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BackgroundLupus is a heterogenous diseases which results in significant premature mortality. Most studies have evaluated risk factors for lupus mortality using regression models which considers the phenotype in isolation. Identifying clusters of patients on the other hand may help overcome the limitations of such analyses.ObjectivesThe objectives of this study were to describe the causes of mortality and to analyze survival across clusters based on clinical phenotype and autoantibodies in patients of the Indian SLE Inception cohort for Research (INSPIRE)MethodsOut of all patients, enrolled in the INSPIRE database till March 3st 2022, those who had <10% missing variables in the clustering variables were included in the study. The cause of mortality and duration between the recruitment into the cohort and mortality was calculated. Agglomerative unsupervised hierarchical cluster analysis was performed using 25 variables that define SLE phenotype in clinical practice. The number of clusters were fixed using the elbow and silhouette methods. Survival rates were examined using Cox proportional hazards models: unadjusted, adjusted for age at disease onset, socio-economic status, steroid pulse, CYC, MMF usage and cluster of the patients.ResultsIndian patients with lupus have significant early mortality and the majority of deaths occurs outside the hospital setting.Out of 2211 patients in the cohort, 2072 were included into the analysis. The median (IQR) age of the patients was 26 (20-33) years and 91.7% were females. There were 288 (13.1%) patients with juvenile onset lupus. The median (range) duration of follow up of the patients was 37 (6-42) months. There were 170 deaths, with only 77 deaths occurring in a health care setting. Death within 6 months of enrollment occured in in 80 (47.1%) patients. Majority (n=87) succumbed to disease activity, 23 to infections, 24 to coexisting disease activity and infection and 21 to other causes. Pneumonia was the leading cause of death (n=24). Pneumococcal infection led to death in 11 patients and SARS-COV2 infection in 7 patients. The hierarchical clustering resulted in 4 clusters and the characteristics of these clusters are represented in a heatmap (Figure-1A,B). The mean (95% confidence interval [95% CI] survival was 39.17 (38.45-39.90), 39.52 (38.71-40.34), 37.73 (36.77-38.70) and 35.80 (34.10-37.49) months (p<0.001) in clusters 1, 2, 3 and 4, respectively with an HR (95% CI) of 2.34 (1.56, 3.49) for cluster 4 with cluster 1 as reference(Figure 1C). The adjusted model showed an HR (95%CI) for cluster 4 of 2.22 (1.48, 3.22) with an HR(95%CI) of 1.78 (1.29, 2.45) for low socioeconomic status as opposed to a high socioeconomic status (Table 1).ConclusionIndian patients with lupus have significant early mortality and the majority of deaths occurs outside the hospital setting. Disease activity as determined by the traditional activity measures may not be sufficient to understand the true magnitude of organ involvement resulting in mortality. Clinically relevant clusters can help clinicians identify those at high risk for mortality with greater accuracy.Table 1.Univariate and multivariate Cox regression models predicting mortalityUnivariateMultivariateVariablesHazard ratio (95% Confidence interval)P valueHazard ratio (95% Confidence interval)P valueCluster1Reference-Reference-20.87 (0.57, 1.34)0.5320.89 (0.57, 1.38)0.59831.22 (0.81, 1.84)0.3371.15 (0.76, 1.73)0.51342.34 (1.56, 3.49)<0.0012.22(1.48, 3.22)<0.001Socioeconomic statusLower1.78 (1.29, 2.45)<0.001Pulse steroidYes1.6 (0.99, 2.58)0.051MMFYes0.71 (0.48, 1.05)0.083CYCYes1.42 (0.99, 2.02)0.052Proliferative LNYes0.99 (0.62, 1.56)0.952Date of birth age0.99 (0.98, 1.01)0.657CYC- cyclophosphamide, MMF- Mycophenolate mofetilFigure 1.A. Agglomerative clustering dendrogram depicting the formation of four clusters. B.Heatmap depicting distribution of variables used in clustering C. Kaplan-Meier curve showing the survival function across the 4 clusters[Figure omitted. See PDF]REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone eclared.
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PurposeTo cater to the senior tourist market, it is essential to comprehend the factors motivating and deterring them from international travel post-COVID-19. This study aims to focus on senior citizens' destination choice intentions and aims to develop a model that prioritizes positive and negative factors leading to international travel destination choices. It uses push-pull factors, perceived travel risks (PTRs) and perceived travel constraints (PTCs). Design/methodology/approachDecision-making trial and evaluation laboratory (DEMATEL) and fuzzy technique for order of preference by similarity to ideal solution (Fuzzy TOPSIS) are two multi-criteria decision-making (MCDM) techniques used to identify connections between variables and determine their relative importance in the decision-making model. FindingsDEMATEL found push and pull factors are "effects" while PTCs and PTRs are "causes" affecting senior citizens' destination choices. Push factors and PTCs have a greater impact than pull factors and PTRs. Fuzzy TOPSIS highlighted "improving health and wellness" and "self-fulfillment and spirituality" as key push factors, "health safety and security quotient" as the most important pull factor, and "interpersonal constraints" as the most critical PTC. Finally, "health risks" is the top PTR. Originality/valueThis paper adds to the tourism literature by looking at the relationship between senior tourists' motivation, PTRs and PTCs and showing how the subfactors affect their choice of destination rank. The data analysis techniques used in this study are also novel, having never been used before in senior tourism research. Finally, even though there is a lot of research on senior tourism, not much is known about how Indian senior tourists act. In light of this study's findings, practical recommendations were offered to tourism stakeholders worldwide, interested in tapping into the market of Indian outbound senior tourists or repositioning product or destination offerings to take this promising market or similar markets into account.
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Background: Isolated tracheobronchial mucormycosis (ITBM) is an uncommonly reported entity. Herein, we report a case of ITBM following coronavirus disease 2019 (COVID-19) and perform a systematic review of the literature. Case description and systematic review: A 45-year-old gentleman with poorly controlled diabetes mellitus presented with cough, streaky haemoptysis, and hoarseness of voice 2 weeks after mild COVID-19 illness. Computed tomography and flexible bronchoscopy suggested the presence of a tracheal mass, which was spontaneously expectorated. Histopathological examination of the mass confirmed invasive ITBM. The patient had complete clinical and radiological resolution with glycaemic control, posaconazole, and inhaled amphotericin B (8 weeks). Our systematic review of the literature identified 25 additional cases of isolated airway invasive mucormycosis. The median age of the 26 subjects (58.3% men) was 46 years. Diabetes mellitus (79.2%) was the most common risk factor. Uncommon conditions such as anastomosis site mucormycosis (in two lung transplant recipients), post-viral illness (post-COVID-19 [n = 3], and influenza [n = 1]), and post-intubation mucormycosis (n = 1) were noted in a few. Three patients died before treatment initiation. Systemic antifungals were used in most patients (commonly amphotericin B). Inhalation (5/26;19.2%) or bronchoscopic instillation (1/26;3.8%) of amphotericin B and surgery (6/26;23.1%) were performed in some patients. The case-fatality rate was 50%, primarily attributed to massive haemoptysis. Conclusion: Isolated tracheobronchial mucormycosis is a rare disease. Bronchoscopy helps in early diagnosis. Management with antifungals and control of risk factors is required since surgery may not be feasible. © 2022 Wiley-VCH GmbH.
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Stress plays a critical role in information security policy (ISP) compliance behavior. Since there are multiple sources of stress, the current literature does not provide a consistent view of the association between stress and ISP compliance behavior. Understanding the significance of the association between stress and ISP compliance behavior is valuable for managers, especially in managing the tradeoff between stress and ISP compliance behavior among individuals. It is also important to understand why there has been so much inconsistency in past studies. Thus, we attempted a meta-analysis to provide a generalized interpretation of the association between stress and ISP non-compliance behavior. A systematic literature review and a meta-analysis are conducted to examine the underlying contradiction and aggregate the findings of relevant studies. The results of this meta-analysis confirmed a weak positive correlation between stress and ISP non-compliance behavior. Demographic characteristics like age, country, and the category of the respondents (employee vs non-employee) are significant predictors of the association between stress and ISP non-compliance behavior. The meta-analysis presented here is also pertinent to the recent COVID-19 pandemic, which forced organizations to engage with their employees in new working conditions, putting employees under more stress and strain. © 2022 Elsevier Ltd
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Background: Impaired generation of antibody responses define 'predominantly antibody immuno-deficiencies' (PAD) with reduced IgG and impaired vaccination responses. However, the antibody repertoire defects underpinning PAD are unknown. Here, we examine the antibody repertoire using mass spectrometry-based proteomics (MS-proteomics) in PAD and healthy controls (HC). Method(s): Following SARS-CoV-2 vaccination, anti -S1 ELISA, and live-virus neutralisation assays were assessed. Purified anti-S1 IgG and IgM was sequenced by MS-Proteomics to define immunoglobulin heavy chain variable region subfamily (IGHVsf) usage and somatic hypermutation (SHM). Result(s): 12 vaccine responsive PAD subjects were included, matched to 11 HC. Neutralisation and anti-S1 titres were reduced in PAD. Strikingly, all PAD subjects demonstrated restricted IgG IGHVsf utilisation, [median 3, (range 2-4), vs 6 (5-11) in HC, p<0.001], irrespective neutralisation or total antibody response. IgG SHM and IgM repertoire did not differ but IgG IGHV 3-7 utilisation was less frequent in PAD. Conclusion(s): MS proteomics uncovers stereotyped anti-S1 IgG IGHVsf restriction in PAD subjects following vaccination. Our results suggest that a relatively pauci-clonal antibody repertoire can produce a functional immune response, otherwise masked by traditional serology measures. Further studies to uncover the determinants of antibody repertoire breadth and elaborate on this novel approach to assessing serological responses are required. Copyright © 2022
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Aim: The COVID-19 global pandemic had resulted in a rise in a spike of Mucormycosis (black fungus) in COVID-19 individuals and diabetes is a standalone risk factor for both severe COVID-19 and black fungus, especially in India. We sought to find out how often CAM (Covid 19-associated Mucormycosis) was among both diabetes and non-diabetic individuals. Method(s): The data was gathered from Kaushik pathology Lab, Barara, Ambala, Haryana. The study includes 300 patients divided into 2 groups. Both the groups comprise of 150 patients each. Group 1 consist of patients with diabetes whereas group 2 comprise of non-diabetic patients. Prevalence of CAM was then noted in both the groups. Result(s): The study showed that in group 1, 74.4% cases were reported as CAM and 25.6% cases were identified as non-CAM whereas in group 2, only 38.4% CAM cases were reported in non-diabetic patients and majority of them (61.6%) were evaluated as non-CAM. A significant difference was also observed between the prevalence rate of both the groups (P < 0.05). Conclusion(s): A significant difference in the CAM cases of both the groups was observed. Interestingly diabetic patients were found to be more prevalent to be infected with CAM. Further, it was concluded that New-onset diabetes was the predominant risk factor for CAM in our study. COVID-19 being other important ones for Mucormycosis in COVID-19 patients. Copyright © 2022 Ubiquity Press. All rights reserved.
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The current article takes a tourism-focused perspective to evaluate the impact of COVID-19 on the attitude of the tourist to travel. For this, the present article conceptualizes, develops, and validates the multidimensional scale on preventive measures of COVID-19. Further, we have developed a new model named Financial Crisis from Contagious Disease (FCCD) stimulator to assess the impact of the virus on the short-term performance of the global tourism industry. The study was exploratory, where initial items were generated through the qualitative method. The purification of the scale items and extraction of the distinct factors were performed through a quantitative approach (exploratory factor analysis). Further, confirmatory factor analysis was used to validate the scale. The findings of the study manifested a multidimensional scale measuring the preventive measures of COVID-19 in the tourism context. The research renders a 25-item scale with four distinct factors named Isolation (7 items), Quarantine (7 items), Social Distancing (6 items), and Community Containment (5 items). The present scale will add to the literature of COVID-19 in the context of the tourism industry. The authors assume that this will be the first comprehensive scale, prepared on the guidelines of the World Health Organization (WHO), that will measure the effect of preventive measures of COVID-19 on the attitude of the tourist to travel during a pandemic situation © 2022 Cognizant, LLC.
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In spite of the advancements in the health department, coronavirus has proved to be an invisible enemy for which the world was not ready. The virus has primarily spread through contact and respiratory droplets. Hand-sanitizing and wearing a mask are the most common ways to avoid the transmission of the infection and prevent people from becoming infected. At public places such as general stores or banks, there is an urgent requirement of a device that can perform these tasks accurately and without human interference. This smart hand sanitizer dispenser automates the job done by the appointed person without human interference. It dispenses the sanitizer and checks the body temperature automatically. This is achieved using an ultrasonic sensor and MLX90614 temperature sensor, respectively. All the sensors and actuators are connected to a microcontroller that acts as the brain of the device. Furthermore, it also detects whether the customer (human) is wearing a mask or not. If the customer is not wearing a mask, he/she will not be allowed inside the shop, or the gates to the shop will not open. OpenCV is used to detect the face in real time, and then, the classification is done using a convolutional neural network. Finally, all the data is stored on the cloud simultaneously for further analysis. © 2022 selection and editorial matter, O.V. Gnana Swathika, K. Karthikeyan and Sanjeevikumar Padmanaban;individual chapters, the contributors
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The COVID-19 outbreak and the subsequent lockdown have had a negative impact on agriculture and other allied activity i.e. food, livestock, dairy etc. The most important and essential aspect of a unsustainable turn of events due to COVID-19 is dairy sector. When it comes to supplying products to clients, dairy suppliers are facing a difficult situation. These disruptions have a sudden impact on the dairy supply chain system and the process can collapse if necessary and immediate actions are not taken. The pandemic and its associated lockdown have not only made it difficult for a large number of poor and marginal dairy farmers but have also had an impact on the livestock feed industry, dairy industry, and related supply value chains of the dairy sector. This review article features different elements of the effects, specifically decreased popularity of various products, wastage of products, supply market chains, work absenteeism due to shortage of labor, and recovery strategy taken by the authorities to recover livestock and dairy sector. This review article provides a comprehensive view of the overall situation, a methodical report gathering critical data across the country and the impact on every sub-area of the dairy sector and associated value supply chains.
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Background: Patients (pts) with indolent lymphomas are at increased risk of severe COVID-19 infection. We have shown limited seroconversion and live viral neutralisation (VN), but preserved COVID-specific T cell responses after 2 doses of mRNA COVID-19 vaccination in such pts. (Beaton, B ASH 2021, 149348). A 3rd vaccine dose to complete primary vaccination has since been recommended. Aims: To assess humoral & cellular immune responses to a 3rd COVID-19 (mRNA) vaccination in pts with follicular lymphoma (FL) & Waldenström Macroglobulinemia (WM), including assessment of response after pausing BTKi therapy in WM pts. Methods: Patients with WM, FL & healthy controls (HC) were enrolled in a prospective observational study to measure immune responses 21-28 days after a 3rd mRNA COVID-19 vaccine. Immune response was measured by mean fluorescence intensity (MFI) of anti-SARS-CoV-2 spike antibodies (ASAb) obtained using a high-sensitivity live cell assay, live VN to a panel of SARS-CoV-2 variants of concern, and CD4+ & CD8+ antigen-specific T cell responses. The associated TRIBECA (TReatment Interruption of BTKi to Enhance COVID-19 Antibody response) study sought to determine if a superior immune response could be gained by pause of BTKi therapy prior to and up to 4 weeks after 3rd vaccine dose. Patients were closely monitored during the BTKi pause with weekly clinical, full blood count and IgM assessments. WM pts receiving a 3rd dose while continuing on BTKi served as a control. Statistical analysis of medians between cohorts were compared by the non-parametric Mann-Whitney (Graphpad Prism). Comparison of medians between paired grouped data was assessed by 2-way ANOVA. Results: To date, 56 of 125 pts had their ASAb measured following 3rd vaccine dose administered between October 2021 and January 2022: 28 WM pts (including 6/9 WM pts on the BTKi pause sub-study), 24 FL pts and 4 HC. Median age was 68 years with 21 females and 35 males. Median follow up from 2nd dose was 140 days (range: 79- 170 days). In antibody responders, median MFI fell from 163042 (IQR 82663-249934) 28 days post 2nd dose to 52117 (IQR 19942-60973) (p<0.0001) immediately before the 3rd dose. Median MFI in all FL & WM pts pre- 3rd dose vaccine was 17111 (IQR 0-52650), rising significantly post 3rd dose to a median of 86730 (IQR 0-221937). Only 4/20 pts without measurable ASAb prior to the 3rd dose (2 WM, 2 FL) developed measurable ASAb following the 3rd dose: 16/20 patients (8 WM, 8FL, all treated) had no ASAb response. The median MFI in pts who underwent a BTKi treatment pause rose from 9151 (IQR 1671-21232) pre-3rd dose to 87720 (IQR 2785-152195) post 3rd dose, significantly higher than the median MFI in WM pts who did not pause their BTKi , which rose from 16769 (IQR 218-22447) pre- to 20252 (IQR 168-114262) post 3rd dose, (p = 0.016). Of the 5/125 with COVID infection in the study to date, only one patient (without measurable ASAb) in this 3-dose cohort had COVID, requiring intensive care support. Summary/Conclusion: Most WM & FL pts who responded to a 2nd dose COVID vaccine showed a decline in ASAb titre over time which increased following a 3rd mRNA vaccine. Only 20% of pts without detectable ASAb pre- 3rd dose showed improvement post 3rd dose, highlighting the importance of other COVID protection strategies in these pts. Although initial numbers are small, there may be a higher increment in ASAb when BTKi therapy is paused around the time of vaccination. Comprehensive immune analysis, including VN and T-cell response on the entire FL & WM cohort will be presented at the EHA congress.
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Background: Denosumab (Dmab), a fully human monoclonal antibody that inhibits receptor activator of nuclear factor kappa-β ligand (RANKL), which selectively inhibits osteoclastogenesis can be used for a long period unlike the relatively short period with Teriparatide.1-2 However the effects of Dmab can quickly regress if the treatment is delayed.3 Objectives: The pandemic led to multiple prolonged lockdowns since March 2020 to Jan 2022 in India. This resulted in follow up Dmab treatment delays. The retrospective study was aimed to look for the effect of the delays. Methods: The bone mineral density (BMD) trends from the central dual-energy X-ray absorptiometry (DXA) at our centre were studied. The trends of patients under Dmab for one year and delay in follow up for 10-12 months for the forth dose were evaluated. 21 postmenopausal women who had been under treatment with Dmab 60 mg subcutaneous injection at 6 monthly interval for one year followed up with such delays. 6 were excluded because of history of sars-cov-2 infection and glucocorticoid use. In the study group of 15 (n=15), the mean BMD at L2, L3 & L4 (sp BMD) and Right and Left Hip (hip BMD) were studied from before treatment (a BMD), 6 months after 1st and at the time of 2nd injection (b BMD), 6 months of the 2nd and at the time of 3 rd injection of Dmab (c BMD), and that due to delay in follow up of 10-12 months (d BMD). The mean percentage trend change between a-b, b-c, and c-d BMDs was evaluated. The least signifcant change (LSC) 4 from a single centre DXA was used to validate the fndings. Results: The mean percentage change after the treatment for the 1st 6 months of Dmab (a-b BMD) was 4.08% and 3.60% and the second injection resulted in a further change (b-c BMD) of 5.98% and 4.52% in the sp BMD & hip BMD respectively. The delay in follow up of 10-12 months resulted in a change (c-d BMD) of-7.81% in the sp BMD and-2.96% in the hip BMD. The LSC from a single centre DXA is 2.6% and 3.6% for sp BMD and hip BMD respectively. A p>0.05 was considered statistically signifcant. Table 1 shows the BMD changes. Conclusion: These fndings suggest that regressive trend in BMD are seen when the treatment with Dmab is delayed even as early as 10 to 12 months. It was seen much faster in the spine compared to the hip. It is therefore advised that short term treatment with Dmab without follow up could lead to loss of all gains and may also worsen the osteoporosis.
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BACKGROUND: Isolated tracheobronchial mucormycosis (ITBM) is an uncommonly reported entity. Herein, we report a case of ITBM following coronavirus disease 2019 (COVID-19) and perform a systematic review of the literature. CASE DESCRIPTION AND SYSTEMATIC REVIEW: A 45-year-old gentleman with poorly controlled diabetes mellitus presented with cough, streaky hemoptysis, and hoarseness of voice two weeks after mild COVID-19 illness. Computed tomography and flexible bronchoscopy suggested the presence of a tracheal mass, which was spontaneously expectorated. Histopathological examination of the mass confirmed invasive ITBM. The patient had complete clinical and radiological resolution with glycemic control, posaconazole, and inhaled amphotericin B (eight weeks). Our systematic review of the literature identified 25 additional cases of isolated airway invasive mucormycosis. The median age of the 26 subjects (58.3% men) was 46 years. Diabetes mellitus (79.2%) was the most common risk factor. Uncommon conditions such as anastomosis site mucormycosis (in 2 lung transplant recipients), post-viral illness (post-COVID-19 [n=3], and influenza [n=1]), and post-intubation mucormycosis (n=1) were noted in a few. Three patients died before treatment initiation. Systemic antifungals were used in most patients (commonly amphotericin B). Inhalation (5/26;19.2%) or bronchoscopic instillation (1/26;3.8%) of amphotericin B and surgery (6/26;23.1%) were performed in some patients. The case-fatality rate was 50%, primarily attributed to massive hemoptysis. CONCLUSION: Isolated tracheobronchial mucormycosis is a rare disease. Bronchoscopy helps in early diagnosis. Management with antifungals and control of risk factors is required since surgery may not be feasible.
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COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the disease mainly affects the lungs. A rare complication reported in these patients has been pneumothorax, whether spontaneous or iatrogenic in ventilated patients. Sudden desaturation or acute deterioration in clinical conditions should immediately raise a suspicion of pneumothorax, and the clinicians must take appropriate measures without any delay. We present a series of 7 cases of COVID-19 admitted to our ICU who developed primary spontaneous pneumothorax. All these patients were on non-invasive ventilation (NIV). They did not have any history of underlying lung disease before the existing ailment, and all of them were non-smokers.
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Indian m-health app Aarogya Setu has made a significant contribution in terms of contactability tracing and disease management during the initial days of the COVID-19 pandemic, with its contact tracking approach to infectious individuals and its health tips for eliminating new coronaviruses. The goal of this study is to forecast whether or not Indian consumers will continue to use this app. According to previous studies, the context or setting has a substantial impact on the customer's perceived value. The current study's unique setting is to investigate the parameters impacting Indians' ongoing use of the mobile mHealth app AarogyaSetu. An extended technology adoption model (TAM) has been proposed and tested to achieve this wide goal, with the addition of three additional constructs: social influence, health consciousness, and trust in the app developer. © 2021 IEEE.
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Mucormycosis is an aggressive invasive fungal infection caused by mycocetes fungi. It is an opportunistic infection, associated with high morbidity and mortality. In the current era of COVID-19 pandemic, the entire world has witnessed a dramatic upsurge in cases of Mucormycosis. Paranasal sinuses are the commonest site to be affected with the tendency for rapid spread to orbit, face, and brain. Early diagnosis and prompt medical or surgical intervention are the only ways for preventing morbidity and saving precious lives. Imaging plays a crucial role not only in diagnosis but also in defining the extent of the disease for presurgical mapping. Black turbinate sign in the nasal cavity, mucosal thickening in paranasal sinuses with periantral invasion, and bony erosion are the early diagnostic signs. This pictorial review shall provide a comprehensive review of the various imaging manifestations of rhino-orbito-cerebral mucormycosis with a final proposed reporting checklist.
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The proportion of coronavirus disease 2019 (COVID-19) patients having a chronic respiratory disease (CRD), and its impact on COVID-19 related patient outcomes, is unclear. We conducted this systematic review to evaluate the proportion of patients with asthma or chronic obstructive pulmonary disease (COPD) among COVID-19 patients, and to assess if comorbid CRD worsens COVID-19 outcomes, in developing countries. We queried PubMed database for studies conducted in developing countries and provided data on the proportion of COVID-19 patients with CRD, or severe disease or mortality among COVID-19 patients with and without CRD. We calculated proportion of CRD patients and relative risk (RR) for each reported outcome of interest. We used random-effects models to summarize our data. We retrieved 1947 citations and included 22 studies from developing countries in our review. The pooled estimate for proportion of asthma and COPD was 2.32% (95% confidence interval [CI] 1.86%-2.83%) and 3.52% (95% CI 2.14%-5.20%), respectively. COVID-19 patients with asthma had a higher risk of severe COVID-19 (summary RR 1.21, 95% CI 1.17-1.25), but not of mortality (summary RR 1.01, 95% CI 0.80-1.28), as compared to COVID-19 patients without asthma. COVID-19 patients with COPD had a higher risk of severe COVID-19 (summary RR 1.48, 95% CI 1.30-1.69) and mortality (summary RR 2.69, 95% CI 1.57-4.61), as compared to COVID-19 patients without COPD. Patients with asthma (but not COPD) in developing countries may be less likely to acquire COVID-19. Both diseases may increase the risk of severe COVID-19, and COPD may increase risk of COVID-19-related mortality.