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Objective: COVID-19 caused a deleterious impact on the health care system globally.The roll out of vaccines seems to be the only effective way to curtail the spread of disease.The purpose of this study is to assess the dermatological adverse effect of post COVID-19vaccination on a gender basis. Methodology: This was an observational,cross-sectional,questionnaire-based survey conducted in Pakistan.The sample comprises 518 participants. The questionnaire was self-designed. The trial lasted six months, from August 1, 2022, until January 31, 2023. We used a non-probability sampling technique.Dermatological adverse effects like burning pain, redness, rashes, and lymphadenopathy at the injection site were recorded.Fever was also noted. All the participants have received booster shots or double doses of any one of CCOVID-19 vaccines, such as AstraZeneca, Pfizer, Sinovac, Sinopharm,Pakvac, etc. A p-value of less than 0.05 was considered statistically significant.Qualitative data was reported as frequency and percentage, and quantitativedata was reported as standard deviation and mean. Result(s): The study included 518 subjects, of whom 262 were males and 256 were females. The mean age of male is 42.70+/-14.05 years and female is 39.04+/-14.6years with a significant difference observed between them (p=0.004). The most common complaint among dermatological adverse effects after first was pain. 106(40.5%) male and 132(51.6%) female reported painwith a significant difference observed between them (p=0.011) followed by swelling which was reported by 92(35.1%) males and 120(46.9%) females with a significant difference observed between them (p=0.006).Burning was reported in 92(35.1%) male and 148(57.8%) female with a significant difference observed between them(p<0.001). Fever was also quite commonly reported in both male 116(44.3%) and female 178(69.5%) with significantdifference observed between them (p<0.001),Likewise post 2nd dose of vaccination, pain was most commonly noted in 90(34.4%) male and female 124(48.4%) female with significant difference observed between them (p=0.001). Moreover, burning was reported by 80(30.5%) malesand 132(51.6%) females with a significant difference observed between them (p<0.001). rashes were reported by76(29.0%) males and 100(39.1%) females with a significant difference observed between them (p=0.016), lymphadenopathy was also significantly associated with genders, (p<0.001). Conclusion(s): This study concluded that the burning pain,redness,rashes,and lymphadenopathywere the most prevalent side effects in male and female post 1st and 2ndCOVID-19 vaccination.Furthermore fever was also reported in majority of subjects.In addition to this higher percentage of side effects were recorded in females as comparedto males.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.
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The emergence of COVID-19 pandemic has forced many countries implement social restrictions, including Indonesia. There has been a growing interest in understanding the impact of the pandemic on air quality. This research analyses the air pollution before and after the COVID-19 pandemic in Jakarta and Banjarmasin, Indonesia, with a detailed analysis. It compared the results with previous years to determine the significant improvement in air quality and related weather factors obtained from Landsat 8 and 9 imagery. OMI and MERRA-2 were analysed for PM2.5, NO2, SO2, O3 and WRF-Chem model result especially for PM2.5 against the COVID-19 pandemic. As a result, there was a decrease in PM2.5 during the pandemic year in Jakarta, although it was not as good as in 2016 conditions. In Jakarta and Banjarmasin, PM2.5, NO2 and SO2 decreased in 2021 from 2020, which were in line with the high incidence of COVID-19 in 2021. This shows that more air quality increased in the form of healthy days in DKI Jakarta in 2020 than in 2019. In other words, there was an increase in air quality during the implementation Large-Scale Social Restriction (PSBB) policy in 2020 compared to 2019 before the COVID-19 pandemic. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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The COVID-19 pandemic took the world by storm, and although it has taken the world's attention, it did not stop the spread of other communicable diseases. Seasonal influenza is a viral infection that could cause severe disease; therefore, annual influenza vaccination is highly recommended, especially among patients with a weakened immune system. However, such vaccination is contraindicated for people with hypersensitivity to the vaccine or any of its components, e.g., eggs. This paper describes a case of an egg-allergic individual who received an influenza vaccine containing egg protein, which only caused mild tenderness at the site of injection. Two weeks later, the subject received a double vaccination of a second booster dose of Pfizer-BioNTech and the seasonal influenza vaccine. The patient reported no local or systemic adverse reactions to the vaccine. This case report suggests vaccination safety for subjects with mild allergies to vaccine components.
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BACKGROUND: For the immune system to protect the body from infectious diseases such as COVID-19, it needs the ideal amount of vital trace elements. Trace element levels, especially, zinc (Zn), copper (Cu), magnesium (Mg), manganese (Mn), chromium (Cr), and iron (Fe) levels, may affect how sensitive an individual is to COVID-19 and other viruses. The current study evaluated the level of those trace elements during stays in the isolation center and investigated their association with vulnerability to COVID-19. METHODS: A total of 120 individuals, 49 males and 71 females aged between 20 and 60 years, were included in this study. Forty individuals infected with COVID-19, 40 individuals who had recovered from it, and 40 healthy individuals, were all evaluated and studied. By using a flame atomic absorption spectrophotometer, levels of Zn, Cu, and Mg were assessed for all samples, whereas levels of Mn, and Cr were determined by a flameless atomic absorption spectrophotometer. RESULTS: The infected individuals had significantly lower levels of Zn, Mg, Mn, Cr, and Fe than recovered individuals and healthy control individuals (P < 0.0001). On the other hand, the total number of infected patients was found to have much higher levels of Cu than those in the recovered group and the control group. For the recovered and healthy control groups, no significant differences were observed in the levels of trace elements (P > 0.05), except for Zn (P < 0.01). Also, the findings indicated no association of trace elements with age and BMI (P > 0.05). CONCLUSION: These results show that an imbalance in the levels of essential trace elements could be associated with increasing the risk of COVID-19 infection. However, additional thorough research of greater scope is required considering the severity of the infection.
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Ingredients for leadership development include strategic intent, sensibility, knowledge, analytic acuity, and the confidence to make tough calls. Emergencies highlight the importance of technical progress and the opportunity to enhance design and productivity. Significant technological and organisational barriers hinder acceptance of these technologies;hence it is necessary to employ strategy. Research should be at the system's heart through planned and unplanned transitions. The vision of building and maintaining business resilience and organising swift changes includes using perceptual methods. With this view, leaders can make deliberate decisions. It also tends to disrupt traditional approaches to dexterity. At the same time, strategic flexibility necessitates an evident connection between the business and the institution's mission. A leader's positive strategic intent is core that better enables investment in crisis response competencies. It includes timely use of knowledge management, organisational learning frameworks, business strategy, and system agility. Many nations in the developing world have simultaneously experienced the rise of digitisation and the spread of the covid-19 epidemic. Thus, academics should focus on the difficulties and prospects associated with people, groups, and management.
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Background: Blood cancer is the most common type of cancer and the leading cause of death by disease past infancy among children. Children with blood cancer are vulnerable population to viral infections such as coronavirus disease 2019 (COVID-19). Objectives: To estimate the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in blood cancer children and analyse the demographic parameters, clinical characteristics and treatment outcomes in blood cancer children with COVID-19 illness. Methods: For this systematic review, we searched ProQuest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus and Nature through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guideline for studies on the development of COVID-19 in children with blood cancer, published from December 1, 2019 to April 30, 2023, with English language restriction. Results: Of the 3077 papers that were identified, 155 articles were included in the systematic review (83 case report, 54 cohort and 18 case-series studies). Studies involving 1289 blood cancer children with confirmed COVID-19 were analysed. Leukaemias (1141 cases) were the most frequent types of blood cancer observed in children who developed COVID-19, followed by non-Hodgkin’s lymphomas (59 cases), Hodgkin’s lymphomas (36 cases), Langerhans cell histiocytosis (7 cases), myelodysplastic syndrome (7 cases) and myeloid neoplasm (1 case). Among all 1289 blood cancer paediatric cases who transmitted SARS-CoV-2, some children were documented to be admitted to the intensive care unit (ICU) (n = 175, 13.6%), intubated and placed on mechanical ventilation (n = 111, 8.6%), suffered acute respiratory distress syndrome (n = 144, 11.2%) or died (n = 111, 8.6%). Overall, COVID-19 in children with different types of blood cancer resulted in no or low severity of disease in more than 78.6% of all included cases (COVID-19 severity: asymptomatic = 239, mild = 603, or moderate = 171). Treatment for COVID-19 was not necessary in a high number of blood cancer children (n = 94, 7.3%). Fatality in blood cancer children with COVID-19 was reported in any of the included blood cancer categories for leukaemias (n = 99, 8.7%), non-Hodgkin’s lymphomas (n = 7, 11.9%), Hodgkin’s lymphomas (n = 2, 5.5%), myelodysplastic syndrome (n = 1, 14.3%) or myeloid neoplasm (n = 1, 100%). Fatality rate in blood cancer children infected with SARS-CoV-2 was the highest in patients with Hispanic ethnicity (n = 44/111, 39.6%) and COVID-19–related fatality was highest in male patients (76.5% of deceased patients). Most studies reported to alter the intensity and regimen of anticancer treatment in blood cancer children during course of SARS-CoV-2 infection, however, many studies have reported to successfully treat COVID-19 without any changes to the anticancer treatment. Conclusion: Globally, leukaemias were the most prevalent and myeloid neoplasms were the least prevalent blood cancer types in children who developed SARS-CoV-2 infection. Children with blood cancer tend to have milder COVID-19 symptoms and are less likely to be hospitalized and have better prognosis when compared to adults. Continuation of anticancer treatment in individual paediatric blood cancer patients with COVID-19 seems to be possible.
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Myelodysplastic Syndromes , Leukemia , Respiratory Distress Syndrome , Lymphoma , Severe Acute Respiratory Syndrome , Lymphoma, Non-Hodgkin , Neoplasms , Death , Hodgkin Disease , COVID-19ABSTRACT
Introduction: During the first wave of COVID-19, weekly departmental teaching was cancelled in our respiratory ward. Methods & Results: We requested feedback from all respirtory trainees (N: 11). On average, they rated their knowledge of respiratory medicine as 5.18 out of 10. 30% of trainees said departmental learning opportunities were 'unsatisfactory,' while 70% said they 'needed improvement'. The idea of resuming teaching was discussed with consultants, ward nurses and matron. We agreed to use the ward conference room for teaching sessions, with an option to join remotely. We successfully conducted weekly teaching sessions for 4 months during the second wave of COVID-19. The social distancing rule was strictly followed during sessions. This platform was used for topic discussions, case presentations and journal club. At these sessions, all junior doctors, respiratory nurses and physiotherapists had the opportunity to present. Another formal feedback was requested. In comparison to initial response, participants scored an average of 8.27 out of 10 on their knowledge of respiratory medicine. 60% of respondents rated departmental learning opportunities as excellent (Figure 1). Conclusion(s): We must not overlook the disruption in medical education and its long-term consequences. A mixture of some careful face-to-face and e-learning activities is the best way going forward.
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BACKGROUND: Since pregnancy increases the risk of coronavirus disease 2019 (COVID-19) and its morbidity in pregnant women, it is necessary and recommended to prevent COVID-19 in pregnant women by vaccination such as by messenger RNA (mRNA) and inactivated vaccines. SARS-CoV-2 antibodies produced from vaccination have different results according to the type of vaccine given. The previous studies showed that IgG SARS-CoV-2 antibody levels were influenced by various factors such as gestational weeks at the time when vaccines were given. Moreover, there have been no previous studies on the effect of gestational age on quantitative IgG levels after the second dose of the vaccine especially in Indonesia during this pandemic due to some restrictions on daily activities. AIM: The aim of this study is to see the effect of giving the COVID-19 vaccine based on maternal gestational age (in trimester units) on maternal immunity (IgG SARS-CoV-2) in Dr. Hasan Sadikin General Hospital Bandung, Bandung Kiwari Hospital and Dr. Slamet Hospital, Garut. METHOD(S): This was a retrospective and cohort study by taking secondary data using consecutive sampling from the previous tests on the levels of SARS-CoV-2 IgG antibodies after two doses of inactivated vaccine and mRNA. Healthy pregnant women 14-34 weeks at the Department of Obstetrics and Gynecology, Dr. Hasan Sadikin (RSHS) Bandung, Bandung Kiwari Hospital, and Dr. Slamet Hospital for the period October 2021 to January 2022 were the target population of this study. Based on inclusion and exclusion criteria, 103 samples met the criteria. Examination of Maternal SARS-CoV-2 IgG Antibody Levels procedures was carried out using Chemiluminescent Microparticle Immunoassay. Statistical analysis was done using IBM SPSS 28.00 and p < 0.05 was considered statistically significant. RESULT(S): There was no significant difference (p = 0.236, p > 0.05) between the mean maternal age in the mRNA and inactivated vaccine groups. The mRNA and inactivated vaccine groups also had no significant difference in the gestational age category (0.70). There was a significant difference (p = 0.0001) between the levels of SARS-CoV-2 IgG antibodies after the vaccine in the mRNA and inactivated vaccine groups. There was no significant difference in the levels of SARS-CoV-2 IgG antibodies in the gestational age group after the mRNA vaccine (p = 0.426) and after the inactivated vaccine (p = 0.293). There was a significant difference (p < 0.05) in the subgroup analysis in each gestational age group (second trimester and third trimester) between SARS-CoV-2 IgG antibody levels after the mRNA vaccine compared to inactivated vaccine. DISCUSSIONS: The mRNA vaccine is based on the principle that mRNA is an intermediate messenger to be translated to an antigen after delivery to the host cell via various routes. However, inactivated vaccines contain viruses whose genetic material has been destroyed by heat, chemicals, or radiation, so they cannot infect cells and replicate but can still trigger an immune response. The administration of the vaccine in the second and third trimesters of pregnancy has the same results in increasing levels of SARS-CoV-2 IgG antibodies after mRNA and inactivated vaccination in this study. CONCLUSION(S): mRNA vaccination in pregnant women is better than inactivated vaccines based on the levels of IgG SARS-CoV-2 antibodies after vaccination. The maternal trimester of pregnancy was not a factor influencing the levels of SARS-CoV-2 IgG antibodies after either mRNA or inactivated COVID-19 vaccinations in this study.Copyright © 2023 Anita Deborah Anwar, Putri Nadhira Adinda Adriansyah, Ivan Christian Channel, Annisa Dewi Nugrahani, Febriani Febriani, Asep Surachman, Dhanny Primantara Johari Santoso, Akhmad Yogi Pramatirta, Budi Handono.
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Purpose: This study investigates the determinants of teleworking before and during COVID-19 in Canada. It explores the extent of telework adoption across industrial sectors, as well as the long-term impacts of large-scale adoption of teleworking on urban travel demand and the dwindling demand for commercial real estate in downtowns. Design/methodology/approach: Using data from a survey of business establishments, this study employs data visualization techniques to illustrate how telework adoption evolved during the early stages of the COVID-19 lockdown. The study also estimates Logit models to explore the determinants of telework before and during the pandemic using a subsample from the Canadian labor force survey. Findings: The study found that telework adoption reached a peak in March and April of 2020 when almost 40% of the workers in Canada were teleworking. Only 12% of employees reported teleworking before the pandemic. The adoption of teleworking was far more pronounced amongst firms that use information and communication technologies (ICTs) extensively. Teleworking appears to be far more frequent among university-educated (knowledge economy) workers. Practical implications: Knowledge economy and highly educated workers, who switched to teleworking during the pandemic at higher rates than workers with less education, are more frequently employed in offices located in the urban core or downtowns. The drastic decline in commuting to the urban core via public transit and record low occupancy levels in downtown office towers suggests that, even if telework prevailed at levels much lower than those observed during March and April of 2020, landlords holding large portfolios of commercial real estate must prepare to cope with the lower demand for commercial real estate. This is especially significant when commercial leases come up for renewal in the next few years. In addition, governments struggling to address traffic congestion by spending hundreds of billions of dollars on transport and transit infrastructure might want to promote teleworking as a means of reducing travel demands and costly infrastructure expenditures. Social implications: Teleworking has partially eroded the boundaries between work and home by enabling millions to continue being productive while working from home. However, teleworking would require new norms and rules to maintain a work-life balance. This change requires workers and employers to cooperate. Originality/value: To the best of the authors' knowledge, this is the first study that explores the extent of telework adoption during COVID-19 in Canada and the determinants of telework adoption, presenting both employee and firm-level perspectives using Canada-wide representative data. © 2021, Emerald Publishing Limited.
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Simultaneously with the development of the COVID-19 vaccination plan for minors, it is critical to understand the reasons related to parental COVID-19 vaccination hesitancy. This study aims to determine the reasons associated with vaccination hesitancy among parents, and the prevalence and the characteristics of the parents who are hesitant to allow their children aged between 5 to 11 years old to be administered the COVID-19 vaccines. A web-based questionnaire was used to perform this study between May 2022 to September 2022 in Saudi Arabia (SA). Several factors, personal and social, affected the participants' willingness to vaccinate their children with the COVID-19 vaccines. The age of the parents was found to have a significant impact on their decision to vaccinate their children. Those between the age of 40-49 years of age were the most willing to vaccinate (almost 41%) compared to those 50 years or older who were most resistant to vaccination. Female participants were more resistant to vaccinating their children compared to their male counterparts. Saudis were more resistant to vaccinating their children compared to the non-Saudi participants. Those private sector-employed parents were the most willing to vaccinate (16.6%), followed by those working in the governmental sector (13.8%). About 40.7% of non-healthcare workers were resistant to vaccinating their minor compared to healthcare workers (8.7%). In conclusion, the study presents several factors that affect the parental willingness to vaccinate their children in SA. These factors should be properly addressed when developing public health strategies to promote the COVID-19 vaccination of children in SA.
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COVID-19 , Urogenital Abnormalities , Humans , Child , Female , Male , Adult , Middle Aged , Child, Preschool , Saudi Arabia , COVID-19 Vaccines/therapeutic use , Vaccination Hesitancy , COVID-19/prevention & control , Government , VaccinationABSTRACT
Background Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, efforts have been in place to tackle the infection. Mass vaccination programs were regarded as the sole solution to end the pandemic. Here, we compare the differential impact of mass vaccination programs in Saudi Arabia (SA) and the United Kingdom (UK) on COVID-19 morbidity and mortality to determine whether vaccines were solely responsible for the changes observed in the disease dynamics. Methodology We retrospectively collected the number of new cases and deaths throughout 2021 in both SA and the UK. Similarly, the number of vaccine doses delivered in both countries was collected and compared. Results Through 2021, the percentage of daily COVID-19 cases was significantly less in SA than in the UK; however, the percentage of deaths was higher in SA. Interestingly, the percentage of daily cases was significantly reduced in SA upon vaccination. The vaccination coverage of both the first and second doses was higher in the UK compared to SA, and, consequently, the percentage of deaths was significantly reduced in the UK compared to SA. Conclusions The UK vaccination program succeeded in curbing the number of daily deaths compared to SA. SA had better control over the percentage of daily cases, primarily due to the restrictive measures and vaccination, such as the imposed social distancing and mandatory face masks.
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COVID-19 coronavirus disease is the latest virus in the new century. The World Health Organization- WHO organization announced that COVID-19 disease is a pandemic that leads to thousands of death in short time of spam. A quick and accurate diagnosis of COVID-19 shows an important role in its prevention. This study is based on a fusion-based Self-Diagnosis Expert System Empowered by the Leven-berg Marquardt Algorithm for the diagnosis of diseases. Leven-berg Marquardt has been implemented for the classification of different symptoms of the diseases and relates the results for their diagnosis. The MatLab software was used for the simulation purpose. The proposed fusion-based LB increased the accuracy in the training and validation process to be 10 times more efficient than the existing. The fusion technique achieved an overall accuracy of 98.86%, and 99.09% in all performance metrics which included TNR, precision, and FPR statistical parameters. © 2022 IEEE.
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Objective: To investigate the policy barriers leading to hindrance in mass immunization of Covid-19 in Pakistan. Study design: A cross-sectional qualitative study was Duration of study: study was conducted from October 2021 to April 2022 Place of study: was conducted on 106 individuals at 4 vaccination centers of Lahore, including Expo center, Pakistan Kidney and Liver Institute and research center (PKLI), Lahore Developmental Authority (LDA) sports complex, Railway dispensary Model Town. Methodology: It covered interviews, focus group discussions and filling in of semi- structured questionnaires from the general public visiting the vaccination center. Individual interviews of hospital administrators and focused group interviews of general public visiting various hospitals of Lahore, including Jinnah Hospital, Services hospital, Lady Wallington hospital and University of Lahore Teaching Hospital were also included in this study. The data obtained was transcribed and analyzed by using SPSS software version 21. The theme we chose was Politically Informed Views and the subthemes were common hurdles, common myths, different vaccine brands, lack of awareness and conspiracy theories. Result(s): The results were significant (p<0.05) with the levels of different variables as: Common hurdles 41%;Common myth 25%;Religious Aspects 17%;Different brands 7% ;Lack of awareness 10% respectively. Each variable showed a remarkable difference from considered standard SOPs. Conclusion(s): To increase the vaccination drive, proper implementation of the already established government policies, with better surveillance and monitoring of the vaccine centers is required. Awareness among the general population should also be increased to debunk myths and motivate them. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.
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Introduction: Covid-19 is a complex respiratory infectious disease that is impacting all sectors and industries. This pandemic is known to create a chaos among the healthcare sector and affecting psychological burden of healthcare professional. Less is known about the negative psychological influence of Covid-19 on the healthcare professionals, working in Pakistani hospitals. This study reported the prevalence of psychological trauma among healthcare professionals during Covid-19 pandemic. Material(s) and Method(s): The study adopted a cross-sectional study design and collected a quantitative sample of 195 healthcare professionals, who are working on front and second line. These professionals include;doctors, nurses, and other hospital staff. The data is collected from Liaquat National Hospital of Karachi, Pakistan during the period from April 2021 to March 2022. The study adopted a COPAQ questionnaire to assess psychological trauma among healthcare professionals. Results & Discussion:Majority of sample were aged less than or equal to 30-years, with more female healthcare professionals than male. Pearson Chi Square showed a significant association of psychological trauma with residence, socioeconomic status, working position and health care professionals with p<0.05. The odds ratio at confidence interval of 95%, for psychological trauma, in Univariate analysis urban resident were found 3.9 times, frontline workers gives 7.8 times, doctors gives 17.8 times and nurses gives 6.9 times more likely for psychological trauma and samples with income less than Rs. 25000 were found 0.13 times less likely for psychological trauma with p<0.05. In multivariate analysis none of the factors give significant association. Conclusion(s): The study recommended that a multi-sectoral and milti-pronged should be developed, to offer technical support for advancing of the healthcare system across the country. Future scholars are recommended to investigate the factors associated to psychological distress across different cities of Pakistan and make a comparison for better understanding. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.
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INTRODUCTION: COVID-19-related organ dysfunction is increasingly recognized as sepsis, & sepsis has been reported as the most common proximate cause of death among COVD-19 patients in autopsy studies. Thus, the COVID-19 pandemic is expected to affect substantially the epidemiology of sepsis. However, the contribution of COVID-19 to sepsis-related mortality in the United States (US) is unknown. METHOD(S): We used the CDC WONDER Multiple Cause of Death database to identify decedents with a diagnosis of sepsis during 2015-2019 and with diagnoses of COVID-19, sepsis, or both during 2020. Sepsis was identified using previously reported ICD-10 code-based taxonomy. COVID-19 was identified by ICD-10 code U071. Negative binomial regression was used on the 2015-2019 data to forecast the number of sepsis-related deaths in 2020. We then compared the number of observed vs expected sepsis-related deaths in 2020. In addition, we examined the reporting of a diagnosis of COVID-19 among decedents with sepsis and the proportion of a diagnosis of sepsis among those with COVID-19. The latter analyses were then repeated across the Department of Health and Human Services (HHS) Regions. RESULT(S): In 2020, there were 242,630 sepsis-related deaths, 384,536 COVID-19-related deaths, & 35,057 deaths with both diagnoses. The expected number of sepsis-related deaths for 2020 was 207,175 (95% CI 205,929-208,429), with the ratio of observed to expected deaths 1.17 (95%CI 1.16-1.18). COVID-19-related deaths comprised 15.0% of all observed sepsis-related deaths, ranging from 8.1% (HHS Region 10) to 18.2% (HHS Region 2). A diagnosis of sepsis was reported in 9.1% of all COVID-19-related deaths, varying from 6.6% (HHS Region 2) to 12.5% (HHS Region 9). CONCLUSION(S): Sepsis-related mortality was reported in less than 1 in 10 COVID-19-related deaths in the US during 2020, with the frequency of sepsis diagnoses varying nearly 2-fold across HHS regions. Although the number of COVID-19-related deaths far exceeded sepsis-related mortality, the contribution of the former to the latter, based on death certificates, was relatively minor. Our findings suggest substantial underdocumentation and possibly underrecognition of sepsis among COVID-19 decedents, likely contributing to varying coding practices during the first year of the pandemic.
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INTRODUCTION: COVID-19-related organ dysfunction is increasingly recognized as sepsis of viral origin and is a common complication among those requiring hospitalization, with estimated prevalence of over 50% among the latter. However, the population-level association of COVID-19 with short-term mortality among septic patients is unknown. METHOD(S): We used a statewide dataset to identify hospitalizations aged >=18 years with sepsis in Texas during April 1-December 31, 2020. Sepsis was defined by "explicit" and ICD-10 codes for severe sepsis (R65.20) and septic shock (R65.21) and COVID-19 by ICD-10 code U07.1. A hierarchical, mixed-effects model was fit to estimate the association of COVID-19 with short-term mortality (defined as in-hospital death or discharge to hospice) among sepsis hospitalizations. Sensitivity analyses of the sepsis hospitalization subsets with septic shock and ICU admission were performed using a similar modeling approach. RESULT(S): Among 55,145 sepsis hospitalizations, 13,149 (23.8%) had COVID-19. Compared to those without COVID-19, sepsis hospitalizations with COVID-19 were younger (aged >=65 years 53.6% vs 55.0%), more commonly male (59.5% vs 50.4%) and racial/ethnic minority (66.1% vs. 46.2%), with lower burden of chronic illness (mean [SD] Charlson comorbidity index 1.8 [1.9] vs 2.8 [2.6]), but with higher mean [SD] number of organ dysfunctions (3.1 [1.4] vs 2.7 [1.6]) [p < 0.0001 for all comparisons]. Short-term mortality among sepsis hospitalizations with and without COVID-19 was 52.7% vs 30.2%, respectively. On adjusted analysis, COVID-19 remained associated with higher risk of short-term mortality (adjusted odds ratio [aOR] 2.54 [95% 2.39-2.70]), with findings on sensitivity analyses consistent with the primary model among sepsis hospitalization subsets with septic shock ([aOR] 2.70 [95% 2.51-2.91]) and ICU admission ([aOR] 2.67 [95% 2.30-3.10]). CONCLUSION(S): COVID-19 infection was associated with over 250% higher odds of short-term mortality among septic patients. Additional studies are needed to determine the mechanisms underlying these observations in order to inform future efforts to reduce the observed outcome disparities.
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INTRODUCTION: Decreasing case fatality among septic patients has been documented in the United States (US). The strain on healthcare resources brought by the COVID-19 pandemic has been associated with a rise in adverse health outcomes in non-COVID patients. However, the populationlevel impact of the COVID-19 pandemic on the case fatality in sepsis among non-COVID patients is unknown. METHOD(S): We used a statewide dataset to identify hospitalizations aged >=18 years in Texas during April 1-December 31, for each year of 2016-2020 (to align each year with the date of introduction of COVID-19-specific ICD-10 code [U071] in the US). Sepsis was defined by "explicit" ICD-10 codes for severe sepsis (R65.20) and septic shock (R65.21). COVID-19 hospitalizations were excluded. Hierarchical models were fit to estimate the changes in shortterm mortality (defined as in-hospital death or discharge to hospice) of sepsis hospitalizations using 2 approaches: 1) using the 2016-2019 data to forecast risk-adjusted shortterm mortality in 2020 and then comparing the predicted and observed 2020 mortality 2) using the 2019-2020 data to estimate the change in short-term mortality in 2020. RESULT(S): There were 207,953 sepsis hospitalizations without a diagnosis of COVID-19 during the study period (45,826 in 2019 and 41,996 in 2020). Short-term mortality has decreased between 2016 and 2019 from 29.7% to 26.6% (adjusted odds ratio [aOR]/year 0.93 [95% CI 0.92-0.94]). The predicted and observed short-term mortality among sepsis hospitalizations in 2020 was 25.8% (95% CI 25.6-26.0) vs 30.8%, respectively (p < 0.0001). Following adjustment for confounders, the risk of short-term mortality among sepsis hospitalizations was higher in 2020 than in 2019 (aOR 1.30 [95% CI 1.25-1.35]). CONCLUSION(S): The COVID-19 pandemic was associated with reversal of the progressive pre-pandemic downtrend in case fatality of septic patients, with 30% higher odds of short-term mortality in 2020 compared to the preceding year among sepsis hospitalizations without COVID-19. Further studies are needed to determine the patient-, health system-, and policy-related contributors to these findings in order to inform potential scalable strategies to reduce pandemicrelated adverse impact on outcomes of septic patients without COVID-19.
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INTRODUCTION: Acute respiratory distress syndrome (ARDS) is the major manifestation of severe respiratory failure due to COVID-19 and is present in the majority of COVID-19-related deaths in autopsy studies. Thus, the COVID-19 pandemic is expected to change substantially the epidemiology of ARDS. However, the contribution of COVID-19 to ARDS-related mortality in the United States (US) is unknown. METHOD(S): We used the CDC WONDER Multiple Cause of Death Data set to identify decedents with a diagnosis of ARDS during 2015-2019, and with a diagnosis of COVID-19, ARDS, or both during 2020. ARDS and COVID-19 were identified by ICD-10 codes J80 and J071, respectively. Negative binomial regression was used on the 2015-2019 data to forecast the number of ARDS-related deaths in 2020. We then compared the number of observed vs expected ARDS-related deaths in 2020. In addition, we examined the reporting of a diagnosis of COVID-19 among decedents with ARDS and the proportion of a diagnosis of ARDS among those with COVID-19. The latter analyses were then repeated across the Department of Health and Human Services (HHS) Regions. RESULT(S): In 2020, there were 51,184 ARDS-related deaths, 384,536 COVID-19-related deaths, and 41,606 deaths with both in the US. The predicted number of ARDSrelated deaths for 2020 was 10,851 (95% CI 9,714-12,120). The ratio of the observed vs expected ARDS-related deaths was 4.71 (95% CI 4.62-4.82). A diagnosis of ARDS was reported in 10.8% of all COVID-19 related deaths, ranging from 8.2% (HHS Regions 1 & 7) to 16.1% (HHS Region 2). COVID-19-related deaths have contributed to 81.3% of observed ARDS-related deaths in 2020, varying from 68.8% (HHS Region 10) to 91.5% (HHS Region 2). CONCLUSION(S): The number of ARDS-related deaths in the US increased nearly 5-fold in 2020, due to the contribution of ARDS among COVID-19 decedents. However, ARDS was reported only in about 1 in 10 COVID-19-related deaths, with the frequency of ARDS diagnosis varying nearly 2-fold across HHS Regions. Our findings suggest that the major rise in ARDS-related deaths in the US in 2020 is nevertheless an underestimate of the actual toll of ARDS-related mortality that year, likely reflecting substantial underdocumentation and possibly underrecognition of ARDS among COVID-19 decedents.