COVID

Emerging but limited evidence suggests that HIV infection does not affect in-hospital COVID-19 mortality, regardless of the prevalence of HIV infection in most parts of sub-Saharan Africa, especially the southern Africa region, and Zambia, Lusaka District in particular, is not an exception. Therefore, this study aimed to determine the effect of HIV infection, demographics, and clinical factors on mortality among hospitalized COVID-19 patients at Levy Mwanawasa University Teaching Hospital (LMUTH). A cross-sectional study was conducted with a sample size of 698 adults admitted for COVID-19 at LMUTH from 18 March 2020 to 31 December 2021. For all statistical analysis of data, STATA statistical software, version 15 MP (College Station, TX 77845, USA) was used—ensuring that appropriate statistical techniques were applied to the data. Unadjusted and adjusted logistic regressions were conducted to model COVID-19 mortality among COVID-19 patients based on their HIV status while controlling for five predictor variables. Based on the results, the best predictors of in-hospital COVID-19 mortality were HIV status, number of comorbidities, age in years, smoking, and alcohol intake. The results suggest that COVID-19 mortality among those with HIV and those without HIV infection was different. People living with HIV infection had increased odds of COVID-19 mortality compared to those without HIV. The results further suggested that a unit increase in age was associated with increased odds of COVID-19 mortality. Furthermore, drinking alcohol and having two or more comorbidities increased the odds of COVID-19 mortality compared to not drinking alcohol, having no comorbidity, or having a comorbidity. This study, therefore, concludes that HIV infection has a significant effect on COVID-19 mortality among patients hospitalized at LMUTH and that the proportion of COVID-19 mortality in the HIV-infected group is relatively higher than in the uninfected group. Therefore, there is a need for close monitoring of COVID-19 patients with HIV infection. Full article

Since the establishment of the State of Alarm resulting from the current COVID-19 pandemic, lockdown, and quarantine have been imposed in most countries, with serious health, social, economic, and educational consequences. The health emergency caused by COVID-19 led to the closure of schools, forcing students from all over the world to stop attending schools and compromising the quality of care offered to students with autism spectrum disorder (ASD). In order to examine how teachers supervised students with ASD virtually during the lockdown period, and to determine whether families considered the support provided by teachers to be adequate, a cross-cultural study design was adopted. An ad hoc questionnaire was administered to 415 families in Spain and Mexico in April 2020. We calculated frequencies and carried out descriptive analyses, parametric inferential analyses, and correlations. Families reported that educational monitoring and contact with the family member with ASD during home lockdown was scarce, despite the provision of activities appropriate to their needs. Significant differences were found as a function of country, age of participant, age of family member with ASD, type of ASD, type of schooling, and length of lockdown. This study highlights the need to train teachers in inclusive digital education and to establish effective protocols for communication and follow-up with the families of students with ASD. Full article

Background: The epidemiology, characteristics and outcomes of coinfections in COVID-19 are still poorly understood. Methods: We investigated the prevalence of coinfections in COVID-19 patients hospitalized in Switzerland over the first three epidemic waves between 1 March 2020 and 1 June 2021, as well as risk factors and outcomes. Patients were identified from six hospitals of the Swiss prospective surveillance system database (CH-SUR). Details of the type and treatment of coinfections were retrieved retrospectively from medical charts. We assessed the proportion of patients with suspected coinfections and analyzed risk factors and 90-day in-hospital survival using logistic and Cox regression. Results: Of 13,265 identified patients, 36.6% (4859/13,625) had suspected coinfections, and 44.8% (5941/13,625) received antibiotics. Respiratory coinfections (25.6%) were the most common, followed by bloodstream (19.8%) and urinary tract infections (14.6%). Escherichia coli (14.8%), Staphylococcus aureus (10.7%) and Klebsiella pneumoniae (6.1%) were the most frequently isolated pathogens. The risk factors for coinfections included increasing age, male gender, certain underlying medical conditions and immunosuppression. Suspected coinfections were associated with a longer hospital stay (13 vs. 7 days, p < 0.001), more frequent ICU admission (26% vs. 6.7%, p < 0.001) and higher rates of in-hospital death (24% vs. 9.5%, p < 0.001). Hospitalization in the ICU at the time of COVID-19 diagnosis had the strongest association with coinfections. Conclusions: A high proportion of COVID-19 patients had coinfections, particularly respiratory infections, and received antibiotics. Coinfections were associated with severe illness and worse outcomes. Full article

The replication machinery of SARS-CoV-2 is a primary target for therapeutic intervention, and has led to significant progress in antiviral medication discovery. This review consolidates contemporary molecular insights into viral replication and rigorously assesses treatment methods at different phases of viruses’ clinical development. Direct-acting antivirals, such as nucleoside analogs (e.g., remdesivir, molnupiravir) and protease inhibitors (e.g., nirmatrelvir), have shown clinical effectiveness in diminishing morbidity and hospitalization rates. Simultaneously, host-targeted medicines like baricitinib, camostat, and brequinar leverage critical host–virus interactions, providing additional pathways to reduce viral replication while possibly minimizing the development of resistance. Notwithstanding these advancements, constraints in distribution methods, antiviral longevity, and the risk of mutational evasion demand novel strategies. Promising investigational approaches encompass CRISPR-mediated RNA degradation systems, inhalable siRNA-nanoparticle conjugates, and molecular glue degraders that target host and viral proteins. Furthermore, next-generation treatments aimed at underutilized enzyme domains (e.g., NiRAN, ExoN) and host chaperone systems (e.g., TRiC complex) signify a transformative approach in antiviral targeting. The integration of high-throughput phenotypic screening, AI-driven medication repurposing, and systems virology is transforming the antiviral discovery field. An ongoing interdisciplinary endeavor is necessary to convert these findings into versatile, resistance-resistant antiviral strategies that are applicable beyond the present pandemic and in future coronavirus epidemics. Full article

Promoting public engagement through social media has always been a core issue in risk communication studies. Based on the Social Amplification of Risk Framework (SARF), this study conducts an online survey in China (N = 908) and constructs a moderated mediation model. Using bootstrapped moderated mediation analysis, this study examines the relationships among social media exposure to pandemic information, risk perception, source credibility, and public engagement on social media at the early stages of the pandemic. The results demonstrate a positive relationship between social media exposure and public engagement, which can be mediated by risk perception. The relationship between social media exposure and public engagement via risk perception is moderated by source credibility. The higher perceived credibility of official and interpersonal sources undermines risk perception, but also hinders public engagement in the crisis. The moderating effect of professional source credibility is not significant. This study has expanded the SARF and has contributed to promoting risk communication strategies from the perspective of risk information processing. Full article

The COVID-19 pandemic disrupted U.S. K-12 education systems, forcing teachers to adopt emergency remote teaching with minimal preparation. This study investigates the challenges and adaptive strategies of 16 U.S. K-12 educators during the pandemic. Qualitative analysis of semi-structured interviews with 16 educators was conducted to identify key themes. Findings reveal that innovative engagement strategies—including interactive activities, long-term projects, and inclusive virtual environments—were pivotal for sustaining participation. Challenges such as disparities in students’ home environments, technical limitations, and motivational declines underscored the need for parental collaboration, emotional support frameworks, and teacher-specific professional development. These results highlight actionable pathways to strengthen resilience and equity in online education systems during crises. Full article

Background/Objectives: This retrospective observational study investigated coronavirus disease 2019 (COVID-19)-related mortality trends in the US throughout the pandemic. Methods: We performed a retrospective, descriptive analysis between 2020 and 2024 using data from the US National Center for Health Statistics. Results: The total number of COVID-19 deaths rose by 19% from 2020 to 2021, followed by a significant decline in the subsequent years, with an average reduction factor of 0.44. Mortality rates remained higher in males compared to females, with a gender disparity between 52 and 62%. Age-specific crude mortality rates increased with advancing age, with higher mortality observed in older populations. However, crude death rates significantly declined across all ages except for the 1–4 years group, which experienced a 33% increase. The majority of fatalities occurred in medical facilities (63–80%), but this proportion gradually decreased over time, while the percentage of deaths occurring at home nearly doubled from 2020 to 2024 (6% to 11%). Conclusions: The initial mortality peak for COVID-19 was followed by a substantial decline, likely influenced by the widespread availability of vaccines, improvements in clinical management, and the emergence of less virulent variants. The persistent gender and age disparities, alongside the fluctuating distribution of the places of death, offer insights for refining healthcare policies and optimizing resource allocation in this and other future pandemics. Full article

Awareness about the attitudes towards the vaccination of persons with schizophrenia is essential, as this group has a greater likelihood of experiencing serious consequences if infected with COVID-19 or other infectious processes. For this reason, 141 persons with schizophrenia completed a survey addressing different aspects of receiving the vaccine for COVID-19. In general, the results are similar to those of people without a severe mental disorder. Persons with schizophrenia were willing to get vaccinated, perceived vaccination as being as safe and effective as the general population did, and reported that they usually followed preventive measures to avoid the spread of the virus. However, their concerns were frequently related to possible health problems or fears about the vaccination. There is no influence from sociodemographic variables, though limited social life, perceived risk in people in their immediate environment, and a negative self-assessment of their own health were associated with increased acceptance of vaccination. Thus, the present study provides useful information on this topic and encourages the development of programs and interventions that promote preventive actions for this group of people. Full article

The COVID-19 pandemic was a worldwide crisis with significant impact on professional, economic, and social well-being. In medical academics, researchers were hampered by the need to provide critical support to pandemic efforts at their institutions, while balancing rapid communication of information that could impact practices and inform behavior. Autoethnography as a research method was employed by many early on as a means of characterizing aspects of the COVID-19 response. Two surgeons from heavily hit areas early in the epidemic—Bergamo, Italy, and Boston, the United States—entered into an online, virtual, professional relationship that helped them both endure the pandemic and inform their institutions and communities. Their relationship influenced practices across the United States and beyond. This paper explores how the principles of autoethnography as a valid, essential and important method of research can lead to significant impacts during times of crises. Full article

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the coronavirus disease 2019 (COVID-19) pandemic that devastated the world. While this is a respiratory virus, one feature of the SARS-CoV-2 infection was recognized to cause pathogenesis of other organs. Because the membrane fusion protein of SARS-CoV-2, the spike protein, binds to its major host cell receptor angiotensin-converting enzyme 2 (ACE2), which regulates a critical mediator of cardiovascular diseases, angiotensin II, COVID-19 is largely associated with vascular pathologies. The present study examined the pulmonary vasculature of COVID-19 patients using large sample sizes and provides mechanistic information through histological observations. We studied 56 postmortal lung samples from COVID-19 patients. The comparative group consisted of 17 postmortal lung samples from patients who died of influenza A virus subtype H1N1. The examination of 56 autopsy lung samples showed thickened vascular walls of small pulmonary arteries after 14 days of disease compared to H1N1 influenza patients who died before the COVID-19 pandemic started. Pulmonary vascular remodeling in COVID-19 patients was associated with hypertrophy of the smooth muscle layer, perivascular fibrosis, edema and lymphostasis, inflammatory infiltration, perivascular hemosiderosis, and neoangiogenesis. We found a correlation between the duration of hospital stay and the thickness of the muscular layer of the pulmonary arterial walls. These results demonstrate that COVID-19 significantly affected the pulmonary vasculature in fatal-course patients, also suggesting the need for careful follow-up in non-fatal cases, at risk of pulmonary hypertension. Full article

The COVID-19 pandemic has led to a general increase in the workload in Intensive Care Units (ICUs). The objective here was to analyze the nursing workload in a Cardiology ICU of a tertiary and teaching inner hospital in Brazil before and during the COVID-19 pandemic. A retrospective and ecological study was conducted. Nursing Activities Score mean by month (NAS-mm) data were collected from the unit’s opening in October 2014 until May 2023. The data were divided into pre-pandemic and pandemic periods, with the pandemic further divided into three phases/years. A workload decrease was observed during the pandemic and varied across different pandemic years. In the pre-pandemic period, the mean was 53.80 points (95%CI: 52.99; 54.60; n = 65), whereas during the pandemic, it was 52.02 points (95%CI: 50.88; 53.17; n = 39). The first year had the lowest mean workload at 50.94 points, followed by the second year with 48.37 points, while the third year had the highest with 55.82 points, exceeding the pre-pandemic period’s workload. Amid the COVID-19 pandemic scenario, a decrease in nursing workload was observed in the unit, only returning to reference values in the third pandemic year, possibly associated with patient and administrative profile changes. Full article

The coronavirus disease of 2019 (COVID-19) presented hospitals not only with significant clinical challenges but also with organizational obstacles, forcing hospitals to adapt their operations to ensure continuity of care. This study aims to explore the challenges that Nebraska hospitals encountered during COVID-19. To achieve this goal, the study draws on data collected through semi-structured interviews with the Chief Executive Officers (CEOs) and Chief Nurse Officers (CNOs) of eight hospitals in the state of Nebraska. These incident commanders held pivotal decision-making positions in their associated hospitals during the COVID-19 pandemic and its surge times. Data were analyzed using inductive thematic analysis, revealing nine key themes related to the challenges faced by hospital leaders. The main challenges included difficulties with hospital operational procedures, issues related to physical layout design, concerns over insufficient capacity to meet patient demand, disruptions in the supply chain affecting essential resources, challenges in managing hospital staff effectively, barriers in communication within and across departments, infrastructure deficiencies that impacted functionality, financial constraints, and complexities in organizational management. These themes are accompanied by their respective sub-themes and supporting quotes from interview transcripts within this paper. The insights from this study can inform healthcare leaders to develop more efficient operational frameworks to navigate public health crises. Full article

SARS-CoV-2 continues to circulate with new variants of uncertain transmissibility and virulence arising over time and resulting in varying morbidity and mortality between and within countries. This study aimed to identify the predictors of mortality among hospitalized COVID-19 patients across the first five waves of the pandemic. We conducted a retrospective cohort study at Tigoni Level 4 Hospital in Kenya. The study included patients admitted between June 2020 to August 2022 who tested positive for SARS-CoV-2. Sociodemographic and clinical data were abstracted from patient records at the time of admission and throughout their hospital stay. We employed Cox proportional hazard regression analysis to estimate the time to event (discharge or death) and identify predictors of mortality. Both time-varying and non-time-varying covariates were included in the models. A total of 1985 patients were admitted, of whom 557 (28%) died. The median hospital stay was 4 (1.0–8.0) days and 9 (5.0–13.0) days for patients who died and those who were discharged alive, respectively. Compared to patients admitted during wave 1, those admitted during the subsequent waves had high risk of death estimated at adjusted HR: 1.66 (95% CI 1.2, 2.54), 5.17 (95% CI 3.55, 7.53), 2.62 (95% CI 1.87, 3.67), and 2.17 (95% CI 1.51, 3.11) for waves 2, 3, 4, and 5, respectively. A proportion of patients presented with persistent chest pain, cough, and hypoxia and continued oxygen therapy for more than two months. In addition, patients who had persistent fever, hypoxia, cough, and fatigue had a significant mortality risk (adjusted HR: 3.00; 95% CI: 1.81–4.98; HR: 1.97; 95% CI: 1.73–2.26; HR: 1.47; 95% CI: 1.24–1.75; HR: 1.64; 95% CI: 1.05–2.54). Conversely, patients who had low oxygen saturation and received oxygen at admission had a 76% (HR: 0.24; 95% CI: 0.13–0.42) reduction in mortality risk and in addition patients whose treatment was altered had a 49% reduction in mortality risk (HR: 0.51; CI: 0.45–0.58). Our study highlights the benefits of oxygen therapy on the outcome of COVID-19 patients and justifies the need to increase investments in oxygen especially in low-and-middle-income countries. It also confirms the need to analyze the pandemic by the different waves. Full article

Adults face a higher risk of exposure to COVID-19 than older adults and children due to their labor force participation. This study investigated the uptake of the initial and second doses of the COVID-19 vaccine among adults, stratified by age, race, ethnicity, sex, and their combinations. Data from the Kentucky Immunization Registry were employed to evaluate temporal changes in COVID-19 vaccine uptake among adults in three age groups (college age: 18–24, prime working age: 25–44, and middle age: 45–64) in Jefferson County, Kentucky (2020 population: 782,969). The analysis explored trends by age, race, and ethnicity; intersections of age with race and ethnicity; and interactions of age–race and age–ethnicity with sex. By May 2022, the highest and lowest COVID-19 vaccination rates were observed among White and Black 45–64-year-old adults: 74.8% and 64.0%, respectively, for dose two. The highest and lowest two-dose vaccination rates at ages 25–44 and 18–24 were also among White and Black residents: 67.9% versus 46.0% and 55.2% versus 35.4%, respectively. Disparities in COVID-19 vaccination by race, ethnicity, sex, and their intersections remained evident during the study period. Efforts in vaccine distribution and promotional initiatives should focus on demographically appropriate strategies. Full article

Background: The COVID-19 pandemic highlighted the crucial role of community preventive behaviors in controlling the virus’ spread. Studies show that people’s risk perceptions and awareness significantly contribute to the containment and prevention of infections by motivating adoption of desired actions and behaviors. This study aimed at assessing the role of risk communication and factors that influenced responses during the COVID-19 pandemic in rural communities in Western Kenya. Methods: A descriptive cross-sectional study was conducted using a quantitative research approach, collecting data from 806 individuals across Kisumu, Vihiga, and Kakamega counties. Descriptive statistics were used to detail the demographic characteristics of the study population, while logistic regression analysis estimated the associations between risk communication and demographic characteristics on COVID-19 vaccine acceptance, compliance with mitigation behaviors, perceived severity, and perceived susceptibility. Results: The results showed that 55% of participants were male and 45% were female, with an average moderate compliance with safety measures (mean = 5.15). A significant portion of participants wore face masks (85.3%), practiced hand hygiene (78.9%), and avoided close contact behaviors (66.6%). Most respondents received information through mass media (86.1%) and health workers (72.9%). Compliance with COVID-19 mitigation measures was highest among those who trusted information from official institutions, health professionals, and mass media, compared to social media, with increased odds of 2.7 times and 2.5 times, respectively. Higher risk perception was significantly associated with older age groups (above 50 years), being male, and working in the private sector. Effective risk communication significantly influenced risk perception, compliance with COVID-19 measures, and vaccination acceptance. Conclusions: The findings suggest that effective risk communication strategies are critical during public health emergencies and hence implications for future public health crises. The results underscore the importance of targeted communication and tailored interventions to improve compliance and vaccine acceptance among different demographic groups, ensuring a more robust public health response during outbreaks and pandemics. Full article

In the past 5 years, the COVID-19 pandemic has experienced frequently changing variants contextualizing immune evasion. The emergence of Omicron with >30–50 mutations on the spike gene has shown a sharp divergence from its relative VOCs, such as WT, Alpha, Beta, Gamma, and Delta. The requisition of prime boosting was essential within 3–6 months to improve the Nab response that had been not lasted for longer. Omicron subvariant BA.1.1 was less transmissible, but with an extra nine mutations in next variant BA.2 made it more transmissible. This remarkable heterogeneity was reported in ORF1ab or TRS sites, ORF7a, and 10 regions in the genomic sequences of Omicron BA.2 and its evolving subvariants BA.4.6, BF.7, BQ.2, BF. 7, BA.2.75.2, and BA.5 (BQ.1 and BQ.1.1). The mutational stability of subvariants XBB, XBB 1, XBB 1.5, and XBB 1.6 conferred a similar affinity towards ACE-2. This phenomenon has been reported in breakthrough infections and after booster vaccinations producing hybrid immunity. The reduced pathogenic nature of Omicron has implicated its adaptation either through immunocompromised individuals or other animal hosts. The binding capacity of RBD and ACE-2, including the proteolytic priming via TMPRSS2, reveals its (in-vitro) transmissibility behavior. RBD mutations signify transmissibility, S1/S2 enhances virulence, while S2 infers the effective immunogenic response. Initial mutations D614G, E484A, N501Y, Q493K, K417N, S477N, Y505H, and G496S were found to increase the Ab escape. Some mutations such as, R346K, L452R, and F486Vwere seen delivering immune pressure. HR2 region (S2) displayed mutations R436S, K444T, F486S, and D1199N with altered spike positions. Later on, the booster dose or breakthrough infections contributed to elevating the immune profile. Several other mutations in BA.1.1-N460K, R346T, K444T, and BA.2.75.2-F486S have also conferred the neutralization resistance. The least studied T-cell response in SARS-CoV-2 affects HLA- TCR interactions, thus, it plays a role in limiting the virus clearance. Antigenic cartographic analysis has also shown Omicron’s drift from its predecessor variants. The rapidly evolving SARS-CoV-2 variants and subvariants have driven the population-based immunity escape in fully immunized individuals within short period. This could be an indication that Omicron is heading towards endemicity and may evolve in future with subvariants could lead to outbreaks, which requires regular surveillance. Full article

This study investigates the cross-cultural experiences and evolving sense of belonging among international students during the COVID-19 pandemic at a large Midwestern U.S. university. Using a mixed-methods approach, we collected quantitative data through a Qualtrics survey and qualitative insights from in-depth interviews. Findings reveal that while students generally adapted to academic and social disruptions, they faced intensified challenges related to cultural isolation, mental health struggles, and immigration uncertainties. Resilience, individualized coping strategies, and shifts in their sense of belonging emerged as key themes. The study contributes practical and theoretical insights by identifying institutional strategies to strengthen cultural inclusion, mental health support, and student engagement during global crises. These findings inform future research, university policies, and support systems aimed at enhancing international students’ wellbeing and fostering more inclusive educational environments during times of uncertainty. Full article

This study explored the integration of technology into teaching practices by examining how faculty members at a newly established university in Saudi Arabia utilized the Blackboard learning system. Specifically, it investigated the use of multimedia e-learning tools by male and female faculty members during regular teaching periods following the COVID-19 pandemic. A survey questionnaire was developed using a 5-point Likert scale. The instrument covered demographic information, content creation, assessment methods, utility tools, and factors influencing Blackboard usage. Upon receiving approval, the survey was distributed via email to all faculty members across nine colleges. A total of 198 responses were collected and analyzed using both descriptive and inferential statistical methods. The findings indicated that gender had little to no statistically significant impact on the use of key Blackboard tools—such as content creation features (e.g., files, folders, items), assessment tools (e.g., tests, assignments), and utilities (e.g., virtual classes, email)—at the college level. However, when analyzed at the university level, some tools’ usage showed statistically significant gender differences at the α = 0.05 level. Furthermore, both male and female faculty members cited convenience, flexibility in uploading materials, access to virtual classes, and remote assessment of students as primary factors influencing their e-learning preferences. Full article

Introduction: A growing body of literature has identified a variety of factors affecting vaccine uptake, but the role of geographic accessibility remains unclear. This study fills this knowledge gap by empirically investigating the extent to which the time driving to vaccine sites as a measure of geographic friction affected COVID-19 vaccine uptake. Methods: A logistic model and a hazard-based duration model were applied to the official data of more than 142,000 adults who took at least one COVID-19 vaccine in Nueces County, Texas, between December 2020 and August 2022. Using the street network, travel time was calculated from individuals’ home addresses to the addresses of the sites where they received their vaccinations. Results: The logistic model indicated that individuals living farther from vaccine sites were less likely to receive full vaccination, controlling for their sociodemographic characteristics that affected vaccine hesitancy. The duration model further showed that fully vaccinated persons would delay a booster shot longer if they had to travel longer for a vaccine. Conclusions: To the extent that the health protection of a COVID-19 vaccine declines over time, the integration of spatial and temporal dimensions in the duration model allowed us to shed light on the relationship between travel time and delay in booster vaccination. A vaccination campaign should make vaccination services physically convenient for vaccine recipients from different communities. Full article