COVID, Volume 5, Issue 4 (April 2025) – 18 articles

Serum ferritin levels increase in severe COVID-19 patients. However, few data correlating the sensitivity and specificity of ferritin levels and mortality prediction in COVID-19 exist. The current study aims to investigate the sensitivity and specificity of ferritin for the prediction of mortality risks relative to COVID-19. Retrospectively, critically ill COVID-19 patients admitted to the general intensive care unit (ICU) of Ankara Bilkent City Hospital, Türkiye, were examined. The median baseline ferritin level in the survivor group was 184.7 µg/L (90.1–430.7), while it was 297.0 µg/L (150.3–851.3) in the deceased group (p = 0.001). The median maximum ferritin in the survivor group was 486.6 µg/L (187.9–1020.0), while it was 1456.7 µg/L (578.5–4388.1) in the deceased group (p < 0.001). In the receiver operating characteristic (ROC) curve analysis, the cut-off baseline ferritin value was 201.5 µg/L for the prediction of mortality (area under the curve [AUC] = 0.615, p < 0.001, 95% Confidence interval [CI]: 0.557–0.671). Baseline ferritin levels were associated with increased in-hospital mortality (p < 0.001, odds ratio: 2.347, 95% CI: 1.5–3.7). Baseline ferritin exhibited 66% sensitivity and 54.2% specificity in predicting mortality. The maximum ferritin cut-off value was 878.6 µg/L (AUC = 0.754, p < 0.001, 95% CI: 0.701–0.802), exhibiting 68% sensitivity and 73.2% specificity for mortality prediction. Ferritin has a moderately effective prediction potential for mortality in COVID-19 patients admitted to the ICU. Full article

Research has established that relatively higher levels of educational achievement are associated with better health outcomes. Thus, while providing every student with a high-quality education is always a public health concern, this matter garnered exceptional attention following the COVID-19 pandemic. It disrupted schooling across the globe, requiring elementary and secondary schools to address many resulting issues, including their students’ learning loss, interrupted learning of grade-level curricula, the need for accelerated learning, increased absenteeism, and staffing shortages. Consequently, this paper reports the many circumstances surrounding one approach employed widely in the United States to address the learning issues resulting from the pandemic: tutoring. First, the extent of students’ academic declines following the pandemic is documented, as is the association between educational attainment and health outcomes. Next, several facets of tutoring are explained, including (a) an operational definition, (b) research support of its effectiveness before and after the pandemic, (c) the characteristics of two types of effective tutoring germane to this paper, and (d) its fit within a school’s systems of interventions for all students. The paper concludes with a case report about relevant work performed at a high-needs school in the southeastern United States to establish a sustainable tutoring program resulting from the pandemic. It is one example of how K-12 schooling in the United States has improved in response to the COVID-19 pandemic. Full article

SARS-CoV-2 has been identified in multiple organs and fluids, including the liver and peritoneal fluid. Gastrointestinal symptoms, such as abdominal pain, diarrhea, nausea, and vomiting, can exacerbate COVID-19 outcomes by contributing to complications, like acid–base imbalances and cardiovascular dysfunction, particularly in patients with pre-existing conditions. We report three cases of COVID-19 cirrhotic patients with SARS-CoV-2 detected in their ascitic fluid and review the relevant literature on the virus’s presence and clinical significance in peritoneal fluid. These findings underscore diagnostic and prognostic challenges in managing COVID-19 in patients with chronic liver disease and highlight the need for further research to clarify viral dissemination mechanisms and optimize protective measures for healthcare workers during surgical procedures. Full article

The level of knowledge, positive attitudes, and adherence to preventive practices among students towards COVID-19 guidelines is essential in minimising transmission and ensuring the maintenance of safe and healthy learning environments. The present study aimed to investigate students’ knowledge, attitudes, and practices towards COVID-19 guidelines at Bushbuckridge Local Municipality, Mpumalanga Province. A quantitative, cross-sectional, descriptive design was employed. Two-stage cluster sampling and systematic sampling were used to select respondents from each sampled school cluster. A total sample size of n = 364 was determined using the Raosoft sample size calculator, with a margin of error (e) of 5% and a confidence level of 95%. Out of the total, 357 respondents who returned the assent forms participated in the study. Data was collected through a questionnaire administered to selected respondents. The findings indicated that the majority of secondary school students possess a good level of knowledge regarding COVID-19 guidelines. Furthermore, 78% of these students have positive attitudes toward COVID-19 guidelines, and 72% exhibit proactive practices in adhering to these guidelines. The Department of Basic Education should emphasise the integration of health education in schools to enhance students’ understanding of COVID-19 guidelines and the virus itself. Continuous education on hygiene practices and COVID-19 guidelines is essential to ensure that students are prepared and able to comply during future pandemics. Full article

Background: Healthcare total spending accelerated during the COVID-19 pandemic. Understanding broad high- and low-cost healthcare utilization while the healthcare system is under stress can help identify strategies and gaps to improve the future quality of care while reducing high-cost care and maximizing low-cost care. Methods: This was a population-based cross-sectional study with 56,141 individuals in the U.S. using 2020–2021 Medical Expenditure Panel Survey (MEPS) data sources. We applied a Poisson regression approach to test differences among patients with/without cancer/COVID-19 in healthcare utilization outcomes, including emergency department (ED) visits, inpatient discharge, inpatient nights of stay, outpatient visits, and home provider days. Results: Outpatient visits were affected by both cancer and COVID-19 diagnoses (86% to 109% higher for individuals with cancer and/or COVID-19, p < 0.001). COVID-19 patients with/without cancer had statistically significant increases in high-cost care, including (1) ED visits (151% to 245% higher, p < 0.001), (2) number of inpatient visits (94% to 170%, p < 0.001, p < 0.001), and (3) inpatient nights of stay (259% to 268% higher, p < 0.001). There were no statistically significant differences in home-based utilization when compared to individuals without cancer and without COVID-19. Conclusions: Improving and adopting innovative low-cost home-based care utilization are critical to reduce future healthcare spending and strengthen pandemic preparedness. Full article

An increase in immunoglobulin G4 (IgG4) levels is typically associated with immunological tolerance states and develops after prolonged exposure to antigens. Accordingly, IgG4 is considered an anti-inflammatory antibody with a limited ability to trigger efficient immune responses. Additionally, IgG4 reduces allergic reactions by blocking immunoglobulin E (IgE) activity. In the case of COVID-19, it has been reported that the repeated administration of some vaccines induces high IgG4 levels. The latest research data have revealed a surprising IgE anti-receptor binding domain response after both natural infection and several SARS-CoV-2 vaccines. The presence of IgG4 and IgE in COVID-19 disease suggests that the virus may induce an “allergic-like” response to evade immune surveillance, leading to a shift from T helper 1 (Th1) to T helper 2 (Th2) cells, which promotes tolerance to the virus and potentially contributes to chronic infection. The spike protein from vaccines could also induce such a response. Interestingly, “allergen-like” epitopes and IgE responses have been reported for other viruses, such as influenza, human immunodeficiency virus (HIV), and respiratory syncytial virus (RSV). The impact of this viral-induced tolerance will be discussed, concerning long COVID and the protective efficacy of vaccines. Full article

Objective: To examine associations among psychological distress, perceptions of life changes, and perceptions of family support among college students during the quarantine period of the pandemic. Background: A supportive family can buffer psychological distress during crises. During the early months of the COVID-19 pandemic, many college students abruptly returned to their family home, disrupting a developmental stage typically oriented toward independence and peer connection. While previous research has highlighted the stressors of this period, less is known about the role of perceived family support in shaping students’ mental health outcomes. Method: Data from a cross-sectional sample of 339 college students were collected. Statistical analysis included a hierarchical multiple regression and moderated moderation to investigate the relationship between the life changes college students experienced due to COVID-19 and distress and how family support moderated this relationship while treating gender as a secondary moderator. Results: Perceptions of worsening life conditions due to COVID-19 were associated with higher levels of distress and vice versa. Perceptions of emotional forms of family support moderated this relationship, but only among male participants. Conclusions: This study contributes to our understanding of the mental health implications of the pandemic on college students by identifying emotional family support as a gender-specific protective factor. Implications: Insights from this study may inform mental health interventions that consider family dynamics and gender-specific coping during large-scale crises. These findings may also guide strategies for supporting students facing the long-term psychological impacts of the COVID-19 pandemic. Full article

(1) Background: Human Leukocyte Antigen (HLA) genetics substantially affect viral infection outcomes. SARS-CoV-2 continues to evolve, potentially escaping HLA presentation and hindering immune control. However, studies on HLA alleles in diverse non-Western populations remain limited. Therefore, we aimed to investigate whether mutations in successive SARS-CoV-2 variants have led to viral escape from common HLA class I alleles in the Saudi Arabian population. (2) Methods: The binding affinities of spike protein epitopes for common Saudi HLA alleles (HLA-A02:01, HLA-C06:02, and HLA-B51:01) were predicted across major SARS-CoV-2 strains using NetMHCpan. One-way ANOVA, one-sample t-tests, and pairwise chi-square analyses were performed to assess the differences in binding affinities and epitope binding categories among strains. (3) Results: One-way ANOVA revealed significant differences in binding affinities among SARS-CoV-2 strains for HLA-A02:01 and HLA-C06:02, but not for HLA-B51:01. One-sample t-tests revealed significant differences in mean binding affinity scores compared to a theoretical mean of 0 for all strain–HLA allele combinations, except for HLA-B51:01. Pairwise chi-square analyses identified significant differences in the epitope binding category distribution between Alpha and Epsilon strains, as well as between Epsilon and Gamma strains for HLA-B51:01. (4) Conclusions: The evolution of SARS-CoV-2 has enabled its escape from common HLA alleles in Saudis. Tracking population-specific HLA binding profiles is crucial for the elucidation of associated evasion mechanisms and guiding the design of future vaccines against COVID-19. Full article

South Africa’s health system was affected by the various mitigation measures implemented to control the rapid spread of the COVID-19 pandemic. However, innovative interventions were introduced to ensure service continuity. This study sought to explore the perspectives of stakeholders regarding the pre-exposure prophylaxis (PrEP) innovative interventions implemented during the COVID-19 lockdown period among adolescent girls and young women (AGYW), as well as their successes and improvements. We selected and interviewed 12 PrEP stakeholders, including professional nurses, case managers, peer educators, and counselors from the TB HIV Care programme in the Dr. Kenneth Kaunda District, in the North-West Province. The qualitative questions explored (1) how PrEP services were disrupted during the lockdown period, (2) how the disruptions were managed, and (3) the challenges and successes of the innovative interventions implemented. The interviews were audio-taped, transcribed, and thematically analyzed through Tesch’s eight steps of analysis. The stakeholders confirmed that COVID-19 disruptions affected the provision of PrEP services in terms of recruitment, counseling, HIV testing, and adherence support offered in different community hotspots. Responding to these difficulties, alternative avenues such as social media platforms were implemented and used for service continuity. The themes that emerged were organized into the following two categories: PrEP services provided during and after the COVID-19 lockdown period, as well as the successes and challenges. The current study provides further insight into COVID-19, aiming to inform preparations for future pandemics. Innovative PrEP interventions alleviated COVID-19 disruptions in some settings and improved HIV services, but this was not the case in the selected study area. Full article

Patients with COVID-19-associated pulmonary embolism have been reported to require higher doses of unfractionated heparin (UFH) to achieve therapeutic activated partial thromboplastin time (APTT) levels. This study aimed to compare the UFH dose in ICU patients with COVID-19 and control ICU patients, exploring possible explanatory factors. In this retrospective cohort study at Leiden University Medical Center, 162 COVID-19 ICU patients (admitted between 15 March 2020 and 1 January 2022) and 1006 control patients (admitted from 1 January 2014 to 1 January 2020) were included. All patients had an indication for therapeutic UFH. The primary endpoint was the UFH dose. A mixed linear model was used to assess the relationship between UFH dose, APTT, antithrombin (AT), c-reactive protein (CRP), and BMI. COVID-19 patients received a median UFH dose of 383 IU/kg/day compared to 308 IU/kg/day in controls (p < 0.001). Median APTT was lower in COVID-19 patients (63 vs. 66 s, p < 0.001). Median CRP was lower and median AT higher in COVID-19 patients. In the mixed linear model, only UFH dose showed a significant relationship with APTT (p = 0.0316). COVID-19 patients received higher UFH doses but had lower APTT values compared to controls. These differences could not be explained by BMI, CRP, or AT levels, suggesting other patient-related factors may influence heparin dosing, for example, factor VIII and fibrinogen. Full article

Objective: To measure the quality of the transition of care for COVID-19 patients after discharge from hospital to home. Method: A cross-sectional, prospective study carried out in a hospital in Santa Catarina, with 201 patients hospitalized for COVID-19. An instrument was used to characterize the patients and the Brazilian version of the Care Transitions Measure. The data were analyzed using descriptive statistics, represented by absolute and relative frequency, and Cronbach’s alpha and parametric tests were used, including the t-test, considering statistical significance at p < 0.05. Results: There was a predominance of male patients (55.2%), with a mean age of 22.2 years (SD = 9.9), 79.6% white, and 60.2% married or in a stable union. The overall mean of the CTM-15 was 52.97, with the highest mean observed in the preparation for self-management factor (58.31) and the lowest in the care plan factor (34.00). Conclusion: The quality of the transition of care for patients hospitalized due to COVID-19 was unsatisfactory. Full article

Cardiovascular diseases (CVD) are among the leading causes of morbidity and mortality worldwide. This descriptive-correlational cross-sectional study analyzed the relationship between lifestyle factors and cardiovascular parameters in 206 university students from the University of Los Lagos in the post-COVID-19 context, with a focus on gender differences. Indicators such as body mass index, waist circumference, blood pressure, blood glucose, sedentary behavior, tobacco and alcohol consumption, sleep quality, and self-reported stress were assessed. The results showed a higher prevalence of abdominal obesity and sedentary behavior in women, whereas men presented higher rates of hypertension and elevated blood glucose. While tobacco and alcohol consumption did not differ significantly between genders, both remain relevant risk factors in the university population. Sleep quality and stress were significantly correlated with various cardiovascular risk factors in both genders. These findings highlight the need for gender-specific interventions to address cardiovascular risk factors in university populations, emphasizing the promotion of physical activity among women and dietary strategies targeting sodium reduction among men. Future longitudinal research should assess whether these trends persist over time and explore effective intervention strategies. Full article

The COVID-19 pandemic has led to persistent complications beyond the respiratory system, with emerging evidence highlighting the role of gut dysbiosis in long COVID. Given the established gut–skin axis, alterations in gut microbiota post-COVID-19 may contribute to persistent dermatologic conditions such as eczema, acne, and rosacea. This review explores the mechanisms by which SARS-CoV-2 disrupts the gut microbiome, leading to systemic inflammation and skin disease. Furthermore, it examines potential interventions, including probiotics, prebiotics, and dietary modifications, as microbiome-targeted therapeutic strategies for post-COVID dermatologic recovery. Understanding this link may open new avenues for treating chronic inflammatory skin conditions in long COVID patients. Full article

During the COVID-19 pandemic, vaccination hesitancy (VH) posed an equally unexpected and significant obstacle to the effectiveness of public health interventions. VH has not only the potential to stir up public unrest, but it may also impede the success of entire immunization programs and thus prevent the attainment of herd immunity. This cross-sectional, quantitative, and descriptive study examined VH and vaccination behavior (VB) among 3486 university students in Ghana, using a standardized self-administered questionnaire based on the 5Cs model among other relevant variables. The findings confirm a significant VH and a VB influenced by both sociodemographic factors, such as gender (OR: 1.45; [CI: 1.26–1.67]), study program (OR: 0.55; [CI: 0.47–0.64]), and ethnicity (OR: 1.31; [CI: 1.12–1.52]) and also four of the 5Cs, i.e., Confidence (OR:1.56; [CI: 1.45–1.68]), Constraints (OR: 0.83; [CI: 0.78–0.87]), Calculation (OR:0.85; [CI: 0.78–0.92]), and Collective Responsibility (OR:1.27; [CI: 1.16–1.38]), yet not Complacency, nor religion. Notably, VH was further shaped by previous vaccine experience, information sources, vaccine attributes, stance on vaccine passport, and conspiracy beliefs, with misinformation from unofficial sources playing a key role. The multiple regression models explained 11% to 34% of the variance in the 5Cs, indicating varying degrees of explanatory power for each factor influencing VB and eventually also VH. This study highlights the urgent need for targeted public health interventions, such as integrating vaccine education into university orientation programs, streamlining vaccination processes, and leveraging influencers for trust-building campaigns. Full article

Long COVID is characterized by persistent symptoms following the resolution of an acute COVID-19 infection. Long COVID may affect cognition due to possible ischemia, neuro-inflammation, and hypoxia related to COVID-19. The purpose of this study was to analyze the association of long COVID with severe cognitive limitations. Utilizing data from the 20 September–2 October 2023 Census Household Pulse Survey among adults, COVID status was categorized as: (1) long COVID, (2) COVID-19, or (3) no COVID. The cognitive limitations were abstracted from the Washington Group Short Set on Functioning, as follows: No difficulty; Some difficulty; A lot of difficulty; and Cannot do at all; we combined “a lot of difficulty” or “unable to do” under the category “severe cognitive limitation”. Rao–Scott Chi-square tests and multivariable multinomial logistic regressions that accounted for replicate weights were used to analyze the adjusted association of long COVID with cognitive limitations. Overall, 15.1% had long COVID. A higher percentage of adults with long COVID (13.1% vs. 4.1%) reported severe cognitive limitations compared to no COVID (p < 0.001). In a fully adjusted logistic regression model, adults with long COVID were more likely to report at least a lot of difficulty in cognition (aOR = 1.64 95% CI = 1.38, 1.96) compared to no COVID. Full article

Background: Compared to other groups of Canadians, Black people have been significantly more affected by COVID-19 and appear to be more hesitant to receive the COVID-19 vaccine. This article identifies approaches or strategies to increase vaccine confidence and uptake among Black people in Canada. Methods: Thirty-six Black people of diverse ethnicities, aged 18 years and above, living in six provinces across Canada were interviewed. An inductive thematic approach was employed to analyze the interview data. Results: Building trust was at the center of the strategies identified and spoke to the meaningful and practical ways the sociocultural realities of Black people living in Canada can be used to inform and implement the most effective health interventions. Identified strategies include public education, building trust through Black-led community engagement, and addressing barriers to vaccine convenience focusing on health literacy and communication. Together, these strategies consider the nuance of the message, diversity of messenger(s), and communication channels and call for a move away from generic health promotion messages to tailored communications grounded in community expertise and the experiences of Black people across all levels of healthcare service provision. Conclusions: Health promotion and public health messages must acknowledge difference, tailor approaches to target audiences, and foster lasting collaborations informed by members of the Black community. Government agencies and healthcare service providers should foster the relationships established during the pandemic, document lessons learned, remove systemic barriers to healthcare, and create an emergency preparedness guide for community engagement and health promotion for Black people living in Canada. Full article

The emergence of COVID-19 necessitated the rapid development of vaccines. While highly effective at reducing severe disease and death, breakthrough infections remain a problem as the virus continues to mutate. To help address this issue, we show the utility of a multiplex immunoassay in measuring multiple aspects of the antibody response generated by SARS-CoV-2 vaccines. We use a multiplex immunoassay platform to measure spike-specific IgG concentration, avidity, and receptor-binding inhibition. In addition, we correlate results from an ACE-2 receptor-binding inhibition assay with corresponding data from a SARS-CoV-2 microneutralization assay to establish this inhibitory assay as a potential predictor of virus neutralization. We studied these antibody responses in SARS-CoV-2-naïve and -convalescent vaccinees. Our results showed increased IgG concentrations, avidity, and inhibition following vaccination in both groups. We were also able to differentiate the immune response between the two groups using the multiplex immunoassay platform to look at antibody diversity. The receptor-binding inhibition assay has strong correlations with a cell-based pseudovirus neutralization assay as well as with WT SARS-CoV-2 Washington and Delta variant PRNT₅₀ assays. This suggests that the inhibition assay may be able to simultaneously predict virus neutralization of different SARS-CoV-2 variants. Overall, we show that the developed custom multiplex immunoassay with several experimental variations is a powerful tool in assessing multiple aspects of the SARS-CoV-2 antibody response in vaccinated individuals. Full article

This analysis was conducted in the context of the crisis caused by the COVID-19 pandemic, when the uncertainty and demand for food modified consumption patterns. Therefore, this study aimed to analyze variations in the expenditures allocated to pasteurized and powdered milk during and after the pandemic, considering the socioeconomic and demographic factors influencing these choices. A cross-sectional ordinary least squares (OLS) regression model was implemented using data from the National Household Income and Expenditure Survey for 2018, 2020, and 2022. The model evaluated variables such as income, household size, educational level, and gender of the household head, as well as the presence of minors and older adults at the regional level. The findings demonstrated that, in 2020, expenditure on pasteurized milk exhibited an elasticity of 0.888, suggesting heightened sensitivity to income during the pandemic period. In contrast, the elasticity of powdered milk was lower, with a value of 0.013 between 2018 and 2020, and negative values by 2022. Additionally, households headed by women, households with a higher level of education, and households with children spent more on pasteurized milk. These findings confirm the importance of milk as an essential commodity and highlight the substitute role of powdered milk in low-income households. Full article