Cognitive impairment in long-COVID and its association with persistent dysregulation in inflammatory markers.

Objective: To analyze the potential impact of sociodemographic, clinical and biological factors on the long-term cognitive outcome of patients who survived moderate and severe forms of COVID-19. Methods: We assessed 710 adult participants (Mean age = 55 ± 14; 48.3% were female) 6 to 11 months after hospital discharge with a complete cognitive battery, as well as a psychiatric, clinical and laboratory evaluation. A large set of inferential statistical methods was used to predict potential variables associated with any long-term cognitive impairment, with a focus on a panel of 28 cytokines and other blood inflammatory and disease severity markers. Results: Concerning the subjective assessment of cognitive performance, 36.1% reported a slightly poorer overall cognitive performance, and 14.6% reported being severely impacted, compared to their pre-COVID-19 status. Multivariate analysis found sex, age, ethnicity, education, comorbidity, frailty and physical activity associated with general cognition. A bivariate analysis found that G-CSF, IFN-alfa2, IL13, IL15, IL1.RA, EL1.alfa, IL45, IL5, IL6, IL7, TNF-Beta, VEGF, Follow-up C-Reactive Protein, and Follow-up D-Dimer were significantly (p<.05) associated with general cognition. However, a LASSO regression that included all follow-up variables, inflammatory markers and cytokines did not support these findings. Conclusion: Though we identified several sociodemographic characteristics that might protect against cognitive impairment following SARS-CoV-2 infection, our data do not support a prominent role for clinical status (both during acute and long-stage of COVID-19) or inflammatory background (also during acute and long-stage of COVID-19) to explain the cognitive deficits that can follow COVID-19 infection.

Stakeholder Participation in Planning of a Sustainable and Competitive Tourism Destination: The Genoa Integrated Action Plan

The outbreak of COVID-19 confronted the international community with critical health, social, and economic challenges. Travel and tourism were among the hardest affected sectors. In 2020 and 2021 new travel trends emerged, emphasizing local destinations, short distances, and consequently, lower-carbon transportation (proximity tourism). Post-pandemic recovery represents an opportunity to bounce back better by rethinking the sector's economic model for the sake of sustainability and innovation. This paper disseminates the research that led to the structuring of guidelines for a breakthrough and inclusive municipal-level action plan for the promotion of sustainable tourism, as part of the Tourism Friendly Cities project. An operational methodology is discussed here, whereby key stakeholder participation, conceptualized through a sextuple helix model, is the foundation of the planning process. A small-scale action and a qualitative assessment tool of the participatory process are also illustrated. The proposed methodology corroborates the vast positive effects deriving from stakeholder participation in terms of trust, ownership, planning quality, innovativeness and sustainability of interventions. In applying the methodology, although the digital framework was evaluated positively in terms of the number of participants that could be involved, data collection, and confidentiality of activities, the evaluation shows that hybrid modes of participation are more desirable.

Association between chemosensory impairment with neuropsychiatric morbidity in post-acute COVID-19 syndrome: results from a multidisciplinary cohort study.

Preliminary methodologically limited studies suggested that taste and smell known as chemosensory impairments and neuropsychiatric symptoms are associated in post-COVID-19. The objective of this study is to evaluate whether chemosensory dysfunction and neuropsychiatric impairments in a well-characterized post-COVID-19 sample. This is a cohort study assessing adult patients hospitalized due to moderate or severe forms of COVID-19 between March and August 2020. Baseline information includes several clinical and hospitalization data. Further evaluations were made using several different reliable instruments designed to assess taste and smell functions, parosmia, and neuropsychiatric disorders (using standardized psychiatric and cognitive measures). Out of 1800 eligible individuals, 701 volunteers were assessed on this study. After multivariate analysis, patients reporting parosmia had a worse perception of memory performance (p < 0.001). Moderate/severe hypogeusia was significantly associated with a worse performance on the word list memory task (p = 0.012); Concomitant moderate/severe olfactory and gustatory loss during the acute phase of COVID-19 was also significantly associated with episodic memory impairment (p = 0.006). We found a positive association between reported chemosensory (taste and olfaction) abnormalities and cognition dysfunction in post-COVID-19 patients. These findings may help us identify potential mechanisms linking these two neurobiological functions, and also support the speculation on a possible route through which SARS-CoV-2 may reach the central nervous system.

Coronary Artery Disease and Severe Aortic Stenosis in the Covid-19 Era: A Case Report

An 81-years-old with a history of hypertension, dyslipidemia, and chronic ischemic heart disease with prior stent implantation of right coronary artery in 2011. Due to its poor compliance, no recurrent symptoms, and, finally, the COVID-19 pandemic, the patient did not perform any cardiological follow-up during these years. Unfortunately, the last six months he has reported the onset of dyspnea and typical angina due to moderate efforts, undervalued by the patient. Because of the rapid worsening of dyspnea and typical angina in the last 5 days, he went to the local emergency department (ED). The role in/role out routine exams performed in the ED documented a COVID-19 infection. At the ED, his vital signs were normal, with a blood pressure of 135/75 mm Hg, heart rate of 74 regular beats/min, body temperature of 36.5 degreeC, oxygen saturation of 97% in ambient air, and respiratory rate of 16/ min. Of note, the chest x-ray was normal, as well as no alterations were documented at the CTscan performed a few hours later. First-line blood sample tests were within range except for Hb 10 mg/dl. Therefore, a cardiological evaluation was requested. Electrocardiogram (ECG) showed inverted T-waves in V1-4 leads, and echocardiography showed normal left ventricular ejection fraction (FE 55% Simpson), left ventricular anterolateral wall hypokinesia, and severe aortic stenosis (V max 4.78 m/ s, Gr max 4.78 m/s, Gr medium 59 mmHg). Since myocardial necrosis enzymes were increased (T-hs 118.7 ng/dl;CK-MB 6.3 ng/L;NT-ProBNP 761 ng/dl), leading to the suspicion of acute coronary syndrome the patient underwent coronary angiography, showing critical stenoses of the left descending artery (LAD), circumflex (LCX), I obtuse marginal (IOM), and patent stent of the right coronary artery. Therefore, the Heart team deemed the patient at high operatory risk choosing, in agreement with the patient, for a percutaneous coronary intervention (PCI) followed by TAVR. Accordingly, the patients underwent PCI of LAD with the implantation of a Xience-Serra 3.0x15 mm and PCI of LCX with the implantation of an Onyx 2.75x18 mm stent. After COVID -19 resolution, which happen 7 days later, the patient was moved to our cardiology department. Two days later in the same procedure, we performed the first PCI of I-OM with the implantation of a Xience Sierra 3.0x18 mm stent following a TAVI with the implantation of Evolute Pro valve 29 mm. The postprocedure echocardiogram showed an optimal valve position with a transvalvular mean pressure gradient of 4 mm Hg. After six days post-TAVI, for a complete atrioventricular block, the patient also underwent a pacemaker implantation. The patient was finally discharged after 10 from TAVI. Discussion(s): This case report offers several foods for thought. First, the COVID-19 pandemic has negatively affected primary and secondary prevention, even for patients affected by cardiovascular disease. Our patient has postponed clinical checks even when the symptoms reappeared, also because of the concerns lead by the COVID-19 pandemic. Second, completeness and timing of coronary disease revascularization, which in this case was staged and performed before TAVI. Finally, the late occurrence of advanced heart block requiring PM implantation. For instance, in an era of fast-track TAVI, more studies are warranted to identify patients who are at higher risk of late PM implantation.

Adjustable lighting system based on circadian rhythm for human comfort

The artificial lighting condition in which humans are exposed have been proven as a harmful factor on their well-being, which is regulated mainly by circadian rhythm. Especially since the COVID-19 pandemic, where external factors forced the society to adapt into new standards when it comes to their jobs and regular activities, lockdowns and work-from-home made most people start spending a portion of their life exposed to artificial sources of light. Technological advances have made lights more efficient and improved their intensity. Light-emitting diodes (LEDs), for example, generally produce high-intensity bluish tone light, which may affect the circadian rhythm. However, it is possible to create lighting systems able to vary the intensity and correlated color temperature (CCT) of the lighting. This work proposes a lighting system that allows adjusting the intensity and CCT of light via remote control on a smartphone application synchronized with time, following a pattern that aims avoid the undesirable artificial lighting effects on circadian rhythm. Using two LED arrays containing 10 LEDs each, suitable results were reached, presenting maximum difference of 3.35 % for CCT and 5.57 % for luminous flux in comparison with reference values.

Clinical, sociodemographic and environmental factors impact post-COVID-19 syndrome.

Background: Sociodemographic and environmental factors are associated with incidence, severity, and mortality of COVID-19. However, little is known about the role of such factors in persisting symptoms among recovering patients. We designed a cohort study of hospitalized COVID-19 survivors to describe persistent symptoms and identify factors associated with post-COVID-19 syndrome. Methods: We included patients hospitalized between March to August 2020 who were alive six months after hospitalization. We collected individual and clinical characteristics during hospitalization and at follow-up assessed ten symptoms with standardized scales, 19 yes/no symptoms, a functional status and a quality-of-life scale and performed four clinical tests. We examined individual exposure to greenspace and air pollution and considered neighbourhood´s population density and socioeconomic conditions as contextual factors in multilevel regression analysis. Results: We included 749 patients with a median follow-up of 200 (IQR = 185-235) days, and 618 (83%) had at least one of the ten symptoms measured with scales. Pain (41%), fatigue (38%) and posttraumatic stress disorder (35%) were the most frequent. COVID-19 severity, comorbidities, BMI, female sex, younger age, and low socioeconomic position were associated with different symptoms. Exposure to ambient air pollution was associated with higher dyspnoea and fatigue scores and lower functional status. Conclusions: We identified a high frequency of persistent symptoms among COVID-19 survivors that were associated with clinical, sociodemographic, and environmental variables. These findings indicate that most patients recovering from COVID-19 will need post-discharge care, and an additional burden to health care systems, especially in LMICs, should be expected.

Post-acute sequelae of SARS-CoV-2 infection: relationship of central nervous system manifestations with physical disability and systemic inflammation.

BACKGROUND: Despite the multitude of clinical manifestations of post-acute sequelae of SARS-CoV-2 infection (PASC), studies applying statistical methods to directly investigate patterns of symptom co-occurrence and their biological correlates are scarce. METHODS: We assessed 30 symptoms pertaining to different organ systems in 749 adults (age = 55 ± 14 years; 47% female) during in-person visits conducted at 6-11 months after hospitalization due to coronavirus disease 2019 (COVID-19), including six psychiatric and cognitive manifestations. Symptom co-occurrence was initially investigated using exploratory factor analysis (EFA), and latent variable modeling was then conducted using Item Response Theory (IRT). We investigated associations of latent variable severity with objective indices of persistent physical disability, pulmonary and kidney dysfunction, and C-reactive protein and D-dimer blood levels, measured at the same follow-up assessment. RESULTS: The EFA extracted one factor, explaining 64.8% of variance; loadings were positive for all symptoms, and above 0.35 for 16 of them. The latent trait generated using IRT placed fatigue, psychiatric, and cognitive manifestations as the most discriminative symptoms (coefficients > 1.5, p < 0.001). Latent trait severity was associated with decreased body weight and poorer physical performance (coefficients > 0.240; p ⩽ 0.003), and elevated blood levels of C-reactive protein (coefficient = 0.378; 95% CI 0.215-0.541; p < 0.001) and D-dimer (coefficient = 0.412; 95% CI 0.123-0.702; p = 0.005). Results were similar after excluding subjects with pro-inflammatory comorbidities. CONCLUSIONS: Different symptoms that persist for several months after moderate or severe COVID-19 may unite within one latent trait of PASC. This trait is dominated by fatigue and psychiatric symptoms, and is associated with objective signs of physical disability and persistent systemic inflammation.

The Burden of Anemia in Pregnancy Among Women Attending the Antenatal Clinics in Mkuranga District, Tanzania.

Introduction: The burden of anemia in pregnancy is of global health importance. Tanzania is no exception. Its effects vary from one region to another due to the differing causes. Overall, it is a significant cause of maternal mortality. This study sought to assess the prevalence and factors associated with anemia among pregnant women attending the antenatal clinic (ANC) in the Mkuranga district of the Pwani region of Tanzania. Methodology: This cross sectional study was conducted among 418 pregnant women aged 15-49 years attending the Mkuranga District Hospital and Kilimahewa Health Center. The outcome variable of interest was anemia in pregnancy defined as a hemoglobin concentration of 11 g/dl or less. Data was collected using face-to-face interviews with a standardized pretested questionnaire, and through blood samples collected for hemoglobin testing. Descriptive analysis was used to determine the prevalence of anemia while multiple logistic regression was used to determine factors associated with anemia in pregnancy. Results: Anemia was prevalent among 83.5% of pregnant women attending the two major ANCs in Mkuranga district. Categorically, the hemoglobin of 16.3% of the included women was normal, 51.9% had moderate anemia, 24.4% had mild anemia, and 7.2% had severe anemia. Factors associated with anemia included being in the third trimester (AOR = 2.87, p = 0.026), not consuming vegetables (AOR = 2.62, p = 0.008), meat (AOR = 2.71, p = 0.003), eggs (AOR = 2.98, p = 0.002), and fish (AOR = 2.38, p = 0.005). The finding of unadjusted analysis revealed that women with inadequate minimum dietary diversity were having significantly greater odds of being anemic as compared with those with adequate dietary diversity (OR = 1.94, P = 0.016). Conclusion: More than 80% of pregnant women attending ANC in Mkuranga districts were anemic. Such unprecedented burden of anemia is associated with several factors, which include poor dietary practices such as not consuming iron-rich foods, for example vegetables, meat, eggs, and fish. Women in their third trimester were also more likely to suffer from anemia. This unprecedented burden of anemia in pregnancy can be addressed if efforts to improve feeding practices and early monitoring at the ANCs are sustained.

Post-COVID-19 psychiatric and cognitive morbidity: Preliminary findings from a Brazilian cohort study.

OBJECTIVE: The present study aims to investigate the occurrence of psychiatric and cognitive impairments in a cohort of survivors of moderate or severe forms of COVID-19. METHOD: 425 adults were assessed 6 to 9 months after hospital discharge with a structured psychiatric interview, psychometric tests and a cognitive battery. A large, multidisciplinary, set of clinical data depicting the acute phase of the disease, along with relevant psychosocial variables, were used to predict psychiatric and cognitive outcomes using the 'Least Absolute Shrinkage and Selection Operator' (LASSO) method. RESULTS: Diagnoses of 'depression', 'generalized anxiety disorder' and 'post-traumatic stress disorder' were established respectively in 8%, 15.5% and 13.6% of the sample. After pandemic onset (i.e., within the previous year), the prevalence of 'depression' and 'generalized anxiety disorder' were 2.56% and 8.14%, respectively. Memory decline was subjectively reported by 51.1% of the patients. Psychiatric or cognitive outcomes were not associated with any clinical variables related to the severity of acute-phase disease, nor by disease-related psychosocial stressors. CONCLUSIONS: This is the first study to access rates of psychiatric and cognitive morbidity in the long-term outcome after moderate or severe forms of COVID-19 using standardized measures. As a key finding, there was no significant association between clinical severity in the acute-phase of SARS-CoV-2 infection and the neuropsychiatric impairment 6 to 9 months thereafter.

Technical details for a robot-assisted hand-sewn esophago-gastric anastomosis during minimally invasive Ivor Lewis esophagectomy.

BACKGROUND: Minimally invasive Ivor Lewis esophagectomy (MIILE) provides better outcomes than open techniques, particularly in terms of post-operative recovery and pulmonary complications. However, in addition to requiring advanced technical skills, thoracoscopic access makes it hard to perform esophagogastric anastomosis safely, and the reported rates of anastomotic leak vary from 5 to 16%. Several minimally invasive esophago-gastric anastomotic techniques have been described, but to date strong evidence to support one technique over the others is still lacking. We herein report the technical details and preliminary results of a new robot-assisted hand-sewn esophago-gastric anastomosis technique. METHODS: From January 2018 to December 2020, 12 cases of laparoscopic/thoracoscopic Ivor Lewis esophagectomy with robot-assisted hand-sewn esophago-gastric anastomosis were performed. The gastric conduit was prepared and tailored taking care of vascularization with a complete resection of the gastric fundus. The anastomosis consisted of a robot-assisted, hand-sewn four layers of absorbable monofilament running barbed suture (V-lock). The posterior outer layer incorporated the gastric and esophageal staple lines. RESULTS: The post-operative course was uneventful in nine cases. Two patients developed chyloperitoneum, one patient a Sars-Cov-2 infection, and one patient a late anastomotic stricture. In all cases, there were no anastomotic leaks or delayed gastric conduit emptying. The median post-operative stay was 13 days (min 7, max 37 days); the longest in-hospital stay was recorded in patients who developed chyloperitoneum. CONCLUSION: Despite the small series, we believe that our technique looks to be promising, safe, and reproducible. Some key points may be useful to guarantee a low complications rate after MIILE, particularly regarding anastomotic leaks and delayed emptying: the resection of the gastric fundus, the use of robot assistance, the incorporation of the staple lines in the posterior aspect of the anastomosis, and the use of barbed suture. Further cases are needed to validate the preliminary, but very encouraging, results.

Cognitive decline following acute viral infections: literature review and projections for post-COVID-19.

Recently, much attention has been drawn to the importance of the impact of infectious disease on human cognition. Several theories have been proposed, to explain the cognitive decline following an infection as well as to understand better the pathogenesis of human dementia, especially Alzheimer's disease. This article aims to review the state of the art regarding the knowledge about the impact of acute viral infections on human cognition, laying a foundation to explore the possible cognitive decline followed coronavirus disease 2019 (COVID-19). To reach this goal, we conducted a narrative review systematizing six acute viral infections as well as the current knowledge about COVID-19 and its impact on human cognition. Recent findings suggest probable short- and long-term COVID-19 impacts in cognition, even in asymptomatic individuals, which could be accounted for by direct and indirect pathways to brain dysfunction. Understanding this scenario might help clinicians and health leaders to deal better with a wave of neuropsychiatric issues that may arise following COVID-19 pandemic as well as with other acute viral infections, to alleviate the cognitive sequelae of these infections around the world.

COVID-19-related Ocular Hypertension Secondary to Anterior Uveitis as Part of a Multisystemic Inflammatory Syndrome.

It is the consensus of the medical community that ocular complications associated with Coronavirus Disease 2019 (COVID-19) are mild, self-limiting, and there are no reports to date of a sight-threatening event. We report a patient with a systemic inflammatory syndrome in the context of COVID-19, with ophthalmological (uveitis), dermatological (erythema and skin nodules), and cardiovascular (edema) manifestations. The anterior uveitis led to an increase in the intraocular pressure that failed to respond to clinical treatment and prompted a surgical intervention to save the vision. To the best of our knowledge, this is the first report of a COVID-19-related ocular hypertension. Timely surgical intervention was key to save the vision in the patient's only eye.

Possible vertical transmission and antibodies against SARS-CoV-2 among infants born to mothers with COVID-19: A living systematic review.

Current evidence suggests that coronavirus disease 2019 (COVID-19), caused by severe respiratory syndrome coronavirus 2 (SARS-CoV-2), is predominantly transmitted from human-to-human. However, evidence on vertical transmission and natural passive immunity among the newborns exposed to COVID-19 is scanty and varies. This poses a challenge on preventive interventions for the newborns. We conducted a systematic review to first, determine the likelihood of vertical transmission among COVID-19 exposed infants and second, determine whether antibodies against SARS-CoV-2 were generated among COVID-19 vertically exposed but negative infants. This review registered in PROSPERO searched evidence from PubMed/MEDLINE and Google Scholar, among others. About 517 studies were pooled, where 33 articles (5.8%) met the inclusion criteria such as infection prevention and control measures at birth. A total of 205 infants born to COVID-19 positive mothers were studied. Overall, 6.3% (13/205; 95% CI: 3.0%-9.7%) of the infants tested positive for COVID-19 virus at birth. Of 33 eligible studies, six studies (18.8%) reported about immunoglobulin G/M (IgG/IgM) against SARS-CoV-2. IgG/IgM were detected in 90% infants (10/11; 95% CI: 73.9%-107.9%) who tested negative for COVID-19 virus. The median antibody levels detected were 75.49 AU/ml (range, 7.25-140.32 AU/ml) and 3.79 AU/ml (range, 0.16-45.83 AU/ml), p = .0041 for IgG and IgM, respectively. In conclusion, the current evidence revealed a low possibility of vertical transmission of COVID-19 and antibodies against SARS-CoV-2 were detected among vertically exposed but negative infants. Further studies on transplacental transmission and the magnitude of natural passive immunity in infants born to mothers with COVID-19 are warranted.

Education Systems' Response to COVID-19 in Brazil: Highlighting Social Inequalities

In Brazil, almost 39 million students enrolled in public schools and more than two million in public universities have no classes for more than three months in 2020. Most schools and universities funded by the government suspended teaching activities in March 2020 and did not reopen until mid-July. Meanwhile, students enrolled in private schools and universities were using different kinds of technological resources to continue educational activities. The private sector was creating their own solutions, while public ones were being left behind. In addition to the COVID-19 pandemic, the country is amid a crisis in education. The Brazilian President is part of right-wing populism and has led a coronavirus-denial movement. His inability to lead in times of crisis and to coordinate actions to promote positive results for all became evident. Brazil does not appear to have a plan that drives the public education system during the pandemic context and social inequalities have become more evident. [ABSTRACT FROM AUTHOR] Copyright of International Studies in Educational Administration (Commonwealth Council for Educational Administration & Management (CCEAM)) is the property of Commonwealth Council for Educational Administration & Management (CCEAM) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Clinical, cerebrospinal fluid, and neuroimaging findings in COVID-19 encephalopathy: a case series.

OBJECTIVE: To describe the clinical, neurological, neuroimaging, and cerebrospinal fluid (CSF) findings associated with encephalopathy in patients admitted to a COVID-19 tertiary reference center. METHODS: We retrospectively reviewed records of consecutive patients with COVID-19 evaluated by a consulting neurology team from March 30, 2020 through May 15, 2020. RESULTS: Fifty-five patients with confirmed SARS-CoV-2 were included, 43 of whom showed encephalopathy, and were further divided into mild, moderate, and severe encephalopathy groups. Nineteen patients (44%) had undergone mechanical ventilation and received intravenous sedatives. Eleven (26%) patients were on dialysis. Laboratory markers of COVID-19 severity were very common in encephalopathy patients, but did not correlate with the severity of encephalopathy. Thirty-nine patients underwent neuroimaging studies, which showed mostly non-specific changes. One patient showed lesions possibly related to CNS demyelination. Four had suffered an acute stroke. SARS-CoV-2 was detected by RT-PCR in only one of 21 CSF samples. Two CSF samples showed elevated white blood cell count and all were negative for oligoclonal bands. In our case series, the severity of encephalopathy correlated with higher probability of death during hospitalization (OR = 5.5 for each increment in the degree of encephalopathy, from absent (0) to mild (1), moderate (2), or severe (3), p < 0.001). CONCLUSION: In our consecutive series with 43 encephalopathy cases, neuroimaging and CSF analysis did not support the role of direct viral CNS invasion or CNS inflammation as the cause of encephalopathy.

A systematic review of vertical transmission and antibodies against SARS-CoV-2 among infants born to mothers with COVID-19 (preprint)

Amidst the Coronavirus Disease 2019 (COVID-19) pandemic, evidence on vertical transmission and natural passive immunity among the newborns exposed to COVID-19 is scanty and varies. This pose a challenge on preventive interventions for the newborns. We conducted a systematic review to first, determine the likelihood of vertical transmission among COVID-19 exposed infants and second, determine whether antibodies against Severe Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)/ COVID-19 virus exist among COVID-19 vertically exposed but negative infants. This review registered in PROSPERO searched evidence from PubMed/ MEDLINE and Google Scholar, among others. About 517 studies were retrieved, where only 33 articles (5.8%) qualified for final analysis. A total of 205 infants born to SARS-CoV-2 positive mothers were pooled from 33 eligible studies. Overall, 6.3% (13/205; 95%CI: 3.0%-9.7%) of the infants tested positive for COVID-19 virus at birth. Of 33 eligible studies, 6 studies (18.8%) reported about IgG/IgM against SARS-CoV-2. Anti-SARS-CoV-2 IgG/IgM were detected in 90% (10/11; 95%CI: 73.9%-107.9%) of infants who had no COVID-19 but vertically exposed. In conclusion, the current evidence revealed a low possibility of vertical transmission of COVID-19 while antibodies against SARS-CoV-2 were detected in most of the infants who had no COVID-19. Further studies on perinatal outcomes and the magnitude of natural passive immunity in infants born to mothers with COVID-19 are warranted.