Associated effects of clinical characteristics, risk factors, and comorbidity on disease severity and mortality among patients with COVID-19 in Sulaimani City/ Kurdistan Region of Iraq.

The effects of clinical symptoms, laboratory indicators, and comorbidity status of SARS-CoV-2-infected patients on the severity of disease and the risk of death were investigated. Questionnaires and electronic medical records of 371 hospitalized COVID-19 patients were used for data collection (demographics, clinical manifestation, comorbidities, laboratory data). Association among categorical variables was determined using Kolmogorov-Smirnov test (P-value ≤0.05). Median age of study population (249 males, 122 females) was 65 years. Roc curves analysis found that age ≥64 years and age ≥67 years are significant cut-offs identifying patients with more severe disease and mortality at 30 days. CRP values at cut-off ≥80.7 and ≥95.8 significantly identify patients with more severe disease and mortality. Patients with more severe disease and risk of death were significantly identified with platelet value at the cut-off ≤160,000, hemoglobin value at the cut-off ≤11.7, D-Dimer values ≥1383 and ≥1270, and with values of neutrophil granulocytes (≥8.2 and ≤2) and lymphocytes (≤2 and ≤2.4). Detailed clinical investigation suggests granulocytes together with lymphopenia may be a potential indicator for diagnosis. Older age, several comorbidities (cancer, cardiovascular diseases, hypertension) and more laboratory abnormalities (CRP, D-Dimer, platelets, hemoglobin) were associated with development of more severity and mortality among COVID-19 patients.

Health related factors contributing to COVID-19 fatality rates in various communities across the world.

INTRODUCTION: Factors such as comorbidity, age and gender distribution are mostly related to hospitalization, numbers requiring intensive care and case fatality rate. In this review, the fatality rate of coronavirus disease 2019 (COVID-19) in different population health background according to comorbidity, age, gender distribution, and laboratory prognosis for COVID-19. METHODOLOGY: The current review was based on the data from copious studies that had homogeneity in relation to the review's objectives. It included the newest studies from December 2019 to September 2020. The epidemiological reasons for the high morbidity and mortality rates among COVID-19 patients were analyzed in different countries. RESULTS: The highest comorbidity prevalence of COVID-19 was recorded in the United States of America (USA) (93.9%) and Italy (68%). Among population health background factors, comorbidity was the most common cause of COVID-19 fatality in the USA. The mean age of the most COVID-19 fatalities was more than 60 years old. Most of the studies show that 60% of COVID-19 patients were male. The fatality rates for the age group of 80-89 years-old in Korea, China, and Italy were 8.7 %, 14.7 %, and 18.8 % respectively. Lymphocytopenia has been observed in 91% of COVID-19 death cases. C - reactive protein had increased in 40-60% of COVID-19 patients. CONCLUSIONS: Many factors contribute to COVID-19 severity and fatality rates. Comorbidity, age, and gender were the main reasons for the Case Fatality Rate. This review recommends to follow preventive measures for overcoming the challenges faced during this emerging pandemic disease.

Genetic Variation and Evolution of the 2019 Novel Coronavirus.

INTRODUCTION: SARS-CoV-2 is a new type of coronavirus causing a pandemic severe acute respiratory syndrome (SARS-2). Coronaviruses are very diverting genetically and mutate so often periodically. The natural selection of viral mutations may cause host infection selectivity and infectivity. METHODS: This study was aimed to indicate the diversity between human and animal coronaviruses through finding the rate of mutation in each of the spike, nucleocapsid, envelope, and membrane proteins. RESULTS: The mutation rate is abundant in all 4 structural proteins. The most number of statistically significant amino acid mutations were found in spike receptor-binding domain (RBD) which may be because it is responsible for a corresponding receptor binding in a broad range of hosts and host selectivity to infect. Among 17 previously known amino acids which are important for binding of spike to angiotensin-converting enzyme 2 (ACE2) receptor, all of them are conservative among human coronaviruses, but only 3 of them significantly are mutated in animal coronaviruses. A single amino acid aspartate-454, that causes dissociation of the RBD of the spike and ACE2, and F486 which gives the strength of binding with ACE2 remain intact in all coronaviruses. DISCUSSION/CONCLUSION: Observations of this study provided evidence of the genetic diversity and rapid evolution of SARS-CoV-2 as well as other human and animal coronaviruses.