COVID, Volume 6, Issue 7 (July 2026) – 24 articles

The COVID-19 pandemic has caused unprecedented upheaval to the worldwide transportation infrastructure and as such, has redefined trends in urban mobility. In the current research, the authors plan to compare six metropolitan areas, including Houston (Texas) and Chicago (Illinois), Singapore, Dubai (United Arab Emirates), Calgary (Canada), and Cairo (Egypt), to assess the effects of the pandemic on transit ridership during the period of 2018 to 2022. The monthly data provided by the official transit agencies was analysed using paired t-tests and correlation statistics to measure the change in the ridership and how they are related to population, urban area, and network length. The results are consistent, and the effects are a three-stage course shock, stabilization, and recovery, but as the rates of recovery are different to the governance, economic structure, and technological preparation. Digitally developed, high-income metropolises like Singapore and Dubai were a bit faster in recovery, and those that relied on cars like Chicago and Calgary showed prolonged declines. Cairo also exhibited resilience driven by necessity and did not decline because of institutional adaptation, but rather because of economic dependence. The paper suggests a three-part model of resilience, including governance, technology, and necessity, that explains these differences and how mobility systems can be changed in response to crises. These findings have both theoretical and policy implications for designing adaptive, equitable, and technology-enhanced transportation planning in the post-pandemic age. Full article

RNA-dependent RNA-polymerase (RdRp), one of the key enzymes in the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) life cycle, is a recognized druggable target for Coronavirus disease 19 (COVID-19) treatment. Its inhibition has been associated with reduced viral loads in infected individuals. A library of 1562 Philippine Natural Compounds was screened in silico for potential SARS-CoV-2 anti-RdRp activity using a high-throughput virtual screening (VS) approach. Molecular docking experiments and in silico absorption, distribution, metabolism, and excretion (ADME) predictions were used to determine compounds with potential inhibitory capabilities against RdRp. The top three compounds, Vitelignin A (VIT), Vitexoside (VIX), and Cannabifolin C (CAN), were subjected to molecular dynamics (MD) simulations in complex with RdRp, confirming the formation of stable protein-ligand complexes. Overall, these results suggest promising inhibitory capabilities of these three compounds against SARS-CoV-2 RdRp. Their shared presence in extracts of Vitex negundo, a Philippine medicinal plant, warrants further in vitro and in vivo investigation regarding the anti-SARS-CoV-2 activity of its extracts and active components. Full article

The COVID-19 pandemic transformed online and distance learning from a supplementary educational option into a central component of education systems, bringing anxiety, stress, and psychological well-being to the forefront of digital learning research. This study traces the two-decade evolution of research on anxiety and stress in online and distance learning between 2005 and February 2026 and examines the thematic reorientation associated with the COVID-19 period. Bibliometric mapping of 243 Web of Science (WoS) records was used to identify publication trends, intellectual structures, international collaboration patterns, and thematic developments. Piecewise analysis indicated a significant post-2020 break in annual scientific output, with the growth rate increasing nearly eightfold (p = 0.0015). Thematic evolution showed that pre-pandemic studies mainly focused on technology acceptance, computer anxiety, and learner adaptation, whereas pandemic and post-pandemic research shifted toward mental health, psychological well-being, social isolation, technostress, and resilience. China and the United States dominated scientific production, while Australia and Saudi Arabia showed notable mobility in collaboration networks. Overall, the findings suggest that the COVID-19 period was associated with a field-level reorientation toward an interdisciplinary psychosocial agenda for future online education. Full article

This study investigated the perceptions and practices of disinfectant use among students at the City University of New York (CUNY) before, during, and after the peak of the COVID-19 pandemic, with a focus on behaviors observed following a controversial statement made by President Donald Trump in April 2020 suggesting the potential use of disinfectants as a treatment for a SARS-CoV-2 infection. Utilizing an online survey of 441 CUNY students, data was collected on cleaning and disinfection behaviors during four distinct periods: pre-pandemic (January–February 2020), during the pandemic’s height (March–April 2020), after the pandemic’s height (June–August 2020), and following the aforementioned presidential statement. Data patterns illustrate an increase in cleaning frequency and disinfectant use during the peak of the pandemic, followed by a notable decrease after the presidential statement. The data also illustrated potentially dangerous practices, such as misting the body with cleaning sprays and using household cleaners on bare skin, though these behaviors generally decreased after the peak of the pandemic. The study highlights the impact of public health communication and the role of misinformation in shaping hygiene practices during a crisis. It underscores the need for clear, evidence-based messaging to promote safe and effective disinfectant use and to counter misinformation that may lead to harmful behaviors. This novel research contributes to the understanding of how a specific student population responded to the pandemic and provides insights for future public health interventions. Full article

Background: Public acceptance of vaccines during emerging infectious disease outbreaks is influenced by perceptions of safety, accessibility, and cost. Understanding these determinants during the early phase of a pandemic is important for informing vaccination policy and communication strategies. This study examined the role of vaccine cost and safety perceptions in shaping COVID-19 vaccination intention among adults in Saudi Arabia prior to national vaccine rollout. Methods: A cross-sectional electronic survey was conducted among adults residing in Saudi Arabia between August and September 2020. Participants were recruited through online distribution using social media and electronic communication channels. The questionnaire assessed socio-demographic characteristics, knowledge and perceptions regarding COVID-19, and intention to receive COVID-19 vaccination under five hypothetical scenarios reflecting vaccine cost and the availability of scientific safety and efficacy evidence. Multivariable logistic regression analyses were performed to identify factors associated with vaccination intention. Results: A total of 1293 respondents completed the survey. When vaccination was offered free of charge, 57.5% of participants reported that they would likely receive the vaccine. Vaccination intention declined as the hypothetical vaccine price increased, reaching 38.7% when the cost exceeded 100 SAR. Intention was lowest when vaccination was presented under conditions in which safety and efficacy evidence had not yet been confirmed. Age, gender, educational attainment, and prior seasonal influenza vaccination were associated with COVID-19 vaccination intention across several scenarios. Conclusions: Perceived vaccine affordability and confidence in scientific safety and efficacy evidence were important factors associated with COVID-19 vaccination intention during the early phase of the pandemic in Saudi Arabia. Providing vaccination without direct cost to recipients and communicating safety and efficacy evidence transparently may support public confidence and vaccine acceptance during future large-scale immunization campaigns. These findings should be interpreted as an early-pandemic baseline and should not be extrapolated to current post-rollout attitudes. Full article

Background: The COVID-19 pandemic underscored the importance of understanding the psychological factors associated with engagement in recommended health behaviours. This study examines how decision regret and conspiracy mentality relate to vaccination engagement and protective health behaviours during the later stages of the COVID-19 pandemic in Cyprus. Methods: A total of 325 Greek-speaking adults completed an online questionnaire that included demographic questions, the Decision Regret Scale (DRS), the Conspiracy Mentality Questionnaire (CMQ), and a COVID-19 Preventive Behaviours Questionnaire developed by the authors. Results: The findings showed that: (a) greater vaccination engagement and protective health behaviours were associated with lower levels of decision regret; and (b) conspiracy mentality was associated with vaccination engagement but not with protective health behaviours. Conclusions: The findings highlight the potential relevance of emotional processes such as decision regret and belief-related factors, such as conspiracy mentality, in relation to engagement with recommended health behaviours. These findings may help inform public health communication strategies aimed at supporting engagement in recommended health behaviours during future health crises. Full article

Background: Persistent cardiovascular and multisystem manifestations remain an important concern following hospitalization for coronavirus disease 2019 (COVID-19). However, the spectrum of newly identified conditions during follow-up and their relationship with acute disease severity remain incompletely characterized. This study aimed to describe cardiovascular and multisystem diagnoses, identified during short-term and long-term follow-up and to evaluate the association between acute-phase clinical characteristics, biomarkers, and subsequent outcomes. Methods: We conducted a retrospective observational cohort study including 762 adults hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection between January 2021 and December 2022. Follow-up data were obtained from patients who re-presented to the same hospital during short-term follow-up (mean 4.33 months; n = 130) or long-term follow-up (mean 2.06 years; n = 186). Newly documented cardiovascular and non-cardiovascular diagnoses recorded during routine clinical care were analyzed separately for each follow-up cohort. Multivariable logistic regression was used to identify predictors of in-hospital mortality and cardiovascular outcomes. Results: At least one newly documented diagnosis was identified in 120/130 patients (92.3%) during short-term follow-up and in 175/186 patients (94.1%) during long-term follow-up. Cardiovascular diagnoses were identified in 32.3% and 45.2% of patients attending short-term and long-term follow-up, respectively. Hypertension and atherosclerosis were the most frequent cardiovascular diagnoses during short-term follow-up, whereas heart failure and ischemic heart disease predominated among patients attending long-term follow-up. Pulmonary fibrosis was the most common non-cardiovascular diagnosis at both follow-up periods. Elevated D-dimer and fibrinogen levels during acute COVID-19 were independently associated with in-hospital mortality, whereas acute-phase NT-proBNP was not independently associated with cardiovascular diagnoses identified during follow-up. Conclusions: Patients who re-presented for clinical evaluation after hospitalization for COVID-19 exhibited a substantial burden of newly documented cardiovascular and multisystem diagnoses. Given the retrospective design, independent follow-up cohorts, and absence of a non-COVID control group, these findings should be interpreted as observational post-hospitalization data rather than evidence of causal or progressive post-COVID-19 disease. Prospective controlled longitudinal studies are needed to better define the long-term health consequences of SARS-CoV-2 infection. Full article

The present study takes place in the context of the COVID-19 pandemic and the Greek economic crisis, in which the health systems reached their limit and the physical and psychological exhaustion of professionals increased, testing supportive leadership in hospitals. An ex post facto, descriptive, and correlational study was designed, with non-probabilistic sampling, applied to 741 health professionals from public and private hospitals located in Attica and Piraeus. An 18-item ad hoc questionnaire was used, validated through an exploratory factor analysis (KMO = 0.805; 4 dimensions) and with a high reliability (α = 0.87). The staff showed a moderately positive assessment of the leadership and the supervisor dynamics, but a low enjoyment of work during the crisis. The hypothesis of generalized stress was discarded, with differences found according to gender (more conflict and less recognition perceived by women) and age (more conflicts between the supervisors and younger staff), without important differences according to level of education or work position. It can be concluded that support, psychological capital, and work relations, appeared as relatively independent constructs, modulated by organizational and personal factors, which underlines the need for specific interventions oriented towards the well-being and recognition of health professionals in contexts of crisis. Full article

Canadian youth experienced profound impacts to mental health (MH) support throughout the COVID-19 pandemic. Given the risk for long-term negative outcomes from unmet MH needs, it is critical to understand access barriers. The purpose of this study was to explore the longitudinal data and personal narratives on MH challenges, needs and access barriers. The Personal Impacts of COVID-19 Survey was administered to parents regarding their youth at baseline (November 2020–July 2021) and follow-up (November 2021–October 2022). Semi-structured interviews of selected youth and parents were conducted. Quantitative data from 507 baseline surveys, 177 follow-up surveys and qualitative data from 35 interviews were included in the study. A modified explanatory sequential/nested mixed methods design was used to analyze the data. Results showed that the use of MH supports among youth increased between timepoints, although 20% had persisting unmet needs for MH supports at follow-up. Youth described waitlist barriers and difficulties finding the “right” therapist, and parents described significant difficulties navigating the MH system that profoundly impacted their families’ ability to access care and mitigate negative MH outcomes. Increased clinician availability, school MH supports, parental education, and tools for navigating the MH system are needed to better support families. Full article

This paper presents an automatic classification system for pulmonary diseases in chest X-rays based on geometric normalization. The proposed method consists of three main modules. Module 1: A landmark detector: A ResNet-18 convolutional neural network with coordinate attention mechanism is trained to predict 15 landmarks defining the lung contour, achieving a mean error of 3.61 pixels (median 3.07 pixels) through an ensemble of four models with test-time augmentation. Module 2: Geometric normalizer: a set of landmarks surrounding the lung region is used to geometrically normalize each image. This normalization involves: Generalized Procrustes Analysis used once to obtain a standard lung shape, Delaunay triangulation to build a deformation mesh, and a piecewise affine transformation (warping) to map the original lung region to a standardized region. This process eliminates variations in position, scale, and orientation in the original set. Module 3: Classifier: normalized images are classified into three categories (COVID-19, Viral Pneumonia, and Normal) using a ResNet-18 classifier with transfer learning and a contrast adjustment (using the SAHS (Statistical Asymmetrical Histogram Stretching) method). The classifier was evaluated through five-fold cross-validation on the COVID-19 Radiography Database, demonstrating high stability with 98.60 ± 0.26% accuracy, and 98.00% F1-Macro, confirming the robustness of the approach. Although the classifier trained with original images reached a higher accuracy than using normalized images, Gradient-weighted Class Activation Mapping (Grad-CAM) analysis and the cropping experiment suggest that this advantage is partly driven by acquisition artifacts rather than lung pathology. In contrast, geometrically normalized images outperform their non-aligned artifact-masked/cropped counterparts: 98.60% vs. 96.24% on the COVID-19 Radiography Database and 94.67% vs. 94.17% on a balanced adult–pediatric mixed dataset including pediatric cases from the Kermany dataset, suggesting that anatomical alignment can yield a more reliable and artifact-resistant representation for pulmonary disease recognition. Full article

Background: Long COVID is a heterogeneous post-viral condition in which persistent neurological, autonomic, cognitive, and psychometric symptoms often occur without clear isolated biomarker abnormalities. This mismatch suggests that disease persistence may be driven not only by changes in individual markers, but by longitudinal reorganization of biological and clinical interactions. Materials and Methods: This observational longitudinal study evaluated patients with persistent symptoms after confirmed SARS-CoV-2 infection at 3 and 6 months. Clinical assessment included neurological examination, Hospital Anxiety and Depression Scale, Beck Depression Inventory, and COMPASS-31. Biomarkers representing hypoxia signaling, oxidative/redox stress, endothelial and renin–angiotensin system activity, glycation-related processes, and complement regulation were analyzed. Correlation analysis, association-level biomarker–clinical network modeling, and complementary Graphical LASSO-based sparse network estimation were used to compare network density, community organization, centrality, and edge rewiring between time points. Results: Conventional paired analysis identified HIF-1$\alpha$ as the only continuous variable with a statistically significant longitudinal change (Wilcoxon statistic = 610.0, $p=0.000350$), whereas association-level network analysis revealed a broader systems-level signal. The association-level biomarker–clinical network preserved a similar global size at 3 and 6 months, with 16 nodes, 27 versus 26 edges, and densities of 0.225 versus 0.217. However, this apparent stability concealed substantial rewiring: 19 edges were shared, 8 were lost, and 7 emerged. Complementary Graphical LASSO analysis with 1000 bootstrap resamples supported this pattern by identifying a conservative sparse conditional-dependency core, including seven shared conditional-dependency edges across time points and selective weakening of four early conditional dependencies. The C3–C4 relationship reversed from negative to positive correlation ($r=-0.618$ to $r=0.618$), indicating marked remodeling of complement-associated regulation. A psychometric–autonomic module involving Beck, HADS I, HADS II, and COMPASS-31 remained stable across both assessments. Conclusions: Long COVID progression was characterized by dynamic remodeling of immune, endothelial/RAS, oxidative-redox, hypoxia-related, autonomic, and psychometric interactions. Longitudinal network analysis identified a systems-level interaction structure that was not captured by isolated biomarker comparisons alone and that was further supported by complementary sparse conditional-dependency analysis. Full article

During the SARS-CoV-2 pandemic, healthcare systems faced an increased burden of secondary infections, including those caused by Candida auris, an emerging multidrug-resistant pathogen associated with hospital outbreaks worldwide. We aimed to describe the clinical and microbiological characteristics of a hospital outbreak of Candida auris fungemia in patients with COVID-19 in a tertiary care center. This retrospective observational study included 14 patients diagnosed between November 2020 and April 2021. Infection was initially identified using VITEK2^® and confirmed using MALDI-TOF MS, with antifungal susceptibility determined using broth microdilution. All patients developed fungemia, were mechanically ventilated, and had central venous access and prolonged hospital stays; 64.2% had comorbidities. Resistance frequencies based on CDC tentative MIC thresholds were observed for fluconazole (64.2%) and amphotericin B (71.4%). In-hospital mortality was 50%; exploratory analyses of factors associated with mortality should be interpreted cautiously given the small sample size. These findings highlight the significant clinical impact of Candida auris in critically ill COVID-19 patients, particularly in the context of invasive care and antimicrobial resistance. The outbreak underscores the importance of early identification, appropriate antifungal therapy, and strict infection prevention and control measures. Further studies are needed to better define risk factors and optimize management strategies in similar settings. Full article

Background: Post-COVID-19 syndrome or Long COVID (LC) is a multi-system condition characterised by persistent symptoms beyond three months following SARS-CoV-2 infection. Pain, particularly musculoskeletal and neuropathic pain, is commonly reported and may substantially affect functioning and health-related quality of life (HRQoL). However, there is limited detailed characterisation of pain phenotypes and their differential impact on outcomes in LC. This study aimed to (i) characterise pain associated with LC, (ii) identify factors associated with pain type and severity, and (iii) examine its impact on HRQoL, physical activity, and work. Methods: A cross-sectional survey was conducted among adults with clinician-diagnosed or self-reported LC who reported current or previous joint, muscle, or nerve pain. Participants completed validated patient-reported outcome measures including the C19-YRS, Nordic Musculoskeletal Questionnaire, Pain Detect Questionnaire (PD-Q), Musculoskeletal Health Questionnaire, and EQ-5D-5L. Participants were classified into neuropathic, nociceptive, or ambiguous pain groups based on PD-Q scores. Descriptive analyses, group comparisons, and backward stepwise ordinary least squares regression were used to examine factors associated with overall pain (PD-Q Total). Results: Among 198 participants (73% female; mean age 52 ± 12.7 years; mean LC duration 2.4 years), 96% reported new or worsened pain following COVID-19 infection, with muscle pain (87%), joint pain (84%), and nerve pain (66%) most frequently reported. PD-Q scores suggestive of neuropathic pain were identified in 28% of participants and were associated with significantly greater pain intensity, symptom burden, functional impairment, and lower HRQoL (p < 0.05). These participants reported higher average pain scores across all body regions and greater radiating pain (76%) compared to other groups. Functional disability and anxiety were significant factors associated with pain severity. Conclusions: Pain is highly prevalent in LC, with neuropathic pain representing a distinct and more severe phenotype associated with substantial functional and quality-of-life impacts. This study provides novel comparative evidence on pain phenotypes and their differential burden, highlighting the need for targeted pain assessment and management strategies in LC. Full article

While conventional theories posit that stronger institutions buffer economies against crises, the COVID-19 pandemic presents a puzzle: despite substantial variation in institutional capacity, the global economic contraction of 2020 was both severe and widespread. Motivated by this puzzle, we constructed a global panel dataset from 2014 to 2024 and employed two-way fixed-effect estimation with Driscoll–Kraay robust standard errors to examine the differential role of state capacity across COVID-19 crisis phases. The results confirm that the shock caused by the pandemic reduced GDP per capita growth across countries, with the Americas experiencing disproportionately deeper contractions and stronger rebounds relative to other regions. Most importantly, the findings reveal a temporal asymmetry in institutional effectiveness: our constructed composite resource-based measure of state capacity does not mitigate the initial economic contraction but exerts a positive, statistically significant effect on post-pandemic recovery. Unsurprisingly, model re-estimation with the conventional perception-based measure of state capacity fails to replicate this dynamic, underscoring the importance of measurement strategy in institutional research. These results challenge the assumption that institutions uniformly buffer shocks, demonstrating instead that state capacity is more consequential for recovery than crisis prevention. Full article

Post-COVID condition is frequently associated with persistent fatigue, reduced functional capacity, and loss of independence in activities of daily living. Exercise intolerance and post-exertional symptom exacerbation limit participation in conventional rehabilitation programs, highlighting the need for safe and scalable home-based interventions. The REACT-COVID project aims to evaluate the feasibility, safety, and potential effects of a home-based intervention combining whole-body electromyostimulation (WB-EMS) with functional activities of daily living in individuals with post-COVID condition. This study will be a randomized, placebo-controlled, participant-blinded pilot trial including 30 participants allocated to either an experimental group receiving active WB-EMS or a control group receiving sham stimulation over a 12-week period. The primary aim is to assess feasibility, safety, and acceptability. As exploratory clinical outcomes, fatigue severity (Chalder Fatigue Questionnaire, CFQ-11) and functional capacity (Six-Minute Walk Test, 6 MWT) will also be evaluated. Secondary outcomes include handgrip strength and independence in activities of daily living (ADLQ). Assessments will be conducted at baseline (week 0), post-intervention (week 12), and three-month follow-up (week 24). This intervention is designed to provide a low-mechanical-load, accessible alternative for individuals unable to tolerate conventional exercise programs. This study’s findings will inform larger multicenter trials and contribute to scalable rehabilitation models for post-COVID care. Trial registration number: ClinicalTrials.gov (NCT07312357). Full article

Background: The COVID-19 pandemic was accompanied by an infodemic that promoted the use of so-called “miracle products” lacking scientific evidence, posing significant public health risks. Despite increasing concern, evidence on effective educational strategies to counteract this misinformation remains limited, particularly in Latin America. Methods: A quasi-experimental pre–post study without a control group was conducted among university students in Mexico City between February and June 2021. Participants were recruited via Facebook using a snowball sampling approach. A validated nine-item questionnaire assessed knowledge about miracle products before and after exposure to an educational video intervention. Paired statistical analyses were performed to evaluate changes in knowledge. Results: A total of 157 participants completed the pre-test, and 103 completed the post-test. The intervention resulted in a significant increase in knowledge scores, from a mean of 5.98 (SD = 1.73) to 9.05 (SD = 1.54) (p < 0.001). Significant improvements were observed in eight of nine items, with the largest increases in knowledge related to high-risk substances and reporting mechanisms. No significant baseline differences were found between participants who completed and those who did not complete the post-test. Conclusions: The video-based educational intervention was effective in improving knowledge about miracle products during COVID-19. These findings support the use of digital health education strategies as scalable tools to combat misinformation, particularly in resource-constrained settings. However, further research using controlled designs is needed to assess long-term effects and behavioral outcomes. Full article

The COVID-19 pandemic prompted the introduction of South Africa’s Social Relief of Distress (SRD) grant to mitigate income shocks among individuals excluded from existing social programs. This study utilizes a three-year national representative dataset from the General Household Survey and applies a fixed effects regression framework to estimate the association between COVID-19 SRD grants and unemployment. The findings indicate a positive and statistically significant association between grant receipt and unemployment. Specifically, the results suggest that grant recipients are approximately 27–32% more likely to be unemployed than non-recipients. The findings suggest that while the grant provided necessary initial financial relief, in the absence of complementary labour market interventions, income support alone may be insufficient to address unemployment. The study concludes by recommending the coordination of temporary income relief integrated with active labour market policies to promote sustainable employment outcomes. Full article

Background: During the recent COVID-19 pandemic, nursing students faced heightened infection risks during clinical practicum while managing significant psychological demands. However, factors predicting the preventive practices of future healthcare professionals remain poorly understood. Methods: This cross-sectional study examined 261 nursing students on COVID-19 knowledge, attitudes, practices, psychological distress, self-efficacy, and resilience during the fourth wave of the COVID-19 pandemic in South Korea. Grounded in the Knowledge–Attitudes–Practice (KAP) framework, hierarchical multiple regression analysis was conducted to identify predictors of preventive practice behaviors. Results: Depressive symptoms (β = 0.27, p = 0.023) and resilience (β = 0.29, p < 0.001) were significantly positive predictors of COVID-19 preventive practice. Conclusions: Resilience emerged as the strongest predictor of COVID-19 preventive practice among nursing students, highlighting the importance of psychological resources in sustaining infection prevention behaviors. Nursing education programs should incorporate resilience-building strategies to strengthen pandemic preparedness and clinical readiness among future healthcare professionals. Full article

Background: SARS-CoV-2 infection during pregnancy has been associated with adverse maternal and neonatal outcomes, particularly in severe disease. However, evidence stratified by disease severity from Southeastern Europe remains limited. The aim of this study was to compare obstetric and neonatal outcomes between mild and severe COVID-19 among pregnant women managed in tertiary maternity hospitals in Tirana, Albania. Methods: A retrospective multicenter observational study was conducted between January 2020 and December 2022 in the two main tertiary maternity hospitals in Tirana. Pregnant or postpartum women with RT-PCR-confirmed SARS-CoV-2 infection were included. COVID-19 cases were classified as mild or severe according to clinical presentation and oxygen saturation. Maternal, obstetric, and neonatal outcomes were analyzed and multivariable logistic regression was used to evaluate associations between disease severity and selected outcomes. Results: A total of 270 pregnant women were included, of whom 212 (78.5%) had mild COVID-19 and 58 (21.5%) severe disease. The mean maternal age was 29.4 years and most infections occurred during the third trimester (80.8%). Severe COVID-19 was associated with significantly higher odds of NICU admission (aOR 2.87, 95% CI 1.36–6.05), Apgar score < 7 at 5 min (aOR 8.39, 95% CI 1.49–47.35), low birth weight (aOR 2.53, 95% CI 1.06–6.03), and emergency cesarean section (aOR 8.10, 95% CI 2.64–24.86). Maternal age, obesity, parity, and comorbidities were not significantly associated with the examined outcomes. Conclusions: Severe COVID-19 during pregnancy was associated with poorer neonatal condition at birth and increased obstetric intervention, highlighting the importance of close monitoring and coordinated obstetric–neonatal management in pregnancies complicated by severe SARS-CoV-2 infection. Full article

The Omicron variant of SARS-CoV-2 is associated with milder symptoms and lower hospitalization and mortality rates than Delta variants, although the impact of Omicron on immunocompromised patients, especially solid organ transplant (SOT) recipients, is still unclear. This study compares the hospitalization rate and outcomes between immunocompromised, immunocompetent, and SOT patients during the Delta and Omicron periods. We included adult patients who tested positive for SARS-CoV-2 on PCR or nasopharyngeal antigen test between 26 June 2021 to 8 September 2022, at our institution. A total of 12,401 COVID-19 patients were included, of which 11,055 were immunocompetent, and 1346 were immunocompromised (375 SOT recipients). Throughout the Delta and Omicron outbreaks, immunocompromised patients exhibited higher comorbidities and 30-day hospitalizations, but rates of mechanical ventilation and ICU-level care were like immunocompetent patients. During the Omicron wave, immunocompromised patients had higher unadjusted relative risk estimates (RR = 2.37, 95% CI 1.96–2.87, p < 0.05) than Delta (RR = 1.58, 95% CI 1.24–2.01, p < 0.05), with higher adjusted relative risk for hospitalization in Omicron (RR = 1.50, 95% CI 1.10–2.03, p = 0.01). Analyses show increased hospitalization risk in immunocompromised during the Omicron wave compared to the Delta wave, with no significant difference in hospitalization outcomes. The relative risk of hospitalization for SOT patients was higher in both waves. Full article

Background: COVID-19 during pregnancy has been associated with various obstetric complications; however, epidemiological evidence regarding its relationship with hypertensive disorders of pregnancy (HDP) and preterm birth remains inconclusive. Therefore, we aimed to evaluate the association between COVID-19 during pregnancy and the risk of HDP and preterm birth among Mexican pregnant women. Methods: We conducted a retrospective cohort study based on a review of 3710 medical records of women treated at a tertiary hospital between 2020 and 2023. COVID-19 was diagnosed by real-time reverse transcription polymerase chain reaction (RT-PCR) assay. We estimated adjusted risk ratios (aRRs) using robust Poisson regression models, controlling for potential confounders. Results: The COVID-19 rate was 2.5%. We observed that women with COVID-19 had a higher risk of HDP (aRR = 1.59; 95% CI = 1.07–2.36). When HDP subgroups were analyzed separately, COVID-19 was associated with an increased risk of preeclampsia (aRR = 2.04; 95% CI = 1.34–4.20) and preterm birth (aRR = 1.50; 95% CI = 1.02–2.19). The association with gestational hypertension lost statistical significance after adjustment. Conclusions: Our findings suggest that COVID-19 during pregnancy may be associated with hypertensive disorders of pregnancy and preterm birth. However, the observed association with preeclampsia should be interpreted cautiously because diagnostic overlap between severe COVID-19 and preeclampsia cannot be excluded. Full article

Background/Objectives: The health status of institutionalized older adults is determined by the interaction of functional, cognitive, nutritional, anthropometric, and biochemical factors, which may not be adequately captured through single-domain assessments. Within the framework of the VIVA Project (Vulnerability Index: Valencia institutionalized Adults), this study aimed to characterize institutionalized older adults during the COVID-19 pandemic using an integrated multidimensional approach and to explore clinically interpretable vulnerability profiles. Methods: This cross-sectional study included 124 residents from 10 nursing homes of Valencia, Spain. Data were obtained from institutional records and included age, sex, body mass index (BMI), Barthel Index, Mini-Examination of Cognition (MEC), Tinetti scale, Mini Nutritional Assessment-Short Form (MNA-SF), and biochemical markers related to protein status, lipid metabolism, micronutrient availability, and renal function. An exploratory VIVA multidimensional index was constructed from nine standardized variables, and k-means clustering was applied to these variables rather than to a single summed score to identify residents’ phenotypes. An exploratory logistic regression model was used to assess the internal discrimination of the high-vulnerability phenotype. Results: The cohort showed marked heterogeneity across functional, cognitive, nutritional, anthropometric, and biochemical domains. Cluster analysis identified three clinically interpretable phenotypes ranging from lower to higher vulnerability. Functional impairment, particularly the Barthel Index and Tinetti score, was the main driver of separation between phenotypes, while biochemical markers contributed to refining profile discrimination. The exploratory logistic regression model showed high internal discrimination for the high-vulnerability phenotype, supporting the internal coherence of the integrated framework. Conclusions: An integrated multidimensional framework may be useful for characterizing vulnerability among institutionalized older adults and supporting risk stratification in long-term care settings. The logistic regression findings, including the high AUC, should be interpreted only as evidence of internal discrimination and internal coherence of the exploratory construct, not as evidence of external validity, reproducibility, diagnostic accuracy, or future predictive utility. Full article

Introduction: From 12 March 2020, when the first cases of COVID-19 were registered in Kosovo, to 9 March 2023, there were a total of 273,310 reported cases of COVID-19 and 3211 reported deaths in Kosovo (CFR: 1.17%). Health care workers (HCWs) have been at a higher risk of contracting SARS-CoV-2 infection; nevertheless, data on seroprevalence of SARS-CoV-2 antibodies among HCWs in Kosovo are very limited. Methodology: A cross-sectional serology study with 1654 healthcare professionals throughout Kosovo was conducted to determine the presence of antibodies against the spike antigen of SARS-CoV-2. In addition, a structured questionnaire was administered to study participants to obtain basic demographic data, and information on prior infection and COVID-19 vaccination status. Results: Antibodies against the spike antigen of SARS-CoV-2 were detected in almost all (99.8%) HCWs that participated in the study. The average antibody titer was 8030.8 AU/mL in women and 9533.7 AU/mL in men. Sixty-four percent of HCWs in this study reported prior infection with SARS-CoV-2, 6% of whom were hospitalized. Over 98% of study participants had received SARS-CoV-2 vaccination. Conclusions: Almost all HCWs participating in the study had antibodies against the spike antigen of SARS-CoV-2. This is most probably the result of the high COVID-19 vaccination rate in Kosovo as well as infection with SARS-CoV-2. Full article

Introduction: Several Enterobacterales species harboring New Delhi metallo-β-lactamase (NDM-1) have been reported worldwide. Among them is Providencia stuartii (P. stuartii), an emerging pathogen in nosocomial infections. Objective: This study aimed to perform the clinical and genomic characterization of NDM-1-producing P. stuartii isolates recovered from hospitalized patients during the COVID-19 pandemic in Southern Brazil. Materials and Methods: A retrospective observational study was conducted between April and September 2021 at a Brazilian teaching hospital. Fifty P. stuartii isolates were identified, and carbapenem-resistant isolates underwent phenotypic and molecular characterization. Genetic relatedness was assessed by Enterobacterial Repetitive Intergenic Consensus PCR (ERIC-PCR), and selected isolates were subjected to whole-genome sequencing using the Illumina NextSeq platform to determine sequence types, resistance genes, virulence determinants, and plasmid content. Statistical analyses were performed using SPSS version 20.0. Results: Among the 50 isolates, 21 (42%) harbored the blaNDM-1 gene. Most isolates were recovered from tracheal aspirates (57.2%), followed by blood (23.8%), urine (9.5%), and skin and soft tissue samples (9.5%). Significant associations were observed between NDM-1-producing isolates and SARS-CoV-2 infection (p = 0.013), central venous catheter use (p = 0.012), mechanical ventilation (p = 0.006), hemodialysis (p = 0.033), previous antimicrobial exposure, and mortality (p = 0.021). Genomic analysis revealed the presence of blaNDM-1, blaOXA-1, and multiple resistance determinants associated with aminoglycosides, fluoroquinolones, macrolides, tetracyclines, and folate pathway inhibitors. ERIC-PCR demonstrated low genetic variability among isolates, suggesting possible clonal dissemination within the hospital environment. Conclusions: This study reports the emergence of NDM-1-producing P. stuartii during the COVID-19 pandemic in a Brazilian teaching hospital. The low genetic variability among isolates and the multidrug-resistant profile highlight the potential for nosocomial dissemination and reinforce the importance of genomic surveillance and infection control strategies. Full article