COVID

Pernambuco, a northeastern Brazilian state, suffered significantly during the COVID-19 pandemic. The incidence, mortality, and fatality rates were incredibly high; these outcomes were a direct failure of the public health system to manage the COVID-19 pandemic. We developed an efficient method to analyze the trends in incidence, mortality, and lethality indicators of COVID-19 and the dynamics of their main determinants in the state of Pernambuco from March 2020 to March 2022. This was a time series ecological study. We calculated the lethality, mortality, and incidence rates with official and public data from the Health Department of this state. The effective reproduction number (Rt) was estimated, and then the periods were delimited, thus creating the efficiency model. Differences were considered significant when p < 0.05. We found 585,551 cases and 18,233 deaths from COVID-19. January 2022 was the month with the highest number of cases (6312) and, in May 2020, we recorded the highest number of deaths (149). Our method was efficient in analyzing periods of COVID-19, noting a contrast between the early and most recent periods, with the latter showing a stable number of new cases and patient deaths. Full article

We describe two patients with a recent stroke or traumatic brain injury associated with aphasia and cognitive impairment who required detention (under the Mental Health Act) as well as some form of restraint during their inpatient rehabilitation. Each of these episodes of care occurred early into the COVID-19 pandemic and we speculate that the detention (and restraint) was attributable, at least in part, to the difficulty in comprehending COVID-19-related changes in patterns of staff interaction and the mandated social and visiting restrictions. We reflect on the impact of these restrictions on the need for detention and how these factors could have been mitigated through speech and language therapist (SLT) and broader multidisciplinary team (MDT) intervention. Full article

At 63.7 million, Latinxs constitute the largest racial/ethnic minority in the United States (US). Early during the COVID-19 pandemic, Latinxs were disproportionately impacted and exhibited lower vaccine uptake. Widespread infodemics contributed to confusion, eroded trust, and fostered vaccine hesitancy among this population. This study used a convergent parallel mixed-methods approach to analyze, integrate, and interpret concurrently collected data gathered as part of the Community Engaged Alliance (CEAL) Against COVID-19 Disparities project, initiated by the National Institutes of Health (NIH) in response to the COVID-19 pandemic in the US. Target populations were three underserved Latinx communities of Miami-Dade County (MDC), Florida, during the pandemic’s peak. Qualitative findings show six themes and subthemes that integrate with quantitative survey data (N = 451). Themes included a “wait-and-see” approach to vaccine uptake; concerns about infodemics; attitudes about science, education, healthcare providers; and personal sources of information. Our findings highlight cultural significance, trusted sources, and reasons for hesitancy before vaccination decisions as corroborated by quantitative results. However, divergence was found regarding media sources. Consistent with the literature, although participants report concerns about infodemics and media bias, they still rely on media for updates, particularly with established television networks and trusted personalities. The value placed on education throughout the study (quantitative and qualitative) highlights the importance of culturally appropriate educational interventions. Moreover, the complex nature of the impact that media has on health-related information and vaccine uptake in this population underscores the need for media literacy interventions alongside health education. Full article

Background: The COVID-19 pandemic has exerted immense pressure on healthcare systems, particularly in the management of patients with acute respiratory distress syndrome (ARDS). Identifying predictors of survival in critically ill patients is crucial for optimizing treatment strategies. Methods: A retrospective cohort study was conducted in an Intensive Care Unit (ICU) in Mexico City, spanning from March 2020 to March 2023. This study included patients aged 18 years and older with confirmed COVID-19 who required invasive mechanical ventilation. Logistic regression and Kaplan–Meier analyses were performed to evaluate factors associated with mortality. Results: A total of 157 patients were included, with a mean age of 62.8 years, and 74.5% were male. The 90-day survival rate was 41.4%, with a mortality rate of 58.6%. Acute kidney injury (AKI) (OR = 3.4), hemodynamic failure (OR = 6.5), and elevated lactate levels (OR = 0.201) were significantly associated with increased mortality risk. Kaplan–Meier analysis demonstrated significantly reduced survival among patients with AKI, hemodynamic failure, and hyperlactatemia. Discussion: AKI, hemodynamic instability, and hyperlactatemia emerged as pivotal predictors of mortality. The high incidence of AKI and associated adverse outcomes underscore the urgent need for tailored management strategies in this vulnerable patient cohort. Conclusions: The 90-day survival rate was 41.4%. AKI, hemodynamic failure, and elevated lactate levels were independently associated with increased mortality, highlighting the necessity for focused and strategic interventions. Full article

Objective: To examine patient-user symptom reporting to an AI-based online virtual triage (VT) and care-referral engine to assess patterns of mental health symptoms (MHS) reporting prior to and during the COVID-19 pandemic. Methods: The frequencies of 11 MHS reported through VT were analyzed over three time intervals: one year prior to the WHO declaring a global COVID-19 emergency; from pandemic declaration to a mid-point in US vaccine distribution/uptake; and one year thereafter. Results: A total of 4,346,987 VT encounters/interviews presenting somatic and MHS occurred, increasing over time and peaking in the COVID-19 post-vaccine interval with 2,257,553 encounters (51.9%). In 866,218 encounters (19.9%), at least one MHS was reported. MHS reporting declined across subsequent time intervals, was lowest in the COVID-19 post-vaccine period (19.1%), and slightly higher in the pre-pandemic and COVID-19 pre-vaccine intervals (p = 0.05). The most frequently reported symptoms were anxiety, sleep disorder, general anxiety, irritability, and nervousness. Women reported anxiety less often and nervousness and irritability more often. Individuals aged 60+ years reported anxiety and nervousness less frequently, insomnia and sleep disorder more often than individuals 18–39 and 40–59 years old, and sleep disorder more often than those aged 40–59 years in all periods (all p = 0.05). Conclusions: Overall VT usage for somatic and mental health symptom reporting and care referral increased dramatically during the pandemic. VT effectively screened and provided care referral for patient-users presenting with MHS. Virtual triage offers a valuable additional vehicle to detect mental health symptoms and potentially accelerate care referral for patients needing care. Full article

Background: People consumed more sugary foods and neglected oral hygiene during the lockdowns due to the coronavirus disease (COVID-19) pandemic. The study aimed to compare the oral hygiene status and dietary habits of children with high caries risk and their parents before and after COVID-19. Methods: The study was conducted with the parents of 155 children aged 3–5 years. A questionnaire including both the children’s and parents’ dietary and oral hygiene habits was completed by the parents. Decay, missing, filling teeth (dmft/DMFT) status of the children was recorded before and after COVID-19. Results: A significant decrease was observed in the parents’ tooth brushing frequency (p = 0.028), while no difference was observed in the children’s brushing frequency before and after COVID-19 (p = 0.216). Both children and parents ate significantly more frequently (p = 0.047, p = 0.043). dmft/DMFT values increased significantly after COVID-19 (p = 0.005). Conclusions: The study showed that the COVID-19 pandemic had a limited effect on tooth brushing habits in children with high caries risk. Additionally, it resulted in increased consumption of sugary foods among both children and parents, exacerbating caries in children aged 3–5 years. Healthcare professionals and parents can work together to mitigate the negative effects of the COVID-19 pandemic on oral health, especially for high-caries-risk children. Full article

Improper use of hydroxychloroquine to treat COVID-19 has been linked to 17,000 preventable deaths. This content analysis study investigates the emergence of this conspiracy theory, the role of the news media in perpetuating and disseminating it, and whether coverage differed by outlet political alignment. We searched Nexis for relevant media from 17–31 March 2020. A total of 128 media pieces were coded qualitatively and thematically analysed. The news media amplified the voices of right-wing political elites and used a variety of manipulative tactics in reporting on hydroxychloroquine. Powerful ingroup/outgroup mechanisms polarised the American public and created a schism between Trump supporters and the public health apparatus that reflected the political asymmetry in reporting on hydroxychloroquine. The widespread use of optimistic framings and anecdotal evidence contributed to public misunderstandings of the evidence. Therefore, strategic and interventionist public health efforts are required to combat misinformation. This study informs discussions of how politicised media coverage catalyses conspiracism. Full article

The COVID-19 pandemic had a global impact on mental health. Identification of individuals at higher or lower risk of mental health problems may assist with targeting prevention, support and treatment efforts during future pandemics. Using a Canadian national mental health survey that collected data during the pandemic period (March 2022–December 2022), this study examined the vulnerability of participants reporting abuse during their childhood by examining the annual prevalence of mood, anxiety and substance use disorders. Psychiatric disorders were identified using a version of the Composite International Diagnostic Interview (CIDI). Because childhood adversities are well-known risk factors for mental disorders, the analysis focused on interactions between childhood adversities and pandemic-related stressors by estimating the relative excess risk due to interaction (RERI). RERIs provide evidence of synergy based on the occurrence of greater than additive interactions. Physical and sexual abuse interacted synergistically with pandemic-related stressors in predicting mood and anxiety disorders. No synergies were found for substance use disorders. Childhood adversities increase vulnerability to later stressors and may be useful for the identification of individuals more likely to have mental health needs during this type of public health emergency. Full article

Focusing on the COVID-19 period in Japan, this study identifies the effectiveness of a municipal unit-based pricing (UBP) system on household waste reduction through a panel data analysis targeting 770 cities for 2013–2022. It focuses on simple unit pricing (SUP) and two-tiered pricing (TTP) systems as the UBP components. As previous studies have not considered the COVID-19 period when assessing UBP, this study significantly contributes to the literature by providing new evidence. The main findings are as follows: First, SUP effectively reduced household waste even during the COVID-19 period; however, its effectiveness was slightly neutralized owing to the pandemic environment. Second, TTP also restrained household waste efficiently; however, its effect was smaller than that of SUP, and its reduction effect accelerated during the COVID-19 period (in 2020) because people became cautious about excessive waste volumes beyond the TTP criteria. The study implicates the need to expand the municipal adoption of the UBP system for household waste reduction. Full article

COVID-19 is characterized by a striking similarity to premature aging. Its clinical manifestations range from asymptomatic to critical illness. No single central agent has been demonstrated so far. We present Klotho, an antiaging protein, as a key factor in COVID-19 pathophysiology. There is epidemiological evidence that both acute and chronic uses of Klotho agonists have a beneficial effect in reducing COVID-19 severity and mortality. A review of the PubMed epidemiological, clinical, and mechanistic evidence supports a role for Klotho deficit as a central determinant of severe COVID-19. Clinical data support the idea that chronic use of Klotho agonists protects against severe COVID-19 and that its acute use may be beneficial. We propose a unifying hypothesis that low Klotho levels play a key role in severe COVID-19, while increasing Klotho levels can have a beneficial effect through the prevention of acute kidney injury (AKI) and potential antiviral effects. Further research is needed. Full article

The focus on college students’ mental and physical health is steadily increasing with more students reporting concern and need for services. This study investigates the results of college students’ utilization of mind–body health activities and services in the wake of COVID-19. As part of a larger research study on college wellbeing, a survey completed by 557 college students between May and August of 2020 assessed student’s use of mind–body health strategies. To examine differences in mind–body health (MBH) service and activity usage before and during COVID-19 campus closures, paired t-tests were used, while one-way ANOVAs were used to determine differences based on demographic variables. Findings across MBH service and activity use during campus closures were variable, with use differing based on a variety of factors including gender, socioeconomic background, age, and race, as well as the participant’s personal prior history of services. These findings provide insight into what services students accessed during the lockdown period to aid university health systems with recommended guidance and resources. Full article

(1) Background: The Coronavirus Disease 2019 (COVID-19) pandemic has raised concerns about the impact of underlying medical conditions on the health outcomes of people living with HIV (PLWH). This study aimed to assess how pre-existing chronic medical conditions affect the health outcomes of PLWH infected with COVID-19. (2) Methods: A retrospective study using data from the Minnesota Fairview network (1 January 2020–31 December 2022) was conducted. Fisher’s exact test, the Kruskal–Wallis rank-sum test, and ordinal logistic regressions with a Benjamini–Hochberg (BH) adjustment on p-values were used to assess the influence of chronic conditions on COVID-19 severity, adjusting for age and gender. (3) Results: Among 216 records, significant associations were found for a stroke, chronic kidney disease, lung disease, and neurologic conditions (p < 0.05). Type 1 diabetes was marginally significant (0.05 < p < 0.1). After adjusting for age and sex, a stroke (p = 0.0008, BH-adjusted p = 0.0044) and chronic kidney disease (p = 0.0003, BH-adjusted p = 0.0033) significantly increased the risk of severe COVID-19 outcomes. (4) Conclusions: Pre-existing medical conditions should be considered in the clinical management and public health interventions for PLWH infected with COVID-19. Tailored strategies are essential to mitigate the higher risk of severe outcomes in PLWH with specific chronic comorbidities. Full article

Multiple cause data refer to all conditions reported on death certificates. Compared to the single underlying cause of death, these data provide additional information concerning the presence of comorbidities and complications leading to death. The objective of the study is to use a novel multiple cause approach for identifying comorbidities and complications of COVID-19. We analysed certificates referring to deaths that occurred in Italy in 2020–2021. With a double step chi squared test, we identified the conditions associated with COVID-19 and whether such conditions were reported as ‘cause of’ (comorbidities) or ‘due to’ (complications) COVID-19. For comparison, we adopted the same procedure for influenza deaths that occurred in Italy in 2016–2019. Pneumonia, respiratory failure and adult respiratory distress syndrome are the most frequent complications of COVID-19 and are also associated with it. These diseases have the same role for influenza, nevertheless this latter is strongly associated also with heart failure reported as a complication. Comorbidities are similar for COVID-19 and influenza: diabetes mellitus, chronic obstructive pulmonary disease (COPD) and obesity are the most frequent, with obesity much more frequent in COVID-19 cases. Hypertension is strongly associated with COVID-19 and is more frequent than in influenza cases. This approach is also suitable for other target diseases. Full article

A list of diagnosis codes mapped to CDC-defined high-risk conditions for severe COVID-19 outcomes is currently not available in the literature. We reviewed the CDC list of underlying conditions associated with severe COVID-19 and a coding expert and two clinicians mapped the relevant high-risk conditions to the appropriate ICD-10-CM codes. We additionally assessed the prevalence of these conditions in the Optum de-identified-Clinformatics^® Data Mart Database and the Optum de-identified Electronic Health Record dataset. A comprehensive list of approximately 8200 codes were mapped to the CDC-defined high-risk underlying conditions; these ICD-10-CM codes were stratified into three groups corresponding with the CDC strength of evidence category (conclusive, suggestive, or mixed evidence). Applying these codes to administrative claims and EHR datasets demonstrated a consistent prevalence of high-risk conditions over four years (2018–2021). These findings present a comprehensive list of codes that can be used by clinicians and researchers to identify and characterize patients at high risk for severe COVID-19 outcomes. Full article

The purpose of this review is to evaluate various challenges and opportunities as well as propose solutions for the development and implementation of a prospective COVID-19 patient registry within a regional context in the Philippines. To comprehensively study the course of COVID-19 in the Philippine population, it is essential to develop a comprehensive dataset that includes relevant treatment and diagnostic information. While individual patient reports related to the disease are available at various institutions in the Philippines, there is a need for a more extensive and representative database to facilitate robust analysis. The primary clinical objective of establishing a COVID-19 patient registry was to enhance the accuracy of disease diagnosis. In this review, we present a comprehensive explanation of the systematic rationale, design, and execution of a COVID-19 patient registry in the Western Visayas region of the Philippines. Based on this review, several factors exist that hinder the implementation of a COVID-19 patient registry in this regional setting in the Philippines, including lack of funding, facilities, infrastructure, manpower, and expertise, and unwillingness of some hospitals to pursue research. We also discussed herewith the proposed program implementation for the establishment of such a registry in a regional setting in the Philippines. Full article

Background: The COVID-19 pandemic posed unprecedented challenges to higher education in Germany, necessitating a rapid transition to remote learning. This study evaluates the impact of the pandemic on academic functioning among German university students. Methods: An online survey was conducted with 207 students aged 18 to 35. Results: Significantly poorer academic functioning was evident during the pandemic, particularly in academic output and role satisfaction. Younger students (18 to 24 years) experienced a greater decrease in contact with teachers and lower academic output compared to older students (25 to 35 years). These findings suggest that younger students may struggle more with remote learning due to challenges in self-regulation and time management. Additionally, pandemic-induced disruptions blurred the boundaries between work and personal life, increasing stress and adversely affecting academic performance. No significant differences were found based on sex or living situation. Conclusion: Academic functioning was significantly poorer during the COVID-19 pandemic. This finding highlights the need for targeted support strategies to mitigate the negative effects of the pandemic on students’ academic performance and well-being. Further research is recommended to explore the long-term implications of the pandemic on academic outcomes and student well-being. Full article

This study aims to identify and compare the prevalence and risk factors associated with psychosocial and psychological complaints, as well as life and study satisfaction, among Greek undergraduate students before and during the COVID-19 pandemic. Data were collected in two phases: initially, from 2018 to 2019 (pre-COVID), through face-to-face surveys, and later, from October 2020 to June 2021 (COVID period), through online surveys. The study, conducted at Democritus University of Thrace (DUTH) in Greece, utilized a repeated descriptive and comparative cross-sectional design. The sample comprised 540 and 641 undergraduate students during the pre-COVID and COVID period, respectively. The following questionnaires were used: I. A socio-demographic characteristics form, II. Psychosocial Complaints List (PCL), and III. Satisfaction with Life and Studies Scale (SLSS). During the COVID period, there was an increase of 63% in psychosocial complaints (p < 0.001), as indicated by the PCL total, and a 25% decrease in satisfaction with life and studies (p = 0.001), according to the SLSS, compared to the pre-COVID period. Incidences of “suicidal thoughts”, “sexual problems”, and “extreme psychological distress” nearly doubled (61%, 67%, and 104%, respectively) during the pandemic. Females exhibited a 33% increase in the PCL total during the COVID period compared to males (p < 0.001). These findings highlight the profound impact of pandemic-induced changes on students’ mental health and quality of life. Female gender and the pandemic period itself emerged as significant factors influencing these outcomes. Universities should prioritize the development of comprehensive support services to mitigate these adverse effects. Full article

COVID-19 caused serious food disruptions worldwide and raised food insecurity levels. To further understand how COVID-19 impacted food insecurity, this study used nationally representative data from Pakistan to examine the effect of negative COVID-19 shock on food insecurity and its heterogeneity across different income groups. COVID-19 shock was quantified by a subjective measure based on self-reported exposure to the severity of COVID-19. We found that households struck severely by COVID-19 were about 26% more likely to report a lack of healthy food, almost 35% more likely to skip a meal, around 33% more likely to run out of food, and around 20% more likely to go without food for one whole day in comparison to the households unexposed to the severe COVID-19 shock. Furthermore, households affected by severe COVID-19 shock, especially those in the lower income quartiles, faced acute food insecurity. We constructed two additional proxies for this negative COVID-19 shock based on the objective assessment of income loss due to the lockdown measures in Pakistan to examine the robustness of the findings, and they also led to similar outcomes. Overall, the findings suggested that poorer and COVID-19-stricken households faced severer food insecurity and required urgent support. Full article

COVID-19’s impact on quality of life (QoL) has been studied; however, data on the effects of long COVID on QoL and mental disability remain limited. This study aimed to investigate whether long COVID is associated with decreased QoL and increased mental disability. We analyzed data from adults (≥18 years) in the 2022 Medical Expenditure Panel Survey (MEPS). Physical and mental QoL were assessed using the Veterans RAND 12-Item Health Survey, while mental disability was measured with the Kessler Index. Long COVID was defined as experiencing COVID-related symptoms for over 3 months. To account for skewness in the outcome variables, the study employed survey-weighted generalized linear regression with a log link and gamma distribution. The analysis included 153,330,408 subjects (unweighted n = 10,975). The average age of those with and without long COVID was similar (51 vs. 52 years, p = 0.46). Subjects with long COVID had a 3% lower physical QoL (β = −0.03, p = 0.02), a 4% lower mental QoL (β = −0.04, p < 0.01), and a 26% higher mental disability score (β = 0.26, p < 0.01) compared to those without long COVID. These findings highlight the urgent need for targeted strategies to address long COVID and support patients in recovering their pre-COVID QoL and mental health. Full article