Risk Of COVID-19 Research Articles

Intolerance of uncertainty and psychological flexibility as predictors of mental health from adolescence to old age.

The COVID-19 pandemic brought with it significant social, economic and health uncertainties. These were proposed to impact young people more compared to adults, leading adolescents to report more mental health problems during the pandemic. The current study examined whether differences in cognitive risk (tolerance of uncertainty) and protective (psychological flexibility) factors accounted for age-related differences in depression and anxiety. These associations were investigated inthe COVID-19 Risks Across the Lifespan (CORAL) cohort (N = 2280, 11-89years). The results showed that adolescents experienced greater intolerance of uncertainty and lower psychological flexibility compared to adults and older adults. Tolerance of uncertainty did not account for age-related differences in depression or anxiety. However, psychological flexibility conferred more protective advantage for anxiety in adults compared to adolescents. The observed age-related differences in risk and protective factors advance our understanding of developmental vulnerabilities to depression and anxiety. Implications for mental health interventions in the context of future pandemics are discussed.

Assessment of COVID-19 risk factors of early and long-term mortality with prediction models of clinical and laboratory variables

BackgroundCoronavirus disease (COVID-19) may lead to serious complications and increased mortality. The outcomes of patients who survive the early disease period are burdened with persistent long-term symptoms and increased long-term morbidity and mortality. The aim of our study was to determine which baseline parameters may provide the best prediction of early and long-term outcomes.MethodsThe study group comprised 141 patients hospitalized for COVID-19. Demographic data, clinical data and laboratory parameters were collected. The main study endpoints were defined as in-hospital mortality and 1-year mortality. The associations between the baseline data and the study endpoints were evaluated. Prediction models were created.ResultsThe in-hospital mortality rate was 20.5% (n = 29). Compared with survivors, nonsurvivors were significantly older (p = 0.001) and presented comorbidities, including diabetes (0.027) and atrial fibrillation (p = 0.006). Assessment of baseline laboratory markers and time to early death revealed negative correlations between time to early death and higher IL-6 levels (p = 0.032; Spearman rho − 0.398) and lower lymphocyte counts (p = 0.018; Pearson r -0.438). The one-year mortality rate was 35.5% (n = 50). The 1-year nonsurvivor subgroup was older (p < 0.001) and had more patients with arterial hypertension (p = 0.009), diabetes (p = 0.023), atrial fibrillation (p = 0.046) and active malignancy (p = 0.024) than did the survivor subgroup. The model composed of diabetes and atrial fibrillation and IL-6 with lymphocyte count revealed the highest value for 1-year mortality risk prediction.ConclusionsDiabetes and atrial fibrillation, as clinical factors, and LDH, IL-6 and lymphocyte count, as laboratory determinants, are the best predictors of COVID-19 mortality risk.

Complex patterns of multimorbidity associated with severe COVID-19 and long COVID

BackgroundEarly evidence that patients with (multiple) pre-existing diseases are at highest risk for severe COVID-19 has been instrumental in the pandemic to allocate critical care resources and later vaccination schemes. However, systematic studies exploring the breadth of medical diagnoses are scarce but may help to understand severe COVID-19 among patients at supposedly low risk.MethodsWe systematically harmonized >12 million primary care and hospitalisation health records from ~500,000 UK Biobank participants into 1448 collated disease terms to systematically identify diseases predisposing to severe COVID-19 (requiring hospitalisation or death) and its post-acute sequalae, Long COVID.ResultsHere we identify 679 diseases associated with an increased risk for severe COVID-19 (n = 672) and/or Long COVID (n = 72) that span almost all clinical specialties and are strongly enriched in clusters of cardio-respiratory and endocrine-renal diseases. For 57 diseases, we establish consistent evidence to predispose to severe COVID-19 based on survival and genetic susceptibility analyses. This includes a possible role of symptoms of malaise and fatigue as a so far largely overlooked risk factor for severe COVID-19. We finally observe partially opposing risk estimates at known risk loci for severe COVID-19 for etiologically related diseases, such as post-inflammatory pulmonary fibrosis or rheumatoid arthritis, possibly indicating a segregation of disease mechanisms.ConclusionsOur results provide a unique reference that demonstrates how 1) complex co-occurrence of multiple – including non-fatal – conditions predispose to increased COVID-19 severity and 2) how incorporating the whole breadth of medical diagnosis can guide the interpretation of genetic risk loci.

DIAGNÓSTICO DE ANSIEDADE E DEPRESSÃO ENTRE PROFESSORES DURANTE A PANDEMIA DA COVID-19

To estimate the prevalence of anxiety and depression diagnosis during the COVID-19 pandemic among teachers and to identify the associated factors. Epidemiological websurvey, carried out in 2020, with teachers of public basic education in Minas Gerais/Brazil, using a digital form. The dependent variables analyzed were self-reported formal diagnoses of anxiety and depression during the pandemic. For data analysis, Binary Logistic Regression was used. The study involved 15,641 teachers. 25% reported a diagnosis of anxiety during the pandemic and 8.6% a medical diagnosis of depression. There was a significantly higher chance of an anxiety diagnosis among women, teachers dissatisfied with their work, who were part of the COVID-19 risk group, with a family member/friend who died from COVID-19, who presented severe fear of COVID-19, with sleep problems, who were smokers and among those who were overweight/obese. There was a significantly higher chance of depression among women, who worked 40 or more hours a week, who had a lot of difficulty with remote work, who were dissatisfied with work, who were part of the COVID-19 risk group, with a family member/friend who died due to COVID-19, with severe fear of COVID-19, with sleep problems, among smokers, those who have increased alcohol consumption, with a less healthy dietary pattern and among those with obesity. A relevant prevalence of anxiety and depression was observed among teachers during the pandemic. Changes caused by the pandemic in the work, routine and health of teachers contributed to increased rates of mental health problems.

Pathway-Based Mendelian Randomization for Pre-Infection IL-6 Levels Highlights Its Role in Coronavirus Disease.

Interleukin 6 (IL-6) levels at hospital admission have been suggested for disease prognosis, and IL-6 antagonists have been suggested for the treatment of patients with severe COVID-19. However, less is known about the relationship between pre-COVID-19 IL-6 levels and the risk of severe COVID-19. To fill in this gap, here we extensively investigated the association of genetically instrumented IL-6 pathway components with the risk of severe COVID-19. We used a two-sample Mendelian randomization study design and retrieved genetic instruments for blood biomarkers of IL-6 activation, including IL-6, soluble IL-6 receptor, IL-6 signal transducer, and CRP, from respective large available GWASs. To establish associations of these instruments with COVID-19 outcomes, we used data from the Host Genetics Initiative and GenOMICC studies. Our analyses revealed inverse associations of genetically instrumented levels of IL-6 and its soluble receptor with the risk of developing severe disease (OR = 0.60 and 0.94, respectively). They also demonstrated a positive association of severe disease with the soluble signal transducer level (OR = 1.13). Only IL-6 associations with severe COVID-19 outcomes reached the significance threshold corrected for multiple testing (p < 0.003; with COVID-19 hospitalization and critical illness). These potential causal relationships for pre-COVID-19 IL-6 levels with the risk of developing severe symptoms provide opportunities for further evaluation of these factors as prognostic/preventive markers of severe COVID-19. Further studies will need to clarify whether the higher risk for a severe disease course with lower baseline IL-6 levels may also extend to other infectious diseases.

Pre-existing sleep disturbances and risk of COVID-19: a meta-analysis

Sleep disturbances are widespread but usually overlooked health risk factors for coronavirus disease 2019 (COVID-19). We aimed to investigate the influence of pre-existing sleep disturbances on the susceptibility, severity, and long-term effects of COVID-19. We searched PubMed, Web of Science, and Embase for relevant articles from inception to October 27, 2023 and updated at May 8, 2024. Sleep disturbances included obstructive sleep apnea (OSA), insomnia, abnormal sleep duration, night-shift work, and any other sleep disturbances. Outcomes were COVID-19 susceptibility, hospitalization, mortality, and long COVID. The effect sizes were pooled odds ratios (ORs) and 95% confidence intervals (95% CIs). This study is registered with PROSPERO (CRD42024503518). A total of 48 observational studies (n=8,664,026) were included. Pre-existing sleep disturbances increased the risk of COVID-19 susceptibility (OR=1.12, 95% CI 1.07-1.18), hospitalization (OR=1.25, 95% CI 1.15-1.36), mortality (OR=1.45, 95% CI 1.19-1.78), and long COVID (OR=1.36 95% CI 1.17-1.57). Subgroup analysis showed that younger individuals with sleep disturbances were associated with higher susceptibility and hospitalization and a lower risk of mortality than older individuals. Males with sleep disturbances were associated with higher mortality. For specific sleep disturbances, the susceptibility and hospitalization of COVID-19 were associated with OSA, abnormal sleep duration, and night-shift work; mortality of COVID-19 was linked to OSA; risk of long COVID was related to OSA, abnormal sleep duration and insomnia. Pre-existing sleep disturbances, especially OSA, increased the risk of COVID-19 susceptibility, hospitalization, mortality, and long COVID. Age and sex played important roles in the effect of sleep disturbances on COVID-19. The National Natural Science Foundation of China and the Key Laboratory of Respiratory Diseases of Liaoning Province.

Relationship between acute SARS-CoV-2 viral clearance with Long COVID Symptoms: a cohort study.

The relationship between SARS-CoV-2 viral dynamics during acute infection and the development of long COVID is largely unknown. A total of 7361 asymptomatic community-dwelling people enrolled in the Test Us at Home parent study between October 2021 and February 2022. Participants self-collected anterior nasal swabs for SARS-CoV-2 RT-PCR testing every 24-48 hours for 10-14 days, regardless of symptom or infection status. Participants who had no history of COVID-19 at enrollment and who were subsequently found to have ≥1 positive SARS-CoV-2 RT-PCR test during the parent study were recontacted in August 2023 and asked whether they had experienced long COVID, defined as the development of new symptoms lasting 3 months or longer following SARS-CoV-2 infection. Participant's cycle threshold values were converted into viral loads, and slopes of viral clearance were modeled using post-nadir viral loads. Using a log binomial model with the modeled slopes as the exposure, we calculated the relative risk of subsequently developing long COVID with 1-2 symptoms, 3-4 symptoms, or 5+ symptoms, adjusting for age, number of symptoms, and SARS-CoV-2 variant. Adjusted relative risk (aRR) of individual long COVID symptoms based on viral clearance was also calculated. 172 participants were eligible for analyses, and 59 (34.3%) reported experiencing long COVID. The risk of long COVID with 3-4 symptoms and 5+ symptoms increased by 2.44 times (aRR: 2.44; 95% CI: 0.88-6.82) and 4.97 times (aRR: 4.97; 95% CI: 1.90-13.0) per viral load slope-unit increase, respectively. Participants who developed long COVID had significantly longer times from peak viral load to viral clearance during acute disease than those who never developed long COVID (8.65 [95% CI: 8.28-9.01] vs. 10.0 [95% CI: 9.25-10.8]). The slope of viral clearance was significantly positively associated with long COVID symptoms of fatigue (aRR: 2.86; 95% CI: 1.22-6.69), brain fog (aRR: 4.94; 95% CI: 2.21-11.0), shortness of breath (aRR: 5.05; 95% CI: 1.24-20.6), and gastrointestinal symptoms (aRR: 5.46; 95% CI: 1.54-19.3). We observed that longer time from peak viral load to viral RNA clearance during acute COVID-19 was associated with an increased risk of developing long COVID. Further, slower clearance rates were associated with greater number of symptoms of long COVID. These findings suggest that early viral-host dynamics are mechanistically important in the subsequent development of long COVID.

Predictors of COVID-19 vaccine acceptability among refugees and other migrant populations: A systematic scoping review.

This study aimed to map the existing literature to identify predictors of COVID-19 vaccine acceptability among refugees, immigrants, and other migrant populations. A systematic search of Medline, Embase, Scopus, APA PsycInfo and Cumulative Index of Nursing and Allied Health Literature (CINAHL) was conducted up to 31 January 2023 to identify the relevant English peer-reviewed observational studies. Two independent reviewers screened abstracts, selected studies, and extracted data. We identified 34 cross-sectional studies, primarily conducted in high income countries (76%). Lower vaccine acceptance was associated with mistrust in the host countries' government and healthcare system, concerns about the safety and effectiveness of COVID-19 vaccines, limited knowledge of COVID-19 infection and vaccines, lower COVID-19 risk perception, and lower integration level in the host country. Female gender, younger age, lower education level, and being single were associated with lower vaccine acceptance in most studies. Additionally, sources of information about COVID-19 and vaccines and previous history of COVID-19 infection, also influence vaccine acceptance. Vaccine acceptability towards COVID-19 booster doses and various vaccine brands were not adequately studied. Vaccine hesitancy and a lack of trust in COVID-19 vaccines have become significant public health concerns within migrant populations. These findings may help in providing information for current and future vaccine outreach strategies among migrant populations.

COVID-19 risk perception and food security in the MENA region: evidence from a multi-wave household survey

The COVID-19 pandemic had disruptive consequences for MENA countries’ agri-food value chains that exacerbated poverty and jeopardized food security. This study examines the relationship between individuals’ perception of contracting COVID-19 and their experience of food insecurity, using longitudinal data from the Combined COVID-19 MENA Monitor Household survey. It also investigates the underlying mechanisms of COVID-19 concerns and explores coping strategies employed by households to identify vulnerabilities in food security. The results provide compelling evidence of a strong association between individuals’ concern about the virus and various dimensions of food security, particularly reduced purchasing power and decreased meal frequency. Notably, this association follows an inverted U-shaped curve, with food insecurity initially increasing as worry grows, but declining after individuals contract the virus. High levels of concern were also linked to significant income decreases and worsening economic conditions. Moreover, individuals with higher concerns were more likely to rely on specific coping strategies, particularly spending savings and obtaining funds from relatives or friends. These findings underscore the need for government interventions during disease outbreaks and economic downturns to focus on alleviating individuals’ worry and fear to facilitate informed decision-making that minimizes food insecurity consequences. Additionally, the findings emphasize the need to strengthen social protection systems during public health and economic challenges to ensure food security for vulnerable populations.

Eight-Fold Increased COVID-19 Mortality in Autosomal Dominant Tubulointerstitial Kidney Disease due to MUC1 Mutations: An Observational Study.

MUC1 and UMOD pathogenic variants cause autosomal dominant tubulointerstitial kidney disease (ADTKD). MUC1 is expressed in kidney, nasal mucosa and respiratory tract, while UMOD is expressed only in kidney. Due to haplo-insufficiency ADTKD- MUC1 patients produce approximately 50% of normal mucin-1. To determine whether decreased mucin-1 production was associated with an increased COVID-19 risk, we sent a survey to members of an ADTKD registry in September 2021, after the initial, severe wave of COVID-19. We linked results to previously obtained ADTKD genotype and plasma CA15-3 (mucin-1) levels and created a longitudinal registry of COVID-19 related deaths. Surveys were emailed to 637 individuals, with responses from 89 ADTKD- MUC1 and 132 ADTKD- UMOD individuals. 19/83 (23%) ADTKD- MUC1 survey respondents reported a prior COVID-19 infection vs. 14/125 (11%) ADTKD- UMOD respondents (odds ratio (OR) 2.35 (95%CI 1.60-3.11, P = 0.0260). Including additional familial cases reported from survey respondents, 10/41 (24%) ADTKD- MUC1 individuals died of COVID-19 vs. 1/30 (3%) with ADTKD- UMOD , with OR 9.21 (95%CI 1.22-69.32), P = 0.03. The mean plasma mucin-1 level prior to infection in 14 infected and 27 uninfected ADTKD- MUC1 individuals was 7.06±4.12 vs. 10.21±4.02 U/mL ( P = 0.035). Over three years duration, our longitudinal registry identified 19 COVID-19 deaths in 360 ADTKD- MUC1 individuals (5%) vs. 3 deaths in 478 ADTKD- UMOD individuals (0.6%) ( P = 0.0007). Multivariate logistic regression revealed the following odds ratios (95% confidence interval) for COVID-19 deaths: ADTKD- MUC1 8.4 (2.9-29.5), kidney transplant 5.5 (1.6-9.1), body mass index (kg/m 2 ) 1.1 (1.0-1.2), age (y) 1.04 (1.0-1.1). Individuals with ADTKD- MUC1 are at an eight-fold increased risk of COVID-19 mortality vs. ADTKD- UMOD individuals. Haplo-insufficient production of mucin-1 may be responsible.

Impact of COVID-19 Infection in Kidney Transplant Patients: A Review

Managing COVID-19 in kidney transplant patients is complex due to limited data on its severity, treatment, and management. Conflicting information from studies necessitates case-by-case treatment decisions. Atypical symptoms can lead to misdiagnosis, so a thorough evaluation is crucial. Immunosuppressants and comorbidities can worsen the disease, leading to the controversial approach of discontinuing or reducing immunosuppressive drugs. Kidney transplantation is challenging due to the surgical procedure’s sensitivity and high risk of transmission. While vaccines offer protection, their efficacy may be altered by immunosuppressive drugs in these patients. This review summarizes the management of COVID-19 in kidney transplant patients, addressing these complexities. Kidney transplant patients face unique COVID-19 challenges due to weakened immunity. They are at higher risk for severe illness and complications from both the virus and immunosuppressant medications. Early identification and intervention are crucial, including antiviral treatment like remdesivir in severe cases. Managing immunosuppressants is critical to balancing the risk of transplant rejection with COVID-19 severity. Drug interactions with COVID-19 treatments require careful consideration, potentially necessitating dose adjustments or alternative medications. The pandemic has disrupted transplant services, highlighting the need for prioritized vaccination and safe access to care. Telemedicine can help minimize virus exposure during post-transplant follow-up. While immunosuppression may impact vaccine responses, vaccination remains crucial to reducing the severe COVID-19 risk. Booster doses and continued precautions are important. Mental health support is essential to address pandemic-related anxiety, depression, and social isolation. More data is needed on the safety and effectiveness of COVID-19 treatments and vaccines in this population. A multidisciplinary approach, including close monitoring, careful medication management, vaccination, and psychosocial support is needed to optimize management and improve outcomes.

Genetic analyses point to alterations in immune-related pathways underpinning the association between psychiatric disorders and COVID-19.

Current literature suggests that people with psychiatric disorders have a higher risk of COVID-19 infection and a worse prognosis of the disease. We aimed to study the genetic contribution to these associations across seven psychiatric disorders as well as a general psychopathology factor (P-factor) and determine whether these are unique or shared across psychiatric disorders using statistical genetic techniques. Using the largest available genome-wide association studies (GWAS), we found a significant genetic overlap between depression, ADHD, PTSD, and the P-factor with both COVID-19 infection and hospitalization, and between anxiety and COVID-19 hospitalization. We used pairwise GWAS to examine this overlap on a fine-grained scale and identified specific regions of the genome shared between several psychiatric disorders, the P-factor, and COVID-19. Gene-based analysis in these genomic regions suggested possible links with immune-related pathways such as thyroid homeostasis, inflammation, and stress response. Finally, we show preliminary evidence for causal associations between depression, ADHD, PTSD, and the P-factor, and higher COVID-19 infection and hospitalization using Mendelian Randomization and Latent Causal Variable methods. Our results support the hypothesis that the relationship between psychiatric disorders and COVID-19 risk is likely due to shared alterations in immune-related pathways and is not a result of environmental factors alone, shedding light on potentially viable therapeutic targets.

Spatiotemporal dynamics of epidemiology diseases: mobility based risk and short-term prediction modeling of COVID-19.

Nowadays, epidemiological modeling is applied to a wide range of diseases, communicable and non-communicable, namely AIDS, Ebola, influenza, Dengue, Malaria, Zika. More recently, in the context of the last pandemic declared by the World Health Organization (WHO), several studies applied these models to SARS-CoV-2. Despite the increasing number of researches using spatial analysis, some constraints persist that prevent more complex modeling such as capturing local epidemiological dynamics or capturing the real patterns and dynamics. For example, the unavailability of: (i) epidemiological information such as the frequency with which it is made available; (ii) sociodemographic and environmental factors (e.g., population density and population mobility) at a finer scale which influence the evolution patterns of infectious diseases; or (iii) the number of cases information that is also very dependent on the degree of testing performed, often with severe territorial disparities and influenced by context factors. Moreover, the delay in case reporting and the lack of quality control in epidemiological information is responsible for biases in the data that lead to many results obtained being subject to the ecological fallacy, making it difficult to identify causal relationships. Other important methodological limitations are the control of spatiotemporal dependence, management of non-linearity, ergodicy, among others, which can impute inconsistencies to the results. In addition to these issues, social contact, is still difficult to quantify in order to be incorporated into modeling processes. This study aims to explore a modeling framework that can overcome some of these modeling methodological limitations to allow more accurate modeling of epidemiological diseases. Based on Geographic Information Systems (GIS) and spatial analysis, our model is developed to identify group of municipalities where population density (vulnerability) has a stronger relationship with incidence (hazard) and commuting movements (exposure). Specifically, our framework shows how to operate a model over data with no clear trend or seasonal pattern which is suitable for a short-term predicting (i.e., forecasting) of cases based on few determinants. Our tested models provide a good alternative for when explanatory data is few and the time component is not available, once they have shown a good fit and good short-term forecast ability.

COVID-19 Infection in a Group of Egyptian Children with Bronchial Asthma: A Single Center Study

Abstract Background Impact of asthma on COVID-19 severity and outcome in infants is not well investigated. Therefore, we sought to assess the presentation, severity and outcome of COVID-19 infection in a group of Egyptian asthmatic children. Patients and Methods We conducted an observational follow up study on 30 asthmatic children with probable/confirmed COVID-19, aged 6-10 years, who were enrolled consecutively from the Emergency department and Isolation Ward, Children`s Hospital, Ain Shams University, Egypt. COVID-19 clinical manifestations, severity and outcome were studied. Results The median age of the children was 9 years (IQR: 6-18 years). Out of the 30 studied patients, we had 9 boys and 21 girls. COVID-19 was asymptomatic in 2/30 (6.7%), mild in 20/30 (66.7%), and severe in 8/30 (26.7%). Clinical manifestations of COVID-19 included constitutional (22,73.3%), respiratory (21, 70%), gastrointestinal (7, 23%), cardio- vascular (5, 16.7%), and dermatological (1, 3.3%) manifestations. Multisystem inflammatory syndrome (MIS-c) was diagnosed in only one patient. Chest X-ray abnormalities were found in (36.7%). The median duration of hospital stay was 10 days, Complete resolution was the final outcome of all patients. Conclusion Asthma does not represent a risk of severe COVID-19 or poor outcome and COVID-19 course, and the outcome in asthmatic children is similar to the general pediatric population. However, our study is limited by the small sample size and short duration of follow-up. Further longitudinal studies are needed to investigate the exact impact of different SARS-CoV-2 variants with respect to asthma phenotypes and asthma biological treatments and allergen immunotherapies in children.

Preference for working from home – subjective perceptions of COVID-19 matter more than objective information on occupational exposure to contagion

We investigate how subjective and objective assessment of COVID-19 risks affect preferences toward working from home (WFH) and whether informing workers about the level of exposure to contagion in their occupation affects these preferences. In the summer of 2021, we conducted a discrete choice experiment combined with an information provision experiment with more than 11 000 workers in Poland. Estimating willingness to pay for WFH, we find that, on average, workers' are willing to give up 3.2%, 95% CI [2.8%; 3.6%] of earnings for such an option. The subjective assessment of COVID-19 risk matters as workers who perceive COVID-19 as a threat are willing to sacrifice a higher share of earnings for WFH than those who do not (4.1%, vs. 1.3% [p<0.00]). However, the preferences toward WFH differ to a smaller extent between workers in occupations with high or low exposure to COVID-19 [3.8% vs. 2.7%, p=0.01]. Informing workers about occupational exposure to contagion generally does not affect preferences toward WFH.

Complex patterns of multimorbidity associated with severe COVID-19 and Long COVID.

Early evidence that patients with (multiple) pre-existing diseases are at highest risk for severe COVID-19 has been instrumental in the pandemic to allocate critical care resources and later vaccination schemes. However, systematic studies exploring the breadth of medical diagnoses, including common, but non-fatal diseases are scarce, but may help to understand severe COVID-19 among patients at supposedly low risk. Here, we systematically harmonized >12 million primary care and hospitalisation health records from ~500,000 UK Biobank participants into 1448 collated disease terms to systematically identify diseases predisposing to severe COVID-19 (requiring hospitalisation or death) and its post-acute sequalae, Long COVID. We identified a total of 679 diseases associated with an increased risk for severe COVID-19 (n=672) and/or Long COVID (n=72) that spanned almost all clinical specialties and were strongly enriched in clusters of cardio-respiratory and endocrine-renal diseases. For 57 diseases, we established consistent evidence to predispose to severe COVID-19 based on survival and genetic susceptibility analyses. This included a possible role of symptoms of malaise and fatigue as a so far largely overlooked risk factor for severe COVID-19. We finally observed partially opposing risk estimates at known risk loci for severe COVID-19 for etiologically related diseases, such as post-inflammatory pulmonary fibrosis (e.g., MUC5B, NPNT, and PSMD3) or rheumatoid arthritis (e.g., TYK2), possibly indicating a segregation of disease mechanisms. Our results provide a unique reference that demonstrates how 1) complex co-occurrence of multiple - including non-fatal - conditions predispose to increased COVID-19 severity and 2) how incorporating the whole breadth of medical diagnosis can guide the interpretation of genetic risk loci.

Factors Associated With Vaccination Refusal Among a Sample of the Jordanian Population

Using a questionnaire, this study investigated the numerous factors affecting the Jordanian population’s rejection of COVID-19 vaccines. The data were collected in 2020 to 2021. Using the chi-square test, t-test, Cramer’s V-test, and analysis of variance, we found that most of the Sample (72.6%) obtained information on COVID-19 and its vaccines from social media, radio, and television. In comparison, 31.1% and 35.4% of the Sample obtained from government/official sources or health specialists, respectively, with a lesser share relying on colleagues (13.7%) and scientific lectures (17.5%). Furthermore, depending on the participants’ characteristics, there were significant differences in the information sources or abstinence factors. Several factors were associated with vaccine refusal and hesitancy, including contradictory/conflicting information, lack of trust in vaccines/manufacturers, doubt about the vaccines’ effectiveness, and the belief that the risks of COVID-19 are minimal. Based on these findings, we present several recommendations for policymakers.

КОРОНАВИРУСНАЯ ИНФЕКЦИЯ COVID-19 У ПАЦИЕНТОВ С МНОЖЕСТВЕННОЙ МИЕЛОМОЙ: ОБЗОР ЛИТЕРАТУРЫ И СОБСТВЕННЫй ОПЫТ

The presented literature review presents studies, including our own, on the peculiarities of the course of coronavirus infection in patients with hemoblastosis, in particular in patients with multiple myeloma (MM). It has been shown that in patients with MM attachment of the SARS-CoV-2 COVID-19 coronavirus infection, the prognosis of the patient’s life significantly worsens, which makes significant changes in the overall survival and mortality rates. Factors that worsen the prognosis of life in patients with MM are old age, male gender, uncontrolled/active disease and/or high risk of MM, concomitant diseases, MM beyond remission, acute course of SARS-CoV-2 COVID19, interruption of treatment without subsequent resumption. Patients with MM are at high risk of severe coronavirus infection COVID-19 and mortality, however, this risk is lower compared to coronavirus infection SARS-CoV-2 and Delta. MM patients receiving anti-BCMA therapy do not respond to vaccination and have a risk of developing severe course and progression of coronavirus infection due to the lack of an immune response of some Omicron variants. Patients with MM should be vaccinated with updated mRNA-based booster vaccines adapted to Omicron. In case of COVID-19 coronavirus infection, patients with MM should be prescribed oral effective antiviral drugs or remdesivir. Treatment of SARS-CoV-2 COVID19 patients with MM should be carried out in full according to the clinical guidelines for the treatment of SARS-CoV-2 COVID19.

Biomarker of severity in hospitalised patients with COVID-19: a retrospective study

BackgroundThe novel COVID-19 was rapidly spreading and was highly contagious. COVID-19 caused over 6 million deaths worldwide, with high mortality rates, particularly in severe cases.ObjectiveThis study aimed to investigate whether...

Comparative effectiveness of combination therapy with nirmatrelvir–ritonavir and remdesivir versus monotherapy with remdesivir or nirmatrelvir–ritonavir in patients hospitalised with COVID-19: a target trial emulation study

Remdesivir (Veklury, Gilead Sciences, Foster City, CA, USA) and nirmatrelvir-ritonavir (Paxlovid, Pfizer, New York, NY, USA) were reported to improve the outcome of patients with mild-to-moderate COVID-19 symptoms. Preclinical data suggest that nirmatrelvir-ritonavir might be more effective than remdesivir alone or in combination with nirmatrelvir-ritonavir for people at high risk of severe COVID-19. We aimed to assess the safety and effectiveness of combining remdesivir and nirmatrelvir-ritonavir compared with using each drug alone for adults hospitalised with COVID-19. In this target trial emulation study, we used electronic health records of patients aged 18 years or older who received either combination treatment of nirmatrelvir-ritonavir and remdesivir or monotherapy of either drug between March 16 and Dec 31, 2022, within 5 days of hospitalisation for COVID-19 in Hong Kong. Inverse probability of treatment weighting was applied to balance baseline patient characteristics across the treatment groups. The primary outcome was all-cause mortality. Cox proportional hazards regression adjusting weighting was used to compare the risk of all-cause mortality, intensive care unit (ICU) admission, or ventilatory support for 90 days of follow-up between groups. Between March 16 and Dec 31, 2022, 18 196 participants were identified from electronic health records and assigned to receive remdesivir (n=4232), nirmatrelvir-ritonavir (n=13 656), or nirmatrelvir-ritonavir and remdesivir (n=308). By applying an inverse probability of treatment weighting, a weighted sample composed of 18 410 recipients of nirmatrelvir-ritonavir and remdesivir combination treatment, 18 178 recipients of remdesivir monotherapy, and 18 287 recipients of nirmatrelvir-ritonavir monotherapy was obtained. After a median follow-up of 84 days (IQR 45-90), risk of mortality was lower in patients who received nirmatrelvir-ritonavir monotherapy (hazard ratio [HR] 0·18 [95% CI 0·15 to 0·20]; absolute risk reduction [ARR] -16·33% [95% CI -16·98 to -15·68]) or remdesivir and nirmatrelvir-ritonavir combination therapy (HR 0·66 [95% CI 0·49 to 0·89]; ARR -6·52% [95% CI -7·29 to -5·74]) than in patients who received remdesivir monotherapy. Similar results were observed for ICU admission or ventilatory support (nirmatrelvir-ritonavir monotherapy: HR 0·09 [95% CI 0·07 to 0·11]; ARR -10·04% [95% CI -10·53 to -9·56]; combination therapy: HR 0·68 [95% CI 0·42 to 1·12]; ARR -3·24% [95% CI -3·84 to -2·64]). Compared with combination therapy, nirmatrelvir-ritonavir monotherapy was associated with lower risk of mortality (HR 0·27 [95% CI 0·20 to 0·37]; ARR -9·81% [95% CI -10·39 to -9·24]) and ICU admission or ventilatory support (HR 0·13 [95% CI 0·08 to 0·22]; ARR -6·80% [95% CI -7·22 to -6·39]). Our study highlighted the potential for reduced risk of mortality, ICU admission, or the need for ventilatory support in patients hospitalised with COVID-19 treated with nirmatrelvir-ritonavir as a monotherapy compared with treatment regimens based on nirmatrelvir-ritonavir and remdesivir combination therapy or remdesivir monotherapy. Further randomised controlled trials are needed to support the validity of the current results. The Health and Medical Research Fund Commissioned Research on COVID-19. For the Chinese translation of the abstract see Supplementary Materials section.