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1.
Proc Natl Acad Sci U S A ; 119(29): e2208032119, 2022 Jul 19.
Article in English | MEDLINE | ID: covidwho-1960629
2.
Intern Emerg Med ; 17(5): 1413-1424, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1942870

ABSTRACT

One of the most helpful strategies to deal with ongoing coronavirus pandemics is to use some prudence when treating patients infected with SARS-CoV-2. We aimed to evaluate the clinical, demographic, and laboratory parameters that might have predictive value for in-hospital mortality and the need for intensive care and build a model based on them. This study was a prospective, observational, single-center study including non-critical patients admitted to COVID-19 wards. Besides classical clinic-demographic features, basic laboratory parameters obtained on admission were tested, and then new models for each outcome were developed built on the most significant variables. Receiver operating characteristics (ROC) analyses were performed by calculating each model's probability. A total of 368 non-critical hospitalized patients were recruited, the need for ICU care was observed in 70 patients (19%). The total number of patients who died in either ICU or wards was 39 (10.6%). The first two models (based on clinical features and demographics) were developed to predict ICU and death, respectively; older age, male sex, active cancer, and low baseline saturation were noted to be independent predictors. The area under the curve values of the first two models were noted 0.878 and 0.882 (p < .001; confidence interval [CI] 95% [0.837-0.919], p < .001; CI 95% [0.844-0.922]). Following two models, the third and fourth were based on laboratory parameters with clinic-demographic features. Initial lower sodium and lower albumin levels were determined as independent factors in predicting the need for ICU care; higher blood urea nitrogen and lower albumin were independent factors in predicting in-hospital mortality. The area under the curve values of the third and fourth model was noted 0.938 and 0.929, respectively (p < .001; CI 95% [0.912-0.965], p < .001; CI 95% [0.895-962]). By integrating the widely available blood tests results with simple clinic demographic data, non-critical patients can be stratified according to their risk level. Such stratification is essential to filter the patients' non-critical underlying diseases and conditions that can obfuscate the physician's predictive capacity.


Subject(s)
COVID-19 , Critical Care , Hospital Mortality , Albumins , COVID-19/mortality , COVID-19/therapy , Critical Care/methods , Humans , Intensive Care Units , Male , Prospective Studies , Retrospective Studies , SARS-CoV-2
4.
Front Immunol ; 13: 905585, 2022.
Article in English | MEDLINE | ID: covidwho-1933690

ABSTRACT

Background: In Hungary, the pandemic waves in late 2021 and early 2022 were dominated by the Delta and Omicron SARS-CoV-2 variants, respectively. Booster vaccines were offered with one or two doses for the vulnerable population during these periods. Methods and Findings: The nationwide HUN-VE 2 study examined the effectiveness of primary immunization, single booster, and double booster vaccination in the prevention of Covid-19 related mortality during the Delta and Omicron waves, compared to an unvaccinated control population without prior SARS-CoV-2 infection during the same study periods. The risk of Covid-19 related death was 55% lower during the Omicron vs. Delta wave in the whole study population (n=9,569,648 and n=9,581,927, respectively; rate ratio [RR]: 0.45, 95% confidence interval [CI]: 0.44-0.48). During the Delta wave, the risk of Covid-19 related death was 74% lower in the primary immunized population (RR: 0.26; 95% CI: 0.25-0.28) and 96% lower in the booster immunized population (RR: 0.04; 95% CI: 0.04-0.05), vs. the unvaccinated control group. During the Omicron wave, the risk of Covid-19 related death was 40% lower in the primary immunized population (RR: 0.60; 95% CI: 0.55-0.65) and 82% lower in the booster immunized population (RR: 0.18; 95% CI: 0.16-0.2) vs. the unvaccinated control group. The double booster immunized population had a 93% lower risk of Covid-19 related death compared to those with only one booster dose (RR: 0.07; 95% CI. 0.01-0.46). The benefit of the second booster was slightly more pronounced in older age groups. Conclusions: The HUN-VE 2 study demonstrated the significantly lower risk of Covid-19 related mortality associated with the Omicron vs. Delta variant and confirmed the benefit of single and double booster vaccination against Covid-19 related death. Furthermore, the results showed the additional benefit of a second booster dose in terms of SARS-CoV-2 infection and Covid-19 related mortality.


Subject(s)
COVID-19 Vaccines , COVID-19 , Immunization, Secondary , SARS-CoV-2 , Age Factors , Aged , COVID-19/mortality , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , Humans , Hungary/epidemiology , Risk , Vaccination Coverage
5.
BMJ Open ; 12(7): e058078, 2022 07 08.
Article in English | MEDLINE | ID: covidwho-1932738

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has created a huge social and economic burden, and the lifestyles of individuals have significantly changed. In addition, the diagnosis, treatment and management of patients with cancer were greatly affected. Studies have shown that patients with cancer are at a higher risk of COVID-19 infection-related complications, which require aggressive preventive measures. Different types of cancer may have different risks of COVID-19 infection and death, and different preventive care measures are needed for different types of patients with cancer. Here, we designed a protocol for systematic review and meta-analysis to explore the impact of cancer types on COVID-19 infection and mortality risk. METHODS AND ANALYSIS: A systematic search plan will be performed to filter the eligible studies in the seven databases, namely PubMed, Cochrane search strategy, EMBASE search strategy, SinoMed, China National Knowledge Infrastructure, China Science and Technology Journals Database, and Wanfang database from 2019 to 10 August 2021. Two independent reviewers will choose the eligible studies and extract the data. The risk of bias will be evaluated based on the Newcastle-Ottawa Scale recommended by the Cochrane Collaboration. Finally, a systematic review and meta-analysis will be performed using Review Manager (V.5.3) statistical software. ETHICS AND DISSEMINATION: Formal ethical approval is not required, and the findings will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42021271108.


Subject(s)
COVID-19 , Neoplasms , COVID-19/complications , COVID-19/mortality , Humans , Meta-Analysis as Topic , Neoplasms/complications , Pandemics , Research Design , Systematic Reviews as Topic
6.
Lancet Child Adolesc Health ; 6(4): 249-259, 2022 04.
Article in English | MEDLINE | ID: covidwho-1927002

ABSTRACT

BACKGROUND: In the 6 months following our estimates from March 1, 2020, to April 30, 2021, the proliferation of new coronavirus variants, updated mortality data, and disparities in vaccine access increased the amount of children experiencing COVID-19-associated orphanhood. To inform responses, we aimed to model the increases in numbers of children affected by COVID-19-associated orphanhood and caregiver death, as well as the cumulative orphanhood age-group distribution and circumstance (maternal or paternal orphanhood). METHODS: We used updated excess mortality and fertility data to model increases in minimum estimates of COVID-19-associated orphanhood and caregiver deaths from our original study period of March 1, 2020-April 30, 2021, to include the new period of May 1-Oct 31, 2021, for 21 countries. Orphanhood was defined as the death of one or both parents; primary caregiver loss included parental death or the death of one or both custodial grandparents; and secondary caregiver loss included co-residing grandparents or kin. We used logistic regression and further incorporated a fixed effect for western European countries into our previous model to avoid over-predicting caregiver loss in that region. For the entire 20-month period, we grouped children by age (0-4 years, 5-9 years, and 10-17 years) and maternal or paternal orphanhood, using fertility contributions, and we modelled global and regional extrapolations of numbers of orphans. 95% credible intervals (CrIs) are given for all estimates. FINDINGS: The number of children affected by COVID-19-associated orphanhood and caregiver death is estimated to have increased by 90·0% (95% CrI 89·7-90·4) from April 30 to Oct 31, 2021, from 2 737 300 (95% CrI 1 976 100-2 987 000) to 5 200 300 (3 619 400-5 731 400). Between March 1, 2020, and Oct 31, 2021, 491 300 (95% CrI 485 100-497 900) children aged 0-4 years, 736 800 (726 900-746 500) children aged 5-9 years, and 2 146 700 (2 120 900-2 174 200) children aged 10-17 years are estimated to have experienced COVID-19-associated orphanhood. Globally, 76·5% (95% CrI 76·3-76·7) of children were paternal orphans, whereas 23·5% (23·3-23·7) were maternal orphans. In each age group and region, the prevalence of paternal orphanhood exceeded that of maternal orphanhood. INTERPRETATION: Our findings show that numbers of children affected by COVID-19-associated orphanhood and caregiver death almost doubled in 6 months compared with the amount after the first 14 months of the pandemic. Over the entire 20-month period, 5·0 million COVID-19 deaths meant that 5·2 million children lost a parent or caregiver. Our data on children's ages and circumstances should support pandemic response planning for children globally. FUNDING: UK Research and Innovation (Global Challenges Research Fund, Engineering and Physical Sciences Research Council, and Medical Research Council), Oak Foundation, UK National Institute for Health Research, US National Institutes of Health, and Imperial College London.


Subject(s)
COVID-19/mortality , Caregivers/supply & distribution , Child, Orphaned/statistics & numerical data , Adolescent , Adult , Child , Female , Humans , Male , Models, Statistical
7.
Nutr Clin Pract ; 37(4): 852-860, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1925977

ABSTRACT

BACKGROUND: Many hospitals have been using nutrition support guidelines for patients with coronavirus disease 2019 (COVID-19) as outlined in the April 2020 article released by the American Society for Parenteral and Enteral Nutrition (ASPEN) and the Society of Critical Care Medicine (SCCM). Currently, there are insufficient data on the outcomes of following these guidelines. METHODS: This was a retrospective, observational study of 131 adult inpatients with COVID-19 admitted to an intensive care unit (ICU) at Banner Health to observe differences in length of stay, mortality, and number of days intubated based on the timing of nutrition support start relative to hours intubated and hours in the ICU. RESULTS: There were no statistically significant differences between length of stay, mortality, or number of days intubated between patients who started nutrition support within <12 h of intubation, >12 h of intubation and <36 h in the ICU, or >36 h of intubation and those who were not intubated. Patients who started nutrition support after >36 h in the ICU had the longest lengths of stay (median [25th, 75th percentile] = 25.5 [19.25, 35.25] days; P > 0.05) and number of days intubated (16.5 [10.0, 24.75] days; P > 0.050); however, it was not statistically significant. There was a significant difference between the three intubated groups and the nonintubated group on Sequential Organ Failure Assessment scores (P = 0.01). CONCLUSIONS: Prospective, multicenter trials are needed; however, following the SCCM/ASPEN guidelines for nutrition support in patients with COVID-19 may be found to decrease length of stay and number of days intubated.


Subject(s)
COVID-19 , Length of Stay , Nutritional Support , Adult , Airway Extubation , COVID-19/mortality , COVID-19/therapy , Critical Illness/therapy , Humans , Intensive Care Units , Prospective Studies , Retrospective Studies
8.
J Infect Dev Ctries ; 16(6): 1016-1024, 2022 06 30.
Article in English | MEDLINE | ID: covidwho-1924345

ABSTRACT

INTRODUCTION: The mortality rate for any infection is often higher in patients with a kidney transplant (KT) and hemodialysis (HD), which may also be the case in novel coronavirus disease 2019 (COVID-19). METHODOLOGY: In this study, the demographic, clinic, laboratory, and radiologic signs of KT and HD patients diagnosed with COVID-19 infection between 11th March 2020 and 11th March 2021 were evaluated prospectively. RESULTS: In the present study, 72 HD (median age, 57.5 Q1-Q3:43-65; female: 36/50%) and 58 KT patients (median age, 44.5 Q1-Q3:28.75-55.25; female: 21/36.2%) with COVID-19 infection were enrolled. Fifteen patients with HD (20.8%) died. Age, diabetes mellitus (DM), abnormal hemoglobin levels, albumin, C-reactive protein (CRP), ferritin, D-dimer, and procalcitonin were significant in the univariate analysis of survival in patients with HD. However, only age was significant in the Cox-regression analysis [Hazard ratio (HR) (95% CI 1.070 (19.016-1.126)]. Nine (15.5%) KT patients died. The median time from symptoms onset to admission was three days (2-5). This rate was two (2-3) and five (4-5.75) days, respectively, for patients followed up in our center and the external centers (p < 0.001). Although age, DM, shortness of breath, bilateral involvement in CT images, abnormal levels of CRP, urea, leukocyte count, ferritin, and follow-ups of patients from the external center were significant in the univariate analysis of survival in patients with KT, no variables were significant in the cox-regression analysis. CONCLUSIONS: Increased mortality is expected in both HD and KT patients. Early diagnosis of COVID-19 in those patients with COVID-19 infection can be life-saving.


Subject(s)
COVID-19 , Kidney Transplantation , Renal Dialysis , Adult , C-Reactive Protein , COVID-19/diagnosis , COVID-19/mortality , Diabetes Mellitus , Female , Ferritins , Hospitals , Humans , Male , Middle Aged , Pandemics
9.
J Infect Dev Ctries ; 16(6): 981-992, 2022 06 30.
Article in English | MEDLINE | ID: covidwho-1924344

ABSTRACT

The objectives of this study were to determine the prevalence of cerebrovascular diseases caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, and to assess the pharmacological agents used in such cases as reported in the literature. Patient files were retrospectively scanned to determine the prevalence of neurological symptoms of the central nervous system (headache, dizziness, lack of smell and taste, numbness in arms and legs, change in consciousness, muscle weakness, loss of urine and stool control) and cerebrovascular diseases (ischemic cerebrovascular diseases, cerebral venous sinus thrombosis, intracerebral hemorrhage, subarachnoid/subdural hemorrhage) in 2019 novel coronavirus (2019-nCoV) disease (COVID-19) cases (n = 20,099). The diagnostic laboratory, radiology examinations and treatments applied to these cases were recorded. The data from studies presenting cerebrovascular diseases associated with SARS-Cov-2, which constituted 0.035% of all cases, were systematically evaluated from electronic databases. During the treatment of cerebrovascular diseases, it was discovered that high doses of enoxaparin sodium anti-Xa are combined with apixaban or acetylsalicylic acid or clopidogrel or piracetam, and mannitol, in addition to SARS-CoV-2 treatment modalities. While neurological symptoms of the central nervous system are uncommon in cases of SARS-CoV-2 infection, cerebrovascular diseases are far less common, according to the findings of this study. Acute cerebral ischemia was discovered to be the most common cerebrovascular disease associated with SARS-CoV-2. The mortality rate increases with the association between SARS-CoV-2 and cerebrovascular disease.


Subject(s)
COVID-19 , Cerebrovascular Disorders , Aspirin , Brain Ischemia/epidemiology , Brain Ischemia/etiology , Brain Ischemia/mortality , COVID-19/complications , COVID-19/epidemiology , COVID-19/mortality , Cerebrovascular Disorders/epidemiology , Cerebrovascular Disorders/etiology , Cerebrovascular Disorders/mortality , Clopidogrel , Enoxaparin/analogs & derivatives , Humans , Mannitol , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Piracetam , Pyrazoles , Pyridones , Retrospective Studies , SARS-CoV-2
11.
Endocr J ; 69(6): 643-648, 2022 Jun 28.
Article in English | MEDLINE | ID: covidwho-1910715

ABSTRACT

Thyroid dysfunction that is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is becoming increasingly recognized. However, only a few reports in Japan have addressed this issue to date. In this study, we sought to clarify whether infection with SARS-CoV-2 affected thyroid hormone levels and whether these hormones could be better predictors of prognosis in patients with coronavirus disease 2019 (COVID-19). Accordingly, we retrospectively examined 147 cases wherein thyroid hormones were measured at the time of admission among 848 Japanese patients with COVID-19 admitted to the Hyogo Prefectural Kakogawa Medical Center. All patients underwent thyroid function testing upon hospital admission. More than half (59.1%) of the patients were euthyroid. Twenty-four percent of patients had serum thyroid-stimulating hormone (TSH) levels lower than the reference range with normal serum free thyroxine (fT4) levels, and 3.4% of the patients had low TSH with high fT4 levels. Over 70% of the patients with moderate and severe COVID-19 had low serum free triiodothyronine (fT3) levels. Serum TSH and fT3 levels were inversely correlated with disease severity. The mortality rate in patients with low serum fT3 levels was significantly higher than that in those with normal serum fT3 levels.


Subject(s)
COVID-19 , Thyroid Gland , COVID-19/complications , COVID-19/mortality , Humans , Japan/epidemiology , Retrospective Studies , SARS-CoV-2 , Thyroid Function Tests , Thyroid Gland/physiopathology , Thyroid Hormones , Thyrotropin , Thyroxine , Triiodothyronine
12.
PLoS One ; 17(2): e0264072, 2022.
Article in English | MEDLINE | ID: covidwho-1910535

ABSTRACT

COVID-19 pandemic has posed a severe healthcare challenge calling for an integrated approach in determining the clues for early non-invasive diagnostics of the potentially severe cases and efficient patient stratification. Here we analyze the clinical, laboratory and CT scan characteristics associated with high risk of COVID-19-related death outcome in the cohort of severely-ill patients in Russia. The data obtained reveal that elevated dead lymphocyte counts, decreased early apoptotic lymphocytes, decreased CD14+/HLA-Dr+ monocytes, increased expression of JNK in PBMCs, elevated IL-17 and decreased PAI-1 serum levels are associated with a high risk of COVID-19-related mortality thus suggesting them to be new prognostic factors. This set of determinants could be used as early predictors of potentially severe course of COVID-19 for trials of prevention or timely treatment.


Subject(s)
COVID-19/mortality , Interleukin-17/blood , Plasminogen Activator Inhibitor 1/blood , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/blood , Female , Humans , Lymphocyte Count , Male , Middle Aged , Pandemics , Pilot Projects , Prognosis , Russia/epidemiology , Young Adult
13.
PLoS One ; 17(2): e0263417, 2022.
Article in English | MEDLINE | ID: covidwho-1910515

ABSTRACT

BACKGROUND: Given the rapid spread of COVID-19 and its associated morbidity and mortality, healthcare providers throughout the world have been forced to constantly update and change their care delivery models. OBJECTIVE: To assess the outcomes of COVID-19 hospitalized patients during the course of the pandemic in a well-integrated health system. METHODS: The study used data from the electronic health medical records to assess trends in clinical profile and outcomes of hospitalized adult COVID-19 patients hospitalized in our 5-hospital health system from March 2020-May 2021 (n = 6865). Integration of the health system began in February 2020 and was fully actualized by March 30, 2020. RESULTS: Mortality decreased from 15% during first peak (March-May 2020; the rate includes 19% in March-April and 10% in May 2020) to 6% in summer-fall 2020, increased to 13% during the second peak (November 2020-January 2021), and dropped to 7% during the decline period (February-May 2021) (p<0.01). Resource utilization followed a similar pattern including a decrease in ICU use from 35% (first peak) to 16% (decline period), mechanical ventilation from 16% (first peak, including 45% in March 2020) to 9-11% in subsequent periods (p<0.01). Independent predictors of inpatient mortality across multiple study periods included older age, male sex, higher multi-morbidity scores, morbid obesity, and indicators of severe illness on admission such as oxygen saturation ≤90% and high qSOFA score (all p<0.05). However, admission during the first peak remained independently associated with increased mortality even after adjustment for patient-related factors: odds ratio = 1.8 (1.4-2.4) (p<0.0001). CONCLUSIONS: The creation of a fully integrated health system allowed us to dynamically respond to the everchanging COVID-19 landscape. In this context, despite the increasing patient acuity, our mortality and resource utilization rates have improved during the pandemic.


Subject(s)
COVID-19/therapy , Delivery of Health Care, Integrated , Hospitalization , Intensive Care Units , Adult , Aged , Aged, 80 and over , COVID-19/mortality , Female , Hospital Mortality , Humans , Male , Middle Aged , Pandemics , Survival Rate , Treatment Outcome
14.
PLoS One ; 17(2): e0263303, 2022.
Article in English | MEDLINE | ID: covidwho-1910510

ABSTRACT

The calcium ion channel ORAI1 has emerged as a promising therapeutic target for the Coronavirus Disease 19 (COVID-19)-associated pneumonia, and a pharmacological inhibitor of ORAI1 has now reached clinical trials for severe COVID-19 pneumonia. Whether ORAI1 itself is associated with an increased risk for severe COVID-19 presentation is still unknown. Here, we employed genetic association analysis to investigate the potential association of host genetic polymorphisms of ORAI1 with the risk of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and its associated COVID-19 fatality in UK Biobank participants from white British background. The analysis showed no significant association between ORAI1 variants and COVID-19 positivity or fatality, despite the well-established roles of ORAI1 in immune response and inflammation and the success of ORAI1 inhibition in clinical trials. Our results suggest that the host genetic polymorphisms of ORAI1 are unlikely to be implicated in the broad variability in symptoms severity among afflicted patients.


Subject(s)
COVID-19/genetics , COVID-19/mortality , Genetic Predisposition to Disease , Mutation , ORAI1 Protein/genetics , Polymorphism, Single Nucleotide , SARS-CoV-2 , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/virology , Female , Humans , Male , Middle Aged , Retrospective Studies , United Kingdom/epidemiology
15.
PLoS One ; 17(2): e0263069, 2022.
Article in English | MEDLINE | ID: covidwho-1910500

ABSTRACT

OBJECTIVE: Studies have demonstrated a potential correlation between low vitamin D status and both an increased risk of infection with SARS-CoV-2 and poorer clinical outcomes. This retrospective study examines if, and to what degree, a relationship exists between pre-infection serum 25-hydroxyvitamin D (25(OH)D) level and disease severity and mortality due to SARS-CoV-2. PARTICIPANTS: The records of individuals admitted between April 7th, 2020 and February 4th, 2021 to the Galilee Medical Center (GMC) in Nahariya, Israel, with positive polymerase chain reaction (PCR) tests for SARS-CoV-2 (COVID-19) were searched for historical 25(OH)D levels measured 14 to 730 days prior to the positive PCR test. DESIGN: Patients admitted to GMC with COVID-19 were categorized according to disease severity and level of 25(OH)D. An association between pre-infection 25(OH)D levels, divided between four categories (deficient, insufficient, adequate, and high-normal), and COVID-19 severity was ascertained utilizing a multivariable regression analysis. To isolate the possible influence of the sinusoidal pattern of seasonal 25(OH)D changes throughout the year, a cosinor model was used. RESULTS: Of 1176 patients admitted, 253 had records of a 25(OH)D level prior to COVID-19 infection. A lower vitamin D status was more common in patients with the severe or critical disease (<20 ng/mL [87.4%]) than in individuals with mild or moderate disease (<20 ng/mL [34.3%] p < 0.001). Patients with vitamin D deficiency (<20 ng/mL) were 14 times more likely to have severe or critical disease than patients with 25(OH)D ≥40 ng/mL (odds ratio [OR], 14; 95% confidence interval [CI], 4 to 51; p < 0.001). CONCLUSIONS: Among hospitalized COVID-19 patients, pre-infection deficiency of vitamin D was associated with increased disease severity and mortality.


Subject(s)
COVID-19/blood , COVID-19/epidemiology , SARS-CoV-2/genetics , Severity of Illness Index , Vitamin D Deficiency/blood , Vitamin D Deficiency/epidemiology , Vitamin D/analogs & derivatives , Adult , Aged , Aged, 80 and over , COVID-19/mortality , COVID-19/virology , Comorbidity , Female , Humans , Israel/epidemiology , Male , Middle Aged , Patient Admission , Prognosis , Retrospective Studies , Risk Factors , Vitamin D/blood
16.
Proc Natl Acad Sci U S A ; 119(27): e2123533119, 2022 Jul 05.
Article in English | MEDLINE | ID: covidwho-1908381

ABSTRACT

High COVID-19 mortality among Black communities heightened the pandemic's devastation. In the state of Louisiana, the racial disparity associated with COVID-19 mortality was significant; Black Americans accounted for 50% of known COVID-19-related deaths while representing only 32% of the state's population. In this paper, we argue that structural racism resulted in a synergistic framework of cumulatively negative determinants of health that ultimately affected COVID-19 deaths in Louisiana Black communities. We identify the spatial distribution of social, environmental, and economic stressors across Louisiana parishes using hot spot analysis to develop aggregate stressors. Further, we examine the correlation between stressors, cumulative health risks, COVID-19 mortality, and the size of Black populations throughout Louisiana. We hypothesized that parishes with larger Black populations (percentages) would have larger stressor values and higher cumulative health risks as well as increased COVID-19 mortality rates. Our results suggest two categories of parishes. The first group has moderate levels of aggregate stress, high population densities, predominately Black populations, and high COVID-19 mortality. The second group of parishes has high aggregate stress, lower population densities, predominantly Black populations, and initially low COVID-19 mortality that increased over time. Our results suggest that structural racism and inequities led to severe disparities in initial COVID-19 effects among highly populated Black Louisiana communities and that as the virus moved into less densely populated Black communities, similar trends emerged.


Subject(s)
African Americans , COVID-19 , Health Equity , Healthcare Disparities , COVID-19/mortality , Healthcare Disparities/ethnology , Humans , Louisiana/epidemiology , Population Density , Race Factors
17.
Proc Natl Acad Sci U S A ; 119(26): e2202686119, 2022 06 28.
Article in English | MEDLINE | ID: covidwho-1900770

ABSTRACT

Excess mortality associated with the COVID-19 pandemic has led many to experience the loss of family members, with significant negative outcomes. We quantify the extent to which these population-wide rates of kin loss represent a departure from levels expected in the absence of COVID-19 excess mortality and consider which demographic groups are most likely to be affected. Results for biological kin in 31 countries indicate dramatic increases in excess kin loss associated with excess mortality and follow a generational pattern consistent with COVID-19 mortality risk by age. During periods of high excess mortality, the number of younger individuals losing a grandparent increased by up to 845 per 100,000, or 1.2 times expected levels (for individuals aged 30 to 44 y in the United Kingdom in April 2020), while the number of older individuals losing a sibling increased by up to 511 per 100,000 or 1.15 times (for individuals aged 65 y and over in Poland in November 2020). Our monthly multicountry estimates of excess kin loss complement existing point estimates of the number of individuals bereaved by COVID-19 mortality [Verdery et al., Proc. Natl. Acad. Sci. U.S.A. 117, 17695-17701 (2020); Kidman et al., JAMA Pediatr. 175, 745-746 (2021); Hillis et al., Lancet 398, 391-402 (2021)] and highlight the role of heterogeneous excess mortality in shaping country experiences.


Subject(s)
Bereavement , COVID-19 , COVID-19/epidemiology , COVID-19/mortality , Humans , Incidence , United Kingdom/epidemiology
18.
Sci Rep ; 12(1): 2077, 2022 02 08.
Article in English | MEDLINE | ID: covidwho-1900598

ABSTRACT

More than a year after the start of the pandemic, COVID-19 remains a global health emergency. Although the immune response against SARS-CoV-2 has been extensively studied, some points remain controversial. One is the role of antibodies in viral clearance and modulation of disease severity. While passive transfer of neutralizing antibodies protects against SARS-CoV-2 infection in animal models, titers of anti-SARS-CoV-2 antibodies have been reported to be higher in patients suffering from more severe forms of the disease. A second key question for pandemic management and vaccine design is the persistence of the humoral response. Here, we characterized the antibody response in 187 COVID-19 patients, ranging from asymptomatic individuals to patients who died from COVID-19, and including patients who recovered. We developed in-house ELISAs to measure titers of IgG, IgM and IgA directed against the RBD or N regions in patient serum or plasma, and a spike-pseudotyped neutralization assay to analyse seroneutralization. Higher titers of virus-specific antibodies were detected in patients with severe COVID-19, including deceased patients, compared to asymptomatic patients. This demonstrates that fatal infection is not associated with defective humoral response. Finally, most of recovered patients still had anti-SARS-CoV-2 IgG more than 3 months after infection.


Subject(s)
Antibodies, Neutralizing/immunology , Antibodies, Viral/immunology , COVID-19/immunology , Immunity, Humoral , SARS-CoV-2/immunology , Adult , Aged , COVID-19/mortality , Female , Humans , Male , Middle Aged
19.
Sci Rep ; 12(1): 1716, 2022 02 02.
Article in English | MEDLINE | ID: covidwho-1900583

ABSTRACT

The rapid evolution of the novel coronavirus disease (COVID-19) pandemic has resulted in an urgent need for effective clinical tools to reduce transmission and manage severe illness. Numerous teams are quickly developing artificial intelligence approaches to these problems, including using deep learning to predict COVID-19 diagnosis and prognosis from chest computed tomography (CT) imaging data. In this work, we assess the value of aggregated chest CT data for COVID-19 prognosis compared to clinical metadata alone. We develop a novel patient-level algorithm to aggregate the chest CT volume into a 2D representation that can be easily integrated with clinical metadata to distinguish COVID-19 pneumonia from chest CT volumes from healthy participants and participants with other viral pneumonia. Furthermore, we present a multitask model for joint segmentation of different classes of pulmonary lesions present in COVID-19 infected lungs that can outperform individual segmentation models for each task. We directly compare this multitask segmentation approach to combining feature-agnostic volumetric CT classification feature maps with clinical metadata for predicting mortality. We show that the combination of features derived from the chest CT volumes improve the AUC performance to 0.80 from the 0.52 obtained by using patients' clinical data alone. These approaches enable the automated extraction of clinically relevant features from chest CT volumes for risk stratification of COVID-19 patients.


Subject(s)
COVID-19/diagnosis , COVID-19/virology , Deep Learning , SARS-CoV-2 , Thorax/diagnostic imaging , Thorax/pathology , Tomography, X-Ray Computed , Algorithms , COVID-19/mortality , Databases, Genetic , Humans , Image Interpretation, Computer-Assisted/methods , Image Processing, Computer-Assisted/methods , Prognosis , Tomography, X-Ray Computed/methods , Tomography, X-Ray Computed/standards
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