Risk Factor For COVID-19 Infection Research Articles

Relationship between comorbidities and the high mortality rate of Covid 19 patients at Kepatihan Health Centre, Gresik

Background: The Covid-19 pandemic has a broad impact on health and society, comorbidities or comorbidities can be a risk factor for covid-19 infection and can worsen the condition of people who have been infected with COVID-19. The purpose of this study is the relationship between comorbidities and the high mortality rate of Covid-19 patients at the Kepatihan Health Centre, Gresik in 2019-2021. Methods: This study used a cross sectional analytical observational research design, the population in this study were people in the Kepatihan Gresik Health Centre working area who had Covid-19 in 2019-2021, totalling 809 people. Calculated using the slovin formula with a simple random sampling technique, so that the sample size was 75 respondents. The study used secondary data and the analysis used was the chi square test.. Result: the principal results including statistical analysis, and Conclusion: The results showed that most of the respondents in this study were respondents with Covid 19 patient deaths having comorbidities, namely 43 respondents or 57.3%, most of the respondents in this study were respondents with no hypertension, namely 55 respondents or 73%, most of the respondents in this study were respondents with no DM, namely 51 respondents or 68%, and most of the respondents in this study were respondents with no Asthma, namely 63 respondents or 84% The conclusion of the study is that there is a relationship between comorbidities and the high mortality rate of Covid-19 patients at Kepatihan Health Centre, Gresik in 2019-2021 because it has a p-value <0.05

Factors underlying the high occupational risk of healthcare personnel for COVID-19 infection.

To verify the rate of COVID-19 infection among healthcare personnel at high and low risk of COVID-19 infection and identify the underlying risk factors. This cross-sectional study was conducted between December 1, 2020 and February 28, 2021. Associations were verified between the levels of risk (high or low) of occupational COVID-19 infection and participant characteristics using the World Health Organization risk assessment questionnaire and adjusted using logistic regression models in single and multiple approaches. Of the 486 participants, 57.4% were classified as having a high occupational risk for SARS-CoV-2 infection, with a diagnosis rate of 12.1%. The factors identified in the multivariate analysis for high occupational risk were age up to 29 years (odds ratio [OR] = 2.7, 95% confidence interval [95%CI] = 1.63-4.47), monthly family income greater than eight times the basic salary (OR= 1.8, 95%CI= 1.07-3.16), and healthcare personnel who did not participate in initial training to work in the area of patients with COVID-19 infection (OR= 2.39, 95%CI= 1.53-3.75). Encouraging training for occupational infection prevention is very important to reduce the impact of infectious diseases on healthcare personnel, especially young health professionals. COVID-19 infection among healthcare personnel has impacted the workforce in hospitals. Knowledge of the risk factors for COVID-19 infection is important for disease prevention measures. Failure to train healthcare personnel is an important risk factor for acquiring COVID-19.

Risk factors for severe COVID-19 infection and the impact of COVID-19 infection on disease progression among patients with AAV

To identify risk factors for COVID-19 infection and investigate the impact of COVID-19 infection on chronic kidney disease (CKD) progression and vasculitis flare in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). This cohort study retrospectively analyzed the prevalence and severity of COVID-19 infection in 276 patients with AAV who were followed up. Logistic regression was employed to estimate the risk of COVID-19 infection as well as CKD progression and vasculitis flare upon COVID-19 infection. During the 6-month observation period, 213 (77.2%) of 276 patients were diagnosed with COVID-19 infection. Of these 213 patients, 49 (23.0%) had a COVID-19-related inpatient admission, including 17 patients who died of COVID-19 infection. AAV patients with severe COVID-19 infection were more likely to be male (OR 1.921 [95% CI 1.020–3.619], P = 0.043), suffered from worse kidney function (serum creatinine [Scr], OR 1.901 [95% CI 1.345–2.687], P < 0.001), had higher C-reactive protein (CRP) (OR 1.054 [95% CI 1.010–1.101], P = 0.017) and less likely to have evidence of initial vaccination (OR 0.469 [95% CI 0.231–0.951], P = 0.036), and Scr and COVID-19 vaccination were proven to be significantly associated with severe COVID-19 infection even after multivariable adjustment. Severe COVID-19 infection was significantly associated with subsequent CKD progression (OR 7.929 [95% CI 2.030–30.961], P = 0.003) and vasculitis flare (OR 11.842 [95% CI 1.048–133.835], P = 0.046) among patients with AAV. AAV patients who were male, and with worse kidney function were more susceptible to severe COVID-19 infection, which subsequently increased the risk of CKD progression and vasculitis flare.

Is disease-modifying therapy use in multiple sclerosis a risk factor during the COVID-19 pandemic? A large cohort study

Objective: This study aims to investigate the relationship between disease-modifying therapies (DMTs) used in people with MS (pwMS) and the risk of COVID-19 infection. Methods: This longitudinal cohort study included the MS cohort of 3402 people followed for COVID-19 infection. The whole MS cohort was interviewed at least once for information about COVID-19. A semi-structured interview was developed and performed by a team consisting of a medical doctor, nurse, and physiotherapist. Clinical information was obtained from the patient's medical records. This study was approved by the Noninvasive Research Ethics Board (Date: 08.09.2021, Decision No: 2021/25-06). Results: Of the 487 pwMS infected with COVID-19, 35 reported reinfections. The major differences regarding DMT between pwMS with and without COVID-19 infection were observed for fingolimod, ocrelizumab, and azathioprine. Forty-three (8.9%) people experienced the COVID-19 infection severely or critically; 12 (37.5%) had MS treatment with ocrelizumab. Fifty percent of pwMS who were treated in intensive care (7/14 patients) and died (3/6 patients) were being treated with ocrelizumab. As a result of regression analysis, being younger and using dimethyl fumarate, fingolimod, ocrelizumab, and cladribine DMTs were the main factors associated with having COVID-19 infection group. Conclusions: Current results show that disability due to MS and increased disease duration are not risk factors for COVID-19 infection, while age is negatively associated with contracting COVID-19 infection. These results show no relationship between the MS clinic and COVID-19 infection. We have found that using certain DMTs in pwMS increases the risk of contracting COVID-19 infection.

IDF23-0112 Gestational diabetes as a risk factor for COVID-19 infection: A meta-analysis

IDF23-0112 Gestational diabetes as a risk factor for COVID-19 infection: A meta-analysis

Risk Factors for COVID-19 Infection in Adult Patients: A Retrospective Observational Study in Japan

Risk Factors for COVID-19 Infection in Adult Patients: A Retrospective Observational Study in Japan

A systematic two-sample and bidirectional MR process highlights a unidirectional genetic causal effect of allergic diseases on COVID-19 infection/severity

BackgroundAllergic diseases (ADs) such as asthma are presumed risk factors for COVID-19 infection. However, recent observational studies suggest that the assumed correlation contradicts each other. We therefore systematically investigated the genetic causal correlations between various ADs and COVID-19 infection/severity.MethodsWe performed a two-sample, bidirectional Mendelian randomization (MR) study for five types of ADs and the latest round of COVID-19 GWAS meta-analysis datasets (critically ill, hospitalized, and infection cases). We also further validated the significant causal correlations and elucidated the potential underlying molecular mechanisms.ResultsWith the most suitable MR method, asthma consistently demonstrated causal protective effects on critically ill and hospitalized COVID-19 cases (OR < 0.93, p < 2.01 × 10–2), which were further confirmed by another validated GWAS dataset (OR < 0.92, p < 4.22 × 10–3). In addition, our MR analyses also observed significant causal correlations of food allergies such as shrimp allergy with the risk of COVID-19 infection/severity. However, we did not find any significant causal effect of COVID-19 phenotypes on the risk of ADs. Regarding the underlying molecular mechanisms, not only multiple immune-related cells such as CD4+ T, CD8+ T and the ratio of CD4+/CD8+ T cells showed significant causal effects on COVID-19 phenotypes and various ADs, the hematology traits including monocytes were also significantly correlated with them. Conversely, various ADs such as asthma and shrimp allergy may be causally correlated with COVID-19 infection/severity by affecting multiple hematological traits and immune-related cells.ConclusionsOur systematic and bidirectional MR analyses suggest a unidirectional causal effect of various ADs, particularly of asthma on COVID-19 infection/severity, but the reverse is not true. The potential underlying molecular mechanisms of the causal effects call for more attention to clinical monitoring of hematological cells/traits and may be beneficial in developing effective therapeutic strategies for allergic patients following infection with COVID-19.Graphical

COVID-19 infection characteristics, risk factors and its potential impacts on Takayasu arteritis: a web-based survey in a large cohort.

To investigate the characteristics of COVID-19 and its impact on patients with Takayasu's arteritis (TAK). A web-based survey was administered to a TAK cohort and their co-residents in China during January 2023. Infection symptoms, post-acute sequelae of COVID-19 (PASC), potential impacts of COVID-19 on patients' disease condition, treatment and immune-related parameters were analyzed. In addition, risk factors for COVID-19 and disease relapse after infection were explored. The infection rate was significantly lower in patients with TAK than in co-residents (79.13% vs 90.67%, p=0.025). TAK patients were more prone to gastrointestinal symptoms (17.78% vs 5.88%, p=0.024), sleep problems (25.15% vs 10.29%, p=0.011), and symptoms involving more than 2 organs (58.90% vs 35.29%, p=0.001) after infection. Although only 2.45% of TAK patients were hospitalized and none progressed to life-threatening conditions, they were more likely to suffer from PASC (26.38% vs 13.24%, p=0.029), especially active patients. Active disease after the pandemic was significantly lower in infected patients than uninfected patients (21/163, 12.88% vs. 11/43, 25.58%, p=0.041). The presence of multiple system symptoms was a risk factor for active TAK after infection [OR: 3.62 (95% CI 1.06-12.31), p=0.040]. Moreover, csDMARDs treatment was a risk factor for COVID-19 infection [OR: 3.68 (95% CI 1.56-8.66), p=0.002]. Although TAK patients with COVID-19 have more acute and post-acute symptoms, there is no adverse outcome and the risk of disease relapse does not increase. Patients treated with csDMARDs may be at higher risk of infection and deserve more clinical attention.

Primary healthcare workers' COVID-19 infection status following implementation of adjusted epidemic prevention and control strategies: a cross-sectional study in Jiangsu, China.

In times of epidemic outbreaks, healthcare workers (HCWs) emerge as a particularly vulnerable group. This cross-sectional study endeavors to assess the COVID-19 infection rate among the primary HCWs in Jiangsu Province subsequent to the implementation of adjusted epidemic prevention and control strategies. From January 17 to February 2, 2023, an extensive survey was conducted among primary HCWs in Jiangsu Province, employing a self-designed questionnaire. Logistic regression analysis was utilized to identify the factors associated with COVID-19 infection. The overall infection rate among primary HCWs stood at 81.05%, with a 95% confidence interval (CI) of 80.61-81.48%. Among those afflicted, cough, fatigue, and fever emerged as the three most prevalent symptoms, each with an incidence rate exceeding 80%. In the context of multivariate logistic regression, an elevated risk of COVID-19 infection was observed in correlation with female gender (adjusted odds ratio [aOR] = 1.12, 95% CI: 1.04-1.21), possessing a bachelor's degree or higher (aOR = 1.32, 95% CI: 1.23-1.41), accumulating over 10 years of work experience (aOR = 1.28, 95% CI: 1.11-1.47), holding a middle-level cadre position (aOR = 1.22, 95% CI: 1.11-1.35), assuming the role of a unit leader (aOR = 1.30, 95% CI: 1.11-1.54), and working in a fever clinic for 1 to 10 days per month (aOR = 1.42, 95% CI: 1.29-1.57). Conversely, advanced age (aOR = 0.76, 95% CI: 0.70-0.82), being underweight (aOR = 0.78, 95% CI: 0.69-0.90), current smoking (aOR = 0.64, 95% CI: 0.57-0.71), receiving 4 doses of COVID-19 vaccine (aOR = 0.49, 95% CI: 0.37-0.66), and pregnancy or perinatal status (aOR = 0.85, 95% CI: 0.72-0.99) were associated with a diminished risk of infection. Following the implementation of adjusted policies, a substantial proportion of primary HCWs in Jiangsu province contracted COVID-19. Female gender and younger age emerged as risk factors for COVID-19 infection, while no discernible link was established between professions and COVID-19 susceptibility. The receipt of COVID-19 vaccines demonstrated efficacy in curtailing the infection rate, underscoring the significance of bolstering prevention knowledge and heightening self-protective awareness among primary HCWs.

A cohort study on the biochemical and haematological parameters of Italian blood donors as possible risk factors of COVID-19 infection and severe disease in the pre- and post-Omicron period.

To investigate the association between biochemical and blood parameters collected before the pandemic in a large cohort of Italian blood donors with the risk of infection and severe disease. We also focused on the differences between the pre- and post-Omicron spread in Italy (i.e., pre- and post-January 01, 2022) on the observed associations. We conducted an observational cohort study on 13750 blood donors was conducted using data archived up to 5 years before the pandemic. A t-test or chi-squared test was used to compare differences between groups. Hazard ratios with 95% confidence intervals for SARS-CoV-2 infection and severe disease were estimated using Cox proportional hazards models. Subgroup analyses stratified by sex, age and epidemic phase of first infection (pre- and post-Omicron spread) were examined. We confirmed a protective effect of groups B and O, while groups A and AB had a higher likelihood of infection and severe disease. However, these associations were only significant in the pre-Omicron period. We found an opposite behavior after Omicron spread, with the O phenotype having a higher probability of infection. When stratified by variant, A antigen appeared to protect against Omicron infection, whereas it was associated with an increased risk of infection by earlier variants. We were able to stratify for the SARS CoV-2 dominant variant, which revealed a causal association between blood group and probability of infection, as evidenced by the strong effect modification observed between the pre- and post-Omicron spread. The mechanism by which group A acts on the probability of infection should consider this strong effect modification.

Psychological Health Among Older Adults During and After Quarantine: A Multi-Method Study.

Depression among older adults is a growing problem. With aging being a risk factor for COVID-19 infection, depression in this population may have been exacerbated. This study aimed to describe experiences and changes in depressive symptoms and well-being of older adults during and after the COVID-19 first wave in Spain. The study used a multi-method design. Participants self-reported depressive symptoms (Geriatric Depression Scale) and well-being (Cantril Ladder of Life). Participants were asked about changes in depressive symptoms or well-being during quarantine. If a change was perceived, they were asked to describe the change. In addition, the Patient Global Impression of Change scale was used. Both quantitative and qualitative analyses were performed on the data. 111 participants (mean age: 71±5 years; 76% women) completed the study. Sixty-three percent reported mild and 2% reported major depressive symptoms. Nearly half (47.7%) reported changes in depressive symptoms during the lockdown. While 37% reported feeling better during the lockdown, about 11% reported depressive symptoms were worse now compared with during the lockdown. 60% reported worsening well-being during the quarantining period. The qualitative analysis revealed 2 main themes: (1) psychological discomfort (mood deflection, fear/worries, and boredom/inactivity) and (2) social issues (inability to go out, missing family members and others). Worsening depressive symptoms and lowering of well-being were noticed in this sample of older adults during and post-COVID lockdowns. Evaluation of mental health in the primary care setting and providing referrals for mental health services is essential for older adults who experienced COVID-19-related lockdowns.

Risk Factors and Protective Factors for COVID-19 Infection among Patients Visiting University Health Centre of Vadodara District: A Case Control study

Introduction: Identification of risk factors and protective factors of COVID-19 can help in controlling the disease in healthcare and the community. Objective: To determine the risk factors and protective factors of COVID-19 among patients visiting University Health Centre of Vadodara district. Method: A case control study was done at University Health Centre of the district. Hundred cases who were COVID-19 positive by RTPCR/RAT testing and 100 controls who were RTPCR/RAT negative and never displayed its signs and symptoms were asked about knowledge of parameters such as hand hygiene, social distancing, any ayurvedic or homeopathic medicine intake, chemoprophylaxis of HCQ, visit to public places, any travel history outside city, state or country, the manner, place, and type of masks used by them to know the risk and protective factors for COVID-19. Results: Significant risk factors for COVID-19 infection based on logistic regression were increasing age (OR=3.65, p=0.004), higher education (OR=4.72, p=0.001), self-medication of homeopathic or ayurvedic medicines (OR=6.27, p=0.005). Significant protective factors for COVID-19 infection based on logistic regression were regular use of mask (OR=0.03, p=&lt;0.0001), correct technique of mask use (OR=0.17, p=0.02), and maintaining social distance (OR=0.18, p=0.049). Conclusion: This study revealed the factors associated with occurrence of COVID-19 were increasing age, higher education, self- medication and factors which protect from infection were regular use of mask, correct technique of mask use, and maintaining social distance.

Clinical Characteristics and Risk Factors Analysis of COVID-19 Infections- A Single Center Observational Study

Introduction: COVID-19 emerged as a major public health outbreak in late 2019. Bangladesh reported its first case on 8th March 2020 and at Sylhet Div area, first case detected in April 2020, authority adopted a policy of extensive contact tracing, quarantine and initially hospitalizing of all cases. Clinical characteristics of COVID-19 cases have been described as per national and WHO guideline. Objectives: To analyze clinical characteristics and the risk factors of COVID-19 infection. Methods: Clinical records of all COVID-19 confirmed cases aged ≥12 years admitted to COVID Unit or treated at home isolation with complete outcomes at Sylhet area were included in the study. Duration of this study was 1st April to 27th December 2020. Epidemiological history, comorbidities, clinical features, investigations, management and complications of all cases were recorded in preform data sheet and analyzed. Variables were compared between mild and severe diseases. Results: The sample comprised of 515 cases (mean age 30.98 years, male 81.55%). Majority were mild (92%) and 6.4% required intensive care, with 85% admitted within the first five days. Older age (≥51 years), underlying comorbidities, cough, breathlessness, reduced oxygen saturation and abnormal chest radiographs on admission were significant determinants for severity. The case fatality rate was 0.77% and the four commonest complications were ARDS (4.40%). liver injuries (4.07%), bacteraemia (2.33%) and kidney injuries (1.16%). Conclusion: Lower case fatality rate was possibly contributed by young cases with mild diseases and early hospitalization. Abnormal chest radiographic, elderly and other comrbidities require frequent measurement of oxygen saturation with pulse oximetry and close monitoring within the first few days to detect early deterioration and to take appropriate measures. Ivermectin seems to be effective in the treatment of Covid-19 infection but need further large multi-center case control study. JAFMC Bangladesh. Vol 18, No 2 (December) 2022: 19-23

Risk and outcomes of COVID-19 in patients with oxygen-dependent chronic respiratory failure– a national cohort study

BackgroundWe aimed to evaluate cumulative occurrence and impact of COVID-19 in patients with chronic respiratory failure (CRF) treated with long-term oxygen therapy (LTOT). Material and methodsData were obtained from the SCIFI-PEARL study on the entire Swedish population and on patients with oxygen-dependent CRF and no COVID-19 diagnosis before start of LTOT. Analyses were performed for three time periods; pre-alpha (Jan–Dec 2020), alpha (Jan–Mar 2021) and delta/omicron (Apr 2021–May 2022). Cumulative incidence of laboratory-verified COVID-19 was compared between patients with CRF and the general population. Risk factors for severe (hospitalised) to critical (intensive care, or death ≤30 days after infection) COVID-19, and the impact of COVID-19 on one-year mortality, were analysed using multivariable Cox regression. ResultsCumulative incidence of COVID-19 was higher in patients with CRF than in the general population during the pre-alpha period (6.4%/4.9%, p = 0.002), but less common during the alpha and delta/omicron periods (2.9%/3.8% and 7.8%/15.5%, p < 0.0001 for both). The risk of severe/critical COVID-19 was much higher in CRF patients during all periods (4.9%/0.5%, 3.8%/0.2% and 15.5%/0.5%, p < 0.0001 for all). Risk factors for COVID-19 infection in people with CRF were higher age, cardiovascular and renal disease, and COVID-19 was associated with increased one-year mortality following infection in the pre-alpha (HR 1.79; [95% CI] 1.27–2.53) and alpha periods (1.43; 1.03–1.99). ConclusionPatients with CRF had higher risk of severe/critical COVID-19 than the general population. COVID-19 infection was associated with excess one-year mortality.

Impact of nursing home characteristics on COVID-19 infections among residents and staff

Excess mortality occurred in nursing homes during the SARS-CoV pandemic. This study aimed to identify risk factors for COVID-19 infection and mortality in nursing home residents and staff in Hesse, Germany. A retrospective cohort study of 687 nursing homes was performed. We used t tests and logistic regressions to quantify the role of nursing homes' size, location, staff qualification, and room occupancy as potential risk factors. The bivariate statistics show that a higher proportion of infected staff and for-profit operations were associated with an increase in infections among residents and staff, while more single rooms and registered nurses showed protective effects. Our model calculations also show that the presence of a higher ratio of registered nurses was a significant protective factor against resident infection (odds ratios [OR]: 0.969, P=.002), resident mortality (OR: 0.973, P=.006), and safeguarded staff (OR: 0.979, P=.034). In contrast, more single rooms (OR: 0.993, P=.029) were protective for residents, while increased risk factors included more beds (OR: 1.006, P=.006 for residents' infections, OR: 1.008, P<.001 for mortality) and infected staff (OR: 2.363, P<.001 for residents' infections). For staff, medium population density (OR: 2.322, P=.016) and infected residents (OR: 1.308, P<.001) were associated with elevated risk. Preventing infection outbreaks among residents and staff is crucial to reduce mortality. Strategies include increasing single-occupancy rooms, improving staff qualifications, and targeting facilities with lower registered nurse ratios and single-occupancy rooms for inspection.

Risk factors for COVID-19 infection and hospitalization, a population based case-control study from eastern Iran

ObjectivesInvestigating the factors associated with COVID-19 infection and its severity can be a major element in controlling the pandemics. This study aims to assess risk factors of COVID-19 infection and factors associated with hospitalization of COVID-19 cases. MethodsIn this case-control study, 416 confirmed COVID-19 cases based on the polymerase chain reaction test and 535 controls were selected from the urban and rural areas of Sistan-region-East of Iran. ResultsCases had a lower frequency of hypertension than controls (12.3% vs 18.3% respectively, P = 0.011). Out of the investigated factors, only age over 50, increased the chance of hospitalization (odds ratio = 5, P = 0.007). ConclusionAlthough age was expected to be a risk factor, the observed protective effect of hypertension should be considered with caution.

Investigation of a COVID-19 Cluster in a Football Academy of Buri Ram, October 2021

A COVID-19 cluster in a football academy, Buri Ram, Thailand, was notified in October 2021. We aimed to characterize the outbreak, identify the source of disease and risk factors for infection, and give recommendations for preventive measures. We conducted a descriptive study by interviewing cases and academy participants, and assessed ventilation measures at the academy via an environmental survey. We performed a retrospective cohort study among football players using Poisson regression to identify risk factors of COVID-19 infection presenting adjusted incidence rate ratios (AIRR) and 95% confidence intervals (CI). The attack rate was 22.4% (48/214). The median age was 14 years and 77.1% of patients had mild illnesses. All examined environmental surfaces tested negative for SARS-CoV-2. The bedroom density had a strong relationship with attack rates among female bedrooms. Risk factors for infection were being high-risk close contact with the primary case (AIRR 5.4, 95% CI 2.2–12.9) and sleeping in crowded bedrooms (AIRR 2.42, 95% CI 1.14–5.15). Mask-wearing was a protective factor (AIRR 0.32, 95% CI 0.13–0.80). We recommend sports academies and schools encourage mask-wearing during an outbreak, provide living areas that conform to recommended density guidelines, and prepare an isolation or quarantine room for infected students.

Analysis on the factors associated with COVID-19 infection among Chinese residents after the implementation of the 10 new rules to optimize COVID-19 response: a cross-sectional study

IntroductionThis study aimed to investigate the status of COVID-19 infection and the associated factors among Chinese residents after the implementation of the 10 New Rules to optimize COVID response.MethodsParticipants were recruited using convenience sampling. The study used self-filled questionnaires to examine COVID-19 infection and associated factors among Chinese residents, from December 29, 2022, to January 2, 2023. For the statistical analysis, descriptive and quantitative analyses were used. The potential risk factors for COVID-19 infection were identified by multivariable logistic regression analysis.ResultsAfter the adjustments in control strategies against COVID-19, the infection rate of COVID-19 was high among respondents, and 98.4% of individuals who tested positive showed symptoms including cough, fever, fatigue, headache, sore throat, nasal congestion, sputum production, muscle and joint pain, and runny nose. The main problems respondents reported were the shortage of drugs and medical supplies, the increased burden on families, and the unreliable information source of COVID-19 infection. Logistic regression showed that isolating patients with COVID-19 at home was associated with a lower risk of COVID-19 infection (OR = 0.58, 95%CI: 0.42–0.81).ConclusionCOVID-19 infection among residents is closely related to age, gender, and epidemic prevention measures. The government needs to strengthen education for individuals and centrally manage and properly address difficulties that may arise during COVID-19.

COVID-19 pandemic and socio-environmental inequality: A narrative review.

The COVID-19 pandemic has provided preliminary evidence of the existence of health, social, and environmental inequalities. This inequality encompasses inadequate access to safe water, clean air, and wastewater management, as well as limited socioeconomic and educational opportunities. These issues have not received sufficient attention during the pandemic. The purpose of this narrative review is to provide a comprehensive summary and analysis of the existing literature on a specific topic, ultimately leading to a conclusion based on the evidence presented. The search methodology for this study involved conducting comprehensive searches of scientific databases, including PubMed, ScienceDirect, LILACS, and Google Scholar, from 2019 to 2023. The study focused on a specific theme and its relevant aspects related to global environmental health and society. Keywords such as COVID-19, inequities, and environmental health were used for searching. Additionally, the Boolean operator "AND" was used to combine these descriptors. Unequal exposure to air pollution has been reported in Africa, as well as in large parts of Asia and Latin America, according to the data that has been obtained. The pandemic has also resulted in a surge in healthcare waste generation, exacerbating the environmental impact of solid waste. Furthermore, there is evidence indicating significant disparities in the severe lack of access to sanitation services between developing nations and low-income regions. The issues related to water availability, accessibility, and quality are subject to debate. It has been reported that SARS-CoV-2 is present not only in untreated/raw water, but also in water bodies that act as reservoirs. Moreover, insufficient education, poverty, and low household income have been identified as the most significant risk factors for COVID-19 infection and mortality. It is evident that addressing socio-environmental inequality and striving to narrow the gap by prioritizing vulnerable populations are imperative.

Risk factors for COVID-19 infection in people with 4th dose of bivalent mRNA vaccines in general medicine from October 2022 to February 2023

Background: Risk factors of COVID-19 infection in people vaccinated with the 4th dose of mRNA COVID-19 vaccine remain the subject of debate. Objective: To identify risk and protective factors of COVID-19 in vaccinated people with 4th dose of bivalent mRNA vaccines. Location: General Practitioner consultation in Toledo (Spain). Methodology: Longitudinal and prospective study of cases and controls of adult patients with or without COVID-19 infection in vaccinated people with 4th dose of bivalent mRNA vaccines, from October 1, 2022, to February 28, 2023. Results: Five cases of COVID-19 infections in vaccinated people with 4th dose were included, which were compared with 52 controls (with 4th dose and without COVID-19 after the booster). The risk factors for COVID-19 infection with the 4th dose were: Women (RR = 1.67), Socio-Health Care Workers (RR = 10.39; p = 0.0349), Chronic Diseases of the blood (RR = 6.9. p = 0.0322), Chronic Diseases of Endocrine (RR = 2.72. p = 0.039425), and Chronic Diseases of Circulatory system (RR = 1.87). Conclusion: In the general practice setting in Toledo, Spain, being a socio-health care worker and having chronic diseases presumably associated with immunosuppression were statistically significant risk factors for COVID-19 infection in people vaccinated with the 4th dose of bivalent mRNA vaccines. The most exposed or immunosuppressed people continue to be at risk of becoming infected with SARS-CoV-2 despite having received the 4th dose of the mRNA COVID-19 vaccine, so other preventive methods in these groups are advisable.