ABSTRACT
Over the past four decades, studies have consistently shown that regular attendance at religious services is associated with better mental and physical health. At the onset of the COVID-19 pandemic, many congregations paused in-person religious services and moved their worship rituals online. The ways that churches have responded to the threat of infectious disease require new conceptualizations and operationalizations of religious attendance and novel comparisons of the causes and consequences of virtual and in-person attendance. Analyses of data collected from a national probability sample of Americans (n = 1,717) show that while in-person religious attendance is associated with better mental and physical health, virtual attendance is unrelated to both outcomes in fully adjusted models. Taken together, these findings suggest that the association between religious attendance and health during a global pandemic may be contingent on physical proximity and the nature of the social and experiential aspects of religious worship.
ABSTRACT
BACKGROUND: Descriptions of cutaneous findings associated with COVID-19 have not been consistently accompanied by histopathology or confirmatory testing for SARS-CoV-2. OBJECTIVE: To describe and classify the cutaneous findings with supporting histopathology of confirmed COVID-19 inpatients. METHODS: We included consecutive inpatients with a confirmed diagnosis of COVID-19 for whom a dermatology consult was requested. A skin biopsy was performed in all cases. Skin findings were classified as being compatible with a cutaneous manifestation of COVID-19 or as representing a distinct clinical entity. RESULTS: Twenty-eight patients were studied in whom thirty-one dermatologic diagnoses were made. Twenty-two of the dermatoses were compatible with a cutaneous manifestation of COVID-19; nine entities were not associated with infection by SARS-CoV-2. The most common COVID-19-associated pattern was an exanthematous presentation. In four patients, a new pattern was observed, characterized by discrete papules with varied histopathological findings including a case of neutrophilic eccrine hidradenitis. No cases of pernio-like lesions were identified. Skin findings not associated with COVID-19 represented 29% of diagnoses and included Malassezia folliculitis, tinea, miliaria and contact dermatitis. LIMITATIONS: There is no gold-standard test to distinguish between viral exanthems and drug reactions. CONCLUSION: A histopathological study is critical before attributing skin findings to a manifestation of COVID-19.