The mosaic of autoimmunity and autoinflammation and SARS-CoV-2 as an environmental factor

The "Severe Acute Respiratory Syndrome-related Coronavirus type 2” (SARS-CoV-2), the infectious agent responsible for the still ongoing "Coronavirus Disease 2019” (COVID-19) pandemic, represents a major environmental trigger and an important piece of the mosaic of autoimmunity and autoinflammation. Several de novo-onset or flares/relapses of autoimmune/autoinflammatory diseases have been reported associated either directly or indirectly with the viral agent. COVID-19 has represented a unique opportunity for shedding new light and unexpected insights on autoimmune/autoinflammatory diseases. These have, in turn, enabled the discovery of novel aspects of the COVID-19 infection, offering already approved, effective and safe drugs, as options to be repurposed in the fight against the novel coronavirus. However, there is still a dearth of information concerning the long-term impact of the virus on autoimmunity and autoinflammation - the so-called long-COVID or postCOVID, which warrants further investigation. © 2023 Elsevier Inc. All rights reserved.

Chilblain-like lesions (COVID-19 toes) have the same impact on family members than psoriasis systemically treated: insights from a case-control study targeting the pediatric population.

OBJECTIVE: COVID-19 toes represent the main dermatological COVID-19 cutaneous manifestation in pediatric patients. Its diagnosis exposes the whole family to social stigma and this aspect was not previously evaluated. PATIENTS AND METHODS: This was a multicenter, case-control, observational study that compared the family impact of COVID-19 toes vs. psoriasis (PsO). We enrolled 46 pediatric patients (23 with psoriasis and 23 with COVID-19 toes, age and gender matched) and their parents/caregivers that had to fill the Dermatitis Family Impact (DFI) questionnaire. RESULTS: DFI index did not differ significantly between both subgroups (p=0.48), and in psoriatic patients did not correlate with both Psoriasis Area Severity Index (PASI) (p=0.59) and itch-VAS (p=0.16). CONCLUSIONS: COVID-19 toes, a transitory dermatosis, exerted a similar impact/perturbation on family dynamics than PsO, a well-known stigmatizing, chronic inflammatory dermatosis.

The association between the initial outcomes of COVID-19 and the human development index: An ecological study

BACKGROUND & OBJECTIVE: Outcomes of the pandemic COVID-19 varied from one country to another. We aimed to describe the association between the global recovery and mortality rates of COVID-19 cases in different countries and the Human Development Index (HDI) as a socioeconomic indicator. METHODS: A correlational (ecological) study design is used. The analysis used data from 173 countries. Poisson regression models were applied to study the relationship between HDI and pandemic recovery and mortality rates, adjusting for country median age and country male to female sex ratio. RESULTS: During the first three months, the global pooled recovery rate was 32.4% (95% CI 32.3% - 32.5%), and the pooled mortality rate was 6.95% (95% CI 6.94% - 6.99%). Regression models revealed that HDI was positively associated with recovery beta = 1.37, p = 0.016. HDI was also positively associated with the mortality outcome beta = 1.79, p = 0.016. CONCLUSIONS: Our findings imply that the positive association between the HDI and recovery rates is reflective of the pandemics' preparedness. The positive association between the HDI and mortality rates points to vulnerabilities in approaches to tackle health crises. It is critical to better understand the connection between nations' socioeconomic factors and their readiness for future pandemics in order to strengthen public health policies.

Optimal Staged Reopening Schedule Based on ICU Capacity: A Model-Informed Strategy

Reopening plans and strategies remain to be a top priority issue, post a pandemic wave, for economic recovery with a relatively safe community. We use a transmission dynamics model, parameterized through model fitting to cumulative incidence data during different social distancing escalation phases, to identify the optimal timing of reopening based on social-distancing de-escalation in a population. We use the Province of Ontario, Canada as a case study. The optimization is subject to the constraint that a future COVID-19 outbreak will not lead to the need of acute and intensive care unit beds beyond their local public health capacity. We minimize the cost, the total number of contacts lost until we reach a certain targeted date. We illustrate this optimization process by considering a particular de-escalation strategy that simply ‘reverses’ the escalation steps. We consider several scenarios depending on the number of de-escalation phases (characterized by an increase in the daily number of contacts), and different lengths of the period between a date when the cost is evaluated until a targeted data when the constraint is to be removed (for example, the anticipated date when a mass COVID-19 vaccination or an effective treatment becomes available) so that normal contacts prior to COVID-19 pandemic can be resumed. In the case of Ontario, we conclude that resuming 80% of pre-pandemic activity level should not happen 2 months before the vaccine/drug treatment becomes available. We also show that improving contact tracing and diagnosis capacity has a significant effect on the reopening date, whereas increasing ICU beds capacity has only a minor effect. © 2022, Springer Nature Switzerland AG.

How physical activity behavior affected well-being, anxiety and sleep quality during COVID-19 restrictions in Iran

OBJECTIVE: The Islamic Republic of Iran has displayed one of the highest rates of COVID-19 infection in the world and the highest rate of mortality in the Middle East. Iran has used a stringent package of preventive health measures to mitigate the spread of infection, which however has negatively affected individuals' physical and psychological health. This study aimed at examining whether physical-activity (PA) behavior, anxiety, well-being, and sleep-quality changed in response to the COVID-19-related public health restrictions enforced in Iran. PATIENTS AND METHODS: An online questionnaire was disseminated to adults residing in Iran from November 17, 2020, to February 13, 2021 (88 days), during Iran's strictest public health restrictions. Main outcome measures included Godin-Shephard Leisure-Time Exercise Questionnaire, General Anxiety Disorder-7, Mental Health Continuum-Short Form, and Pittsburgh Sleep Quality Index. RESULTS: A total of 3,323 adults (mean age 30 +/- 11 years, 54.3% female) participated in the survey. Firstly, the restrictions generally reduced PA behavior: (a) among inactive participants (IPs), 60.6% became less active vs. 5.1% who became more active;and (b) among active participants (APs), 49.9% became less active vs. 22.8% who became more active. Secondly, PA behavior was associated with higher well-being and sleep quality during the restrictions: (a) APs reported higher (or lower) levels of well-being and sleep quality (or anxiety) than did IPs;and (b) among IPs as well Corresponding as among APs, the more active the participants, the greater (or lower) the levels of well-being and sleep quality (or anxiety). CONCLUSIONS: This study showed the beneficial role of PA behavior for well-being, anxiety, and sleep quality during the COVID-19 restrictions, whereas such restrictions appeared to decrease PA participation. Active lifestyle should be then encouraged during the COVID-19 outbreak while taking precautions.

Higher rates of COVID-19 but less severe infections reported for patients on Dupilumab: a Big Data analysis of the World Health Organization VigiBase.

OBJECTIVE: Dupilumab (Dupixent®) is a monoclonal antibody that inhibits IL-4 and IL-13 signaling used for the treatment of allergic diseases. Whilst biologic therapy is traditionally regarded as immunosuppressive and capable to increase the infectious risk, Dupilumab does not display these characteristics and may be even protective in certain cases. We investigated the link between Dupilumab therapy and SARS-CoV-2 infection. MATERIALS AND METHODS: We carried out a comprehensive data mining and disproportionality analysis of the WHO global pharmacovigilance database. One asymptomatic COVID-19 case, 106 cases of symptomatic COVID-19, and 2 cases of severe COVID-19 pneumonia were found. RESULTS: Dupilumab treated patients were at higher risk of COVID-19 (with an IC0.25 of 3.05), even though infections were less severe (IC0.25 of -1.71). The risk of developing COVID-19 was significant both among males and females (with an IC0.25 of 0.24 and 0.58, respectively). The risk of developing COVID-19 was significant in the age-group of 45-64 years (with an IC0.25 of 0.17). CONCLUSIONS: Dupilumab use seems to reduce COVID-19 related severity. Further studies are needed to better understand the immunological mechanisms and clinical implications of these findings. Remarkably, the heterogenous nature of the reports and the database structure did not allow to establish a cause-effect link, but only an epidemiologically decreased risk in the patients subset treated with dupilumab.

The effectiveness of quarantine and isolation determine the trend of the COVID-19 epidemics in the final phase of the current outbreak in China

Objectives: Since January 23rd 2020, stringent measures for controlling the novel coronavirus epidemics have been gradually enforced and strengthened in mainland China. The detection and diagnosis have been improved as well. However, the daily reported cases staying in a high level make the epidemics trend prediction difficult.

Effects of home-confinement during the Covid-19 outbreak on quality of life enjoyment and satisfaction and lifestyle behaviours

Introduction: Home-confinement during the COVID-19 outbreak may affect lifestyle behaviours. The aim of the present study was to determine the effects of COVID-19 induced home-confinement on lifestyle behaviours and quality of life enjoyment and satisfaction. Materials and methods: Participants health-related quality of life and lifestyle behaviours were assessed using the Health-related Quality of Life Enjoyment and Satisfaction-Short Form (HLESQ-SF) questionnaire and the Simple Lifestyle Indicator Questionnaire adapted and modified (SLIQ), respectively. Total raw scores and the % maximum of the HLESQ-SF and lifestyle behaviours, specifically, diet, exercise/activity, alcohol, smoking, and stress, with respect to before and during confinement conditions were calculated. Results: The data showed that rate of overall life satisfaction and contentment, total raw score, % maximum, and exercise/ activity raw score were higher before confinement than during confinement (all, p<0.01). Diet, alcohol, and stress raw scores were higher during confinement than before confinement (all, p<0.05). Conclusion: Home-confinement has a negative effect on physical health, work, social relationships, lifestyle behaviours, and overall quality of life enjoyment and satisfaction.

Sleep Quality and Physical Activity as Predictors of Mental Wellbeing Variance in Older Adults during COVID-19 Lockdown: ECLB COVID-19 International Online Survey

BACKGROUND: The COVID-19 lockdown could engender disruption to lifestyle behaviors, thus impairing mental wellbeing in the general population. This study investigated whether sociodemographic variables, changes in physical activity, and sleep quality from pre- to during lockdown were predictors of change in mental wellbeing in quarantined older adults. METHODS: A 12-week international online survey was launched in 14 languages on 6 April 2020. Forty-one research institutions from Europe, Western-Asia, North-Africa, and the Americas, promoted the survey. The survey was presented in a differential format with questions related to responses "pre" and "during" the lockdown period. Participants responded to the Short Warwick-Edinburgh Mental Wellbeing Scale, the Pittsburgh Sleep Quality Index (PSQI) questionnaire, and the short form of the International Physical Activity Questionnaire. RESULTS: Replies from older adults (aged >55 years, n = 517), mainly from Europe (50.1%), Western-Asia (6.8%), America (30%), and North-Africa (9.3%) were analyzed. The COVID-19 lockdown led to significantly decreased mental wellbeing, sleep quality, and total physical activity energy expenditure levels (all p < 0.001). Regression analysis showed that the change in total PSQI score and total physical activity energy expenditure (F_{(2, 514)} = 66.41 p < 0.001) were significant predictors of the decrease in mental wellbeing from pre- to during lockdown (p < 0.001, R²: 0.20). CONCLUSION: COVID-19 lockdown deleteriously affected physical activity and sleep patterns. Furthermore, change in the total PSQI score and total physical activity energy expenditure were significant predictors for the decrease in mental wellbeing.

SARS/MERS/SARS-CoV-2 Outbreaks and Burnout Syndrome among Healthcare Workers. An Umbrella Systematic Review

The coronavirus-19 (COVID-19) pandemic is putting a severe strain on all healthcare systems. Several occupational risk factors are challenging healthcare workers (HCWs) who are at high risk of mental health outcomes, including Burnout Syndrome (BOS). BOS is a psychological syndrome characterized by emotional exhaustion, depersonalization, and low personal accomplishment. An umbrella review of systematic reviews and meta-analyses concerning BOS and coronavirus (SARS/MERS/SARS-CoV-2) outbreaks was carried out on PubMed Central/Medline, Cochrane Library, PROSPERO, and Epistemonikos databases. Data relating to COVID-19 is insufficient, but in previous SARS and MERS outbreaks about one-third of HCWs manifested BOS. This prevalence rate is similar to the figure recorded in some categories of HCWs exposed to chronic occupational stress and poor work organization during non-epidemic periods. Inadequate organization and worsening working conditions during an epidemic appear to be the most likely causes of BOS. Preventive care and workplace health promotion programs could be useful for protecting healthcare workers during pandemics, as well as during regular health activities.

Effects of Home Confinement on the Intensity of Physical Activity during the COVID-19 Outbreak in Team Handball According to Country, Gender, Competition Level, and Playing Position: A Worldwide Study

This study investigated effects of home confinement on physical activity (PA) in Team Handball during the COVID-19 outbreak. A total of 1359 handball players participated (age: 23 +/- 6 years). Participants from Europe, Western Asia, and North Africa answered an online version of the International Physical Activity Questionnaire (IPAQ) considering "before" and "during" confinement. COVID-19 home confinement has had a negative effect on PA (vigorous, moderate, walking, and overall). The largest decrease was in the sum parameter "all PA" (MET (metabolic equivalent of task)-min/week, eta_p² = 0.903;min/week, eta_p² = 0.861). Daily sitting time increased from 2.7 to 5.0 h per weekday (p < 0.001, eta_p² = 0.669). For gender, continent, country, level of handball league, and playing position, no significant differences (group and interaction effects) were observed. The largest change in PA behavior was in walking (minutes per day: eta_p² = 0.755), with males displaying the greatest decrease (from 62 +/- 11 to 30 +/- 14 min per weekday;d = 2.67). In terms of magnitude, difference between genders was greatest for sitting time (difference in d = 1.20). In conclusion, while COVID-19 measures were essential to preserve public health, PA was compromised and sedentary behavior increased because of these public health measures regardless of gender, playing position, and competition level.

The Impact of the Social Distancing Policy on COVID-19 Incidence Cases and Deaths in Iran from February 2020 to January 2021: Insights from an Interrupted Time Series Analysis

Background: In December 2019, a viral outbreak occurred in China, and rapidly spread out worldwide. Due to the lack of immediately available vaccines and effective drugs, many policy- and decision-makers have focused on non-pharmacological methods, including social distancing. This study was aimed at assessing the effects of the implementation of this policy in Iran, one of the countries most affected by COVID-19. We conducted a quasi-experimental study, utilizing the interrupted time series analysis (ITSA) approach. Methods: We collected daily data between February 20, 2020 and January 29, 2021, through governmental websites from 954 public hospitals and healthcare settings. The Iranian government launched the social distancing policy on March 27, 2020. Statistical analyses, including ITSA, were carried out with R software Version 3.6.1 (London, UK). Results: During the study period, 1,398,835 confirmed incidence cases and 57,734 deaths occurred. We found a decrease of -179.93 (95% CI: -380.11 to -20.25, P-value=0.078) confirmed incidence cases following the implementation of the social distancing policy, corresponding to a daily decrease in the trend of -31.17 (95% CI: -46.95 to -15.40, P-value=0.08). Moreover, we found a decrease of -28.28 (95% CI: -43.55 to -13.01, P-value=0.05) deaths, corresponding to a daily decrease in the trend of -4.52 (95% CI: -5.25 to -3.78, P-value=0.003). Conclusion: The growth rate of confirmed incidence cases and deaths from COVID-19 in Iran has decreased from March 27, 2020 to January 29, 2021, after the implementation of social distancing. By implementing this policy in all countries, the burden of COVID-19 may be mitigated.

COVID-19 knowledge prevents biologics discontinuation: Data from an Italian multicenter survey during RED-ZONE declaration

SARS-CoV-2 become pandemics and there is still a dearth of data about its the potentially among dermatological patients under biologics. We aimed to assess health literacy, disease knowledge, treatment dissatisfaction and biologics attitudes toward COVID-19. We performed a cross-sectional, questionnaire-based survey on 98/105 consecutive dermatological patients treated with biologics—51 suffering from plaque psoriasis, 22 from atopic dermatitis, and 25 from hidradenitis suppurativa. An ad hoc, validated questionnaire has 44 items investigating the following domains: knowledge of COVID-19 related to (a) epidemiology, (b) pathogenesis, (c) clinical symptoms, (d) preventive measures, and (e) attitudes. Patients data and questionnaires were collected. Despite only 8.1% thought that biologics may increase the risk of COVID-19, 18.4% and 21.4% of the patients were evaluating the possibility to discontinue or modify the dosage of the current biologic therapy, respectively. Globally, male patients (P =.001) with higher scholarity level (P =.005) displayed higher knowledge of COVID-19. Patients with lower DLQI (P =.006), longer disease duration (P =.051) and lower scholarity (P =.007) have thought to discontinue/modify autonomously their biologic therapy. At the multivariate logistic regression, only the knowledge of epidemiology and preventive measures resulted independent predictors of continuation vs discontinuation and modification vs no modification, respectively. Dermatologists should promote COVID-19 knowledge to prevent biologics disruption.

Scenario tree and adaptive decision making on optimal type and timing for intervention and social-economic activity changes to manage the COVID-19 pandemic

We introduce a novel approach to inform the re-opening plan followed by a post-pandemic lockdown by integrating a stochastic optimization technique with a disease transmission model. We assess Ontarios re-opening plans as a case-study. Taking into account the uncertainties in contact rates during different re-opening phases, we find the optimal timing for the upcoming re-opening phase that maximizes the relaxation of social contacts under uncertainties, while not overwhelming the health system capacity before the arrival of effective therapeutics or vaccines.