor activity). Investigations such as this offer useful knowledge to public health officials on ways to mitigate a pandemic. This commentary examines the pivotal role of social science in pandemic control, which up to now has been underfunded and overshadowed by the race to develop vaccines. We also highlight the importance of theory, particularly in research on trust, to producing evidence that is replicable and meaningful for policy application.

SARS-CoV-2 epidemic after social and economic reopening in three U.S. states reveals shifts in age structure and clinical characteristics.

State-level reopenings in late spring 2020 facilitated the resurgence of severe acute respiratory syndrome coronavirus 2 transmission. Here, we analyze age-structured case, hospitalization, and death time series from three states—Rhode Island, Massachusetts, and Pennsylvania—that had successful reopenings in May 2020 without summer waves of infection. Using 11 daily data streams, we show that from spring to summer, the epidemic shifted from an older to a younger age profile and that elderly individuals were less able to reduce contacts during the lockdown period when compared to younger individuals. Clinical case management improved from spring to summer, resulting in fewer critical care admissions and lower infection fatality rate. Attack rate estimates through 31 August 2020 are 6.2% [95% credible interval (CI), 5.7 to 6.8%] of the total population infected for Rhode Island, 6.7% (95% CI, 5.4 to 7.6%) in Massachusetts, and 2.7% (95% CI, 2.5 to 3.1%) in Pennsylvania.

Experience of Rwanda on COVID-19 Case Management: From Uncertainties to the Era of Neutralizing Monoclonal Antibodies.

The management of COVID-19 in Rwanda has been dynamic, and the use of COVID-19 therapeutics has gradually been updated based on scientific discoveries. The treatment for COVID-19 remained patient-centered and entirely state-sponsored during the first and second waves. From the time of identification of the index case in March 2020 up to August 2021, three versions of the clinical management guidelines were developed, with the aim of ensuring that the COVID-19 patients treated in Rwanda were receiving care based on the most recent therapeutic discoveries. As the case load increased and imposed imminent heavy burdens on the healthcare system, a smooth transition was made to enable that the asymptomatic and mild COVID-19 cases could continue to be closely observed and managed while they remained in their homes. The care provided to patients requiring facility-based interventions mainly focused on the provision of anti-inflammatory drugs, anticoagulation, broad-spectrum antibiotic therapy, management of hyperglycemia and the provision of therapeutics with a direct antiviral effect such as favipiravir and neutralizing monoclonal antibodies. The time to viral clearance was observed to be shortest among eligible patients treated with neutralizing monoclonal antibodies (bamlanivimab). Moving forward, as we strive to continue detecting COVID-19 cases as early as possible, and promptly initiate supportive interventions, the use of neutralizing monoclonal antibodies constitutes an attractive and cost-effective therapeutic approach. If this approach is used strategically along with other measures in place (i.e., COVID-19 vaccine roll out, etc.), it will enable us to bring this global battle against the COVID-19 pandemic under full control and with a low case fatality rate.

Segregation Predicts COVID-19 Fatalities in Less Densely Populated Counties.

AimIt is well known that social determinants of health (SDoH) have affected COVID-19 outcomes, but these determinants are broad and complex. Identifying essential determinants is a prerequisite to address widening health disparities during the evolving COVID-19 pandemic.MethodsCounty-specific COVID-19 fatality data from California, Illinois, and New York, three US states with the highest county-cevel COVID-19 fatalities as of June 15, 2020, were analyzed. Twenty-three county-level SDoH, collected from County Health Rankings & Roadmaps (CHRR), were considered. A median split on the population-adjusted COVID-19 fatality rate created an indicator for high or low fatality. The decision tree method, which employs machine learning techniques, analyzed and visualized associations between SDoH and high COVID-19 fatality rate at the county level.ResultsOf the 23 county-level SDoH considered, population density, residential segregation (between white and non-white populations), and preventable hospitalization rates were key predictors of COVID-19 fatalities. Segregation was an important predictor of COVID-19 fatalities in counties of low population density. The model area under the curve (AUC) was 0.79, with a sensitivity of 74% and specificity of 76%.ConclusionOur findings, using a novel analytical lens, suggest that COVID-19 fatality is high in areas of high population density. While population density correlates to COVID-19 fatality, our study also finds that segregation predicts COVID-19 fatality in less densely populated counties. These findings have implications for COVID-19 resource planning and require appropriate attention.

The Role of Information and Communications Technology Policies and Infrastructure in Curbing the Spread of the Novel Coronavirus: Cross-country Comparative Study.

BackgroundDespite worldwide efforts, control of COVID-19 transmission and its after effects is lagging. As seen from the cases of SARS-CoV-2 and influenza, worldwide crises associated with infections and their side effects are likely to recur in the future because of extensive international interactions. Consequently, there is an urgent need to identify the factors that can mitigate disease spread. We observed that the transmission speed and severity of consequences of COVID-19 varied substantially across countries, signaling the need for a country-level investigation.ObjectiveWe aimed to investigate how distancing-enabling information and communications technology (ICT) infrastructure and medical ICT infrastructure, and related policies have affected the cumulative number of confirmed cases, fatality rate, and initial speed of transmission across different countries.MethodsWe analyzed the determinants of COVID-19 transmission during the relatively early days of the pandemic by conducting regression analysis based on our data for country-level characteristics, including demographics, culture, ICT infrastructure, policies, economic status, and transmission of COVID-19. To gain further insights, we conducted a subsample analysis for countries with low population density.ResultsOur full sample analysis showed that implied telehealth policy, which refers to the lack of a specific telehealth-related policy but presence of a general eHealth policy, was associated with lower fatality rates when controlled for cultural characteristics (P=.004). In particular, the fatality rate for countries with an implied telehealth policy was lower than that for others by 2.7%. Interestingly, stated telehealth policy, which refers to the existence of a specified telehealth policy, was found to not be associated with lower fatality rates (P=.30). Furthermore, countries with a government-run health website had 36% fewer confirmed cases than those without it, when controlled for cultural characteristics (P=.03). Our analysis further revealed that the interaction between implied telehealth policy and training ICT health was significant (P=.01), suggesting that implied telehealth policy may be more effective when in-service training on ICT is provided to health professionals. In addition, credit card ownership, as an enabler of convenient e-commerce transactions and distancing, showed a negative association with fatality rates in the full sample analysis (P=.04), but not in the subsample analysis (P=.76), highlighting that distancing-enabling ICT is more useful in densely populated countries.ConclusionsOur findings demonstrate important relationships between national traits and COVID-19 infections, suggesting guidelines for policymakers to minimize the negative consequences of pandemics. The findings suggest physicians’ autonomous use of medical ICT and strategic allocation of distancing-enabling ICT infrastructure in countries with high population density to maximize efficiency. This study also encourages further research to investigate the role of health policies in combatting COVID-19 and other pandemics.

Metformin use is associated with low risk of case fatality and disability rates in first-ever stroke patients with type 2 diabetes.

Background:To assess the effectiveness of metformin treatment on long-term outcomes in first-ever stroke patients with type 2 diabetes mellitus (T2DM) in China.Methods:From August to September 2019, all patients with first-ever stroke and T2DM from 232 hospitals in China Mainland were included. The enrolled patients were divided into two groups: the metformin treatment (MT) and the no-metformin treatment (No-MT) groups. All discharged patients would receive a telephone follow-up at 12-month after admission.Results:In total, 7587 first-ever stroke patients with T2DM [age: median (IQR) = 66 (57–73) years; 57.35% male] were recruited. Out of those 7587 included patients, 3593 (47.36%) received MT. The in-hospital case fatality rate was lower in the MT group than the No-MT group [MT group versus No-MT group: 1.09% versus 2.30%; absolute difference = −1.75% (95% CI = −2.15 to −1.17%); OR = 0.63 (95% CI = 0.47 to 0.84)]. The 12-month case fatality rate was lower in the MT group than the No-MT group [4.72% versus 8.05%; absolute difference = −4.05% (95% CI = −5.58 to −2.41); OR = 0.69 (95% CI = 0.50 to 0.88)]. The 12-month disability rate was also lower in the MT group than the No-MT group [14.74% versus 19.41%; absolute difference = −5.70% (95% CI = −7.25 to −3.22); OR = 0.83 (95% CI = 0.70 to 0.95)]. Furthermore, the recurrence rate did not differ significantly between the MT and No-MT groups (p = 0.29).Conclusion:The study reveals that metformin use in stroke patients with T2DM results in a less severe stroke and lower fatality and disability rates.

COVID-19: Situation analysis in the district of Ernakulam.

Context:Corona Virus Disease 2019 (COVID-19) has become a pandemic causing millions of deaths and causing a devastating blow to the global economy. Like all other countries and territories, the Ernakulam district (Kerala, India) is affected by COVID-19. When the number of COVID-19 cases reported in the other states started coming down, the Ernakulam district continued to record a large number of cases.Aims:To analyse the situation of the COVID-19 pandemic in the district of Ernakulam, Kerala.Material and Methods:The authors were part of the COVID-19 surveillance unit of Ernakulam district, and hence, had access to the data collected. The available data were analysed in the following phases of the pandemic: First phase: From the reporting of the first case in Kerala in January to the reporting of the first case in the Ernakulam district. Second phase: Cases reported mostly in those with a travel history and their contacts to the period of community spread. Third phase: From the start of community spread.Results and Discussion:As of July 5, 2021, the Ernakulam district reported 3,60,345 cases of the COVID-19 infection with 1,317 deaths and the recovery rate being 96.45%. Despite factors like high human development index (HDI), access to the Internet and social media, access to affordable healthcare, etc., factors like high population density, airports, seaports, railway stations, container terminals, IT parks, major highways, tourist spots, beaches, large shopping malls, large floating population, a huge number of migrant labourers, a large proportion of the elderly population, high prevalence of non-communicable diseases, etc., are the some of the major challenges. The preparedness of the fight against COVID-19 included the training of all healthcare workers, ward level rapid response teams (RRT), upgradation of health facilities, district-level patient management system, provisions to manage biomedical waste, etc., The containment zone strategy is currently based on the local self-government area-wise weekly test positivity rate (TPR). The cluster containment is focused on the early identification of clusters. Currently, the Ernakulam district reports one of the highest numbers of COVID-19 cases in India. This is mainly because of the high number of tests (five to six times to national average) and targeted testing strategy. This is scientifically proven by the very low case fatality rate (0.35%), low-bed occupancy rate of the COVID treatment facilities and the latest seroprevalence study by Indian Council for Medical Research (ICMR).Conclusions:So far, the Ernakulam district could excel in its efforts to fight against COVID-19. But even now, when we are moving forward with the immunisation of the healthcare workers, front-line workers, elderly population, our main strategies to prevent COVID-19 remain the same—proper social distancing, hand hygiene, use of masks, avoiding unnecessary travels and gathering, early identification of cases and treatment.

Time-resolved and multi-tissue RNAseq provides new insights on the immune responses of European eels following infection with Aeromonas hydrophila

No studies have systematically compared time-resolved and multi-tissue innate immune responses for European eels (Anguilla anguilla) with Aeromonas hydrophila infection by a high throughput method. Here, we challenged European eels with A. hydrophila (infected) or PBS (control). A low fatality rate (16.1%) was observed for the infected group at 2 ​d post-infection (dpi). Then we examined transcriptional profiles of intestines, livers and spleens from 12 European eels with/without infection by A. hydrophila at 6, 18 and 36 ​h post-infection (hpi). The results showed that the most differentially expressed genes (DEGs) were found in the spleen at 6 hpi (7569 DEGs), followed by the intestine at 6 hpi (3129 DEGs) and the liver at 18 hpi (2722 DEGs). Only 540, 41 and 130 DEGs were found in the spleen, liver, and intestine at 36 hpi, respectively. The comparison of DEG numbers and enriched KEGG pathways suggested a consistent time-course immune response in these tissues. A similar enrichment of pattern recognition receptors-related pathways including Toll-like receptors, NOD-like receptors and RIG-I-like receptors was found in the liver and spleen, but not in the intestine. Among immune-related DEGs, 62 paralogue pairs were found, and the expression trends of most paralogues were consistent. Some paralogues of immune-related DEGs had unique domains. Furthermore, large clusters representing similar tissue were shown for the intestine and spleen. A different co-expression network involved in cytokine signal transduction and interaction existed between the liver and spleen. This study has provided time-resolved and multi-tissue transcriptome characteristics of A. anguilla in response to A. hydrophila infection.

A Decisive Review to Understand the Basic Fundamentals of Novel Corona Viruse Disease

With the development and spread of 2019 novel coronavirus (2019-nCoV), also known as the severe acute respiratory syndrome coronavirus 2, a new public health disaster is threatening the world (SARS-CoV-2). In December 2019, the virus was discovered in bats and transmitted to humans via unidentified intermediary species in Wuhan, Hubei Province, China. To date (05/03/2020), there have been roughly 96,000 recorded cases of coronavirus disease 2019 (COVID-2019) and 3300 documented deaths. The disease is spread through inhalation or contact with contaminated droplets, with a 2 to 14-day incubation period. Fever, cough, sore throat, dyspnea, weariness, and malaise are common symptoms. The disease is mild in most people; in some (usually the elderly and those with comorbidities), it can lead to pneumonia, ARDS (acute respiratory distress syndrome), and multi-organ failure. A large number of persons are asymptomatic. The case fatality rate is expected to be between 2 and 3%. Specimen collection, assay collection, serology, nucleic acid testing or molecular testing, and target selection for RT-PCR are all examples of laboratory diagnosis. Home isolation of suspected cases and those with mild illnesses, as well as tight infection control measures in hospitals, including contact and droplet precautions, are all part of the prevention strategy. The virus has a lower fatality rate than its two ancestors, SARS-CoV and Middle East respiratory sickness coronavirus (MERS-CoV). The global consequences of this new epidemic are still unknown.

Effect of COVID-19 Infection in the Patients with Diabetes Mellitus

Background: Coronavirus is pandemic virus infection which has recently affected the globe, and as a result, in patients with non-communicable diseases, the associated morbidity and death are substantially greater. One of the most common non-communicable diseases linked to worsening clinical conditions in corona virus patients is diabetes mellitus (dm).&#x0D; Covid-19 is a zoonotic illness that was firstly found in wuhan city of china, and is now recognized a zoonotic disease that spreads from moist animals to people in 2019. The disease has a low fatality rate and only affects the most seriously ill patients. Approximately 80% of the cases involve patients who are seriously to moderately ill. Since the outbreak of the disease, the number of people who have died has continuously increased.&#x0D; Summary: The aim for this study is to determine the receptors involved in diabetes and the pathogenetic relationship btw. Covid-19 and diabetes. Both diseases are characterized by inflammation and the release of inflammatory markers. The roles of angiotensin-converting enzyme molecule and dipeptidyl peptidase in covid-19 and diabetes have been investigated. The effects of glucocorticoids and catecholamines, invasion of pancreatic islet cells, medications used to treat covid-19, and hence the lockdown policy, may have a deleterious impact on diabetes patients' glucose control. The results of covid-19 research involving diabetic and non-diabetic patients were also examined. Various medication trials, such as the dapagliflozin and linagliptin trials are still being conducted to see if certain medications are suitable for diabetic people with covid-19.&#x0D; Conclusion: Diabetes is a risk factor for covid-19 patients, according to the data, leading to their severity and mortality. This article also contains guidelines and recommendations that may be useful in the management and avoidance of diabetic individuals who are infected with covid-19.

Outbreak Investigation and Enhanced Contact Tracing of Novel Coronavirus Disease 2019 (COVID-19), Ablekuma North Municipality, Greater Accra, Ghana

Background: After Ghana recorded its first two cases of COVID-19, other cases were subsequently identified in other parts of the country. The Ablekuma North Municipal Health Directorate was notified of a resident who reported to Korle-Bu Teaching Hospital on March 29, 2020 with fever, shortness of breath, general weakness, cough, chest pain. We investigated the report to estimate the magnitude of cases, to determine the secondary infection rate and to institute control and preventive measures. Methods: We conducted active case search using Ghana Health Service interim guideline for COVID-19 case investigation and management in Ablekuma North Municipality from April-July 31, 2020. We interviewed and collected samples of contacts and at-risk groups in affected households using collector for ArcGis and case investigation form. We summarized information of COVID-19 cases on our line list after samples have been confirmed. We analyzed data using Microsoft Excel 2016 and Stata 15, and presented as frequency and proportions. Results: The municipality recorded 213 cases with four deaths (Case fatality Rate=1.88%). The attack rate was 111.47 per 100,000 (213/ 191,075). Males were 135 (63.38%). The median age of case-patients was 27 years (interquartile range: 19 - 36years). Majority were students; 64 (30.05%). Most of the cases 89.20% (190/213) were asymptomatic. The median time between sample collection and release of laboratory results was 15 days (range: 4 - 22days). This response was a multi-sectorial approach, involving the Ministry of Health and the Ghana Health Service, Municipal Assembly, National Security Ministry, Ministry of Communication, Ministry of Information, and other government agencies. Conclusion: All confirmed cases were investigated. The attack rate was relatively high but low case fatality rate in the municipality. Strengthening laboratory capacity to test, to early report results is recommended. Lessons in handling cases indicate the need to sustain multi-sectorial collaboration to fight the outbreak.

Updated COVID-19 Condition in Australia

The COVID-19 pandemic has had detrimental effects on the lives of citizens worldwide in the past two years. The highly infectious respiratory disease discovered in late 2019 was a public health emergency that prompted the rapid development of vaccines to prevent the further spread of the virus. In late 2020, vaccines were finally ready to be distributed globally to reduce the severity of the disease and fatalities. The early stages of the pandemic were crucial as detecting the virus earlier on was a critical step in protecting the community from the coronavirus. In Australia, the local government quickly closed national borders, implemented lockdowns and restrictions, increased testing within the community, established mask mandates and developed vaccination programs. The strategies used by the Australian government have proven to be effective and efficient in managing outbreaks amidst the pandemic. The authorities were able to control the virus spread and maintained a low fatality rate within the country.

State Marijuana Laws and Traffic Fatalities

We examine the relationship between traffic fatalities and state marijuana laws using data from 1985 through 2019 and Poisson difference in difference models that allow effects to vary over time. We show numerous attributes of state marijuana laws are captured by a single underlying dimension, implying interdependence and potential inseparability of the effects of recreational marijuana laws (RMLs) and prior medical marijuana laws (MMLs). Controlling for MMLs, we find no statistically significant change in fatalities associated with RMLs, while, as in earlier work, MMLs are associated with lower fatalities. There is a statistically insignificant decline in fatalities in states bordering RML states. Type 1 error rate inflation is present in this context, but it is not strong enough to overturn the finding that lower fatalities followed MMLs.

Clinical characteristics, risk factors and outcomes in patients with severe COVID-19 registered in the International Severe Acute Respiratory and Emerging Infection Consortium WHO clinical characterisation protocol: a prospective, multinational, multicentre, observational study.

Due to the large number of patients with severe coronavirus disease 2019 (COVID-19), many were treated outside the traditional walls of the intensive care unit (ICU), and in many cases, by personnel who were not trained in critical care. The clinical characteristics and the relative impact of caring for severe COVID-19 patients outside the ICU is unknown. This was a multinational, multicentre, prospective cohort study embedded in the International Severe Acute Respiratory and Emerging Infection Consortium World Health Organization COVID-19 platform. Severe COVID-19 patients were identified as those admitted to an ICU and/or those treated with one of the following treatments: invasive or noninvasive mechanical ventilation, high-flow nasal cannula, inotropes or vasopressors. A logistic generalised additive model was used to compare clinical outcomes among patients admitted or not to the ICU. A total of 40 440 patients from 43 countries and six continents were included in this analysis. Severe COVID-19 patients were frequently male (62.9%), older adults (median (interquartile range (IQR), 67 (55–78) years), and with at least one comorbidity (63.2%). The overall median (IQR) length of hospital stay was 10 (5–19) days and was longer in patients admitted to an ICU than in those who were cared for outside the ICU (12 (6–23) days versus 8 (4–15) days, p<0.0001). The 28-day fatality ratio was lower in ICU-admitted patients (30.7% (5797 out of 18 831) versus 39.0% (7532 out of 19 295), p<0.0001). Patients admitted to an ICU had a significantly lower probability of death than those who were not (adjusted OR 0.70, 95% CI 0.65–0.75; p<0.0001). Patients with severe COVID-19 admitted to an ICU had significantly lower 28-day fatality ratio than those cared for outside an ICU.