ABSTRACT
To tackle the spread of COVID-19 since its outbreak in January 2020, the police have been given additional powers in Taiwan. Studies have consistently revealed that police legitimacy, the belief that the police are trustworthy and allowed to exercise their authority to maintain order, is the main factor determining whether people are willing to cooperate with the police and comply with laws. This paper explores police legitimacy in Taiwan in terms of whether it exists and whether the Taiwanese police have built or damaged their legitimacy during the unprecedented challenges presented by the COVID-19 pandemic. Using the relevant literature, historical events, public opinion survey results, and official crime data, we find that police legitimacy existed before and has continued to exist during the pandemic in Taiwan.
ABSTRACT
Background. People living with HIV (PLHIV) suffer from adverse outcomes of metabolic syndrome. We hypothesized the COVID-19 pandemic, particularly with the stay-at-home status in 2020, resulted in physical inactivity and dietary changes leading to increases in weight and body mass index (BMI). Methods. This retrospective observational chart review evaluated PLHIV at an infectious diseases clinic with a documented BMI from 2017 to 2020. Data on patients' demographics, comorbidities, and antiretroviral therapy (ART) as of 2020 and the yearly values of BMI, A1c, and LDL from 2017 to 2020 were collected. Results. Among 256 HIV-infected persons, mean age+/-SD was 48.5+/-13.1 (median= 51;Q1-Q3: 39.5-57.5;range: 20-78) and 95 (37%) were female. Mean BMI were 28.19+/-6.32, 28.44+/-5.95, 28.57+/-5.91, and 29.00+/-6.09 for 2017, 2018, 2019, and 2020 respectively. Unadjusted and adjusted analysis showed a significant difference in BMI across time, where the mean BMI in 2020 was significantly higher than in 2017 (p< 0.0001), 2018 (p< 0.0001), and 2019 (p< 0.0001). Furthermore, for each consecutive year prior to 2019, there was no significant difference in mean BMI (2017 vs. 2018, p< 0.3464;2018 vs. 2019, p< 0.4671;2017 vs. 2019, p< 0.0861). There was a significant difference in A1c when adjusting for age, sex, race, and ART (Geometric Mean: 5.64, 5.68, 5.68, 5.78 for 2017 through 2020), with the visit year 2020 being significantly higher than 2017 (p< 0.003) and 2019 (p< 0.023) but not 2018 (p< 0.092). There were no significant differences in annual LDL using the same variables for adjustment. Body mass index (BMI) increased over time from 2017 to 2020 Mean BMI were 28.2+/-6.3, 28.4+/-5.9, 28.6+/-5.9, and 29.0+/-6.1 for 2017, 2018, 2019, and 2020 respectively. Pairwise comparison of BMI from 2017 to 2020 Unadjusted and adjusted analysis showed a significant difference in BMI across time, where the mean BMI in 2020 was significantly higher than in 2017 (p<0.0001), 2018 (p<0.0001), and 2019 (p<0.0001). Furthermore, for each consecutive year prior to 2019, there was no significant difference in mean BMI (2017 vs. 2018, p<0.3464;2018 vs. 2019, p<0.4671;2017 vs. 2019, p<0.0861). Conclusion. Among PLHIV at our clinic, there was a substantial BMI increase in 2020, possibly due to the stay-at-home status in early 2020. A previous study utilized questionnaires to estimate the weight change in this patient population but this is the first report of documented BMI in the clinic setting. It is important to note that the magnitude of these differences was small and should be interpreted with caution. On the other hand, depending on a person's initial height and weight, a one-unit change in BMI may translate to a substantial weight gain, which can be meaningful.
ABSTRACT
Background. We studied the safety and efficacy of the use of monoclonal antibodies (MAB) against SARS-CoV-2 in pregnant women who developed COVID-19 infection. Methods. We conducted a cross-sectional descriptive multi-center study of pregnant patients who developed SARS-CoV-2 infection from January 2021 to January 2022 and received MAB therapy. Primary outcomes assessed were infusion-related adverse events and pregnancy outcomes within one month of MAB infusion. The secondary outcomes assessed were hospitalization and ICU admission for COVID19 infection and thirty-day all-cause mortality. Results. 141 patients were included in the study (median age 33 +/- 5.3 SD, median BMI 28.9 +/- 8.42 SD). In terms of COVID vaccination status, 49.6% received one dose, 36.1% were fully vaccinated, and 7% received the booster dose. Most patients received casirivimab/imdevimab (105, 74.5%) followed by sotrovimab (33, 23.4%). Four patients developed adverse reactions to MAB infusion (two grade-2 reactions and two grade-1 reactions as per the National cancer institute infusion reaction grading criteria). Only one patient (0.7%) was hospitalized for COVID-19 infection, however, she was not hypoxic nor required ICU admission. Five patients delivered within four weeks of MAB administration, however, four of those patients were of gestational age > 37 weeks. Data for 30-day all-cause mortality was available on 88.7% (125) of the patients and data for 30-day pregnancy adverse outcomes was available on 86.5% (122) of the patients due to lack of follow-up within the Health System. There was no reported 30-Day all-cause mortality within the cohort. Two patients (1.4%) had premature rupture of the membrane and one patient (0.7%) had premature delivery within 30 days of receiving MAB. Two patients had preeclampsia (1.4%) and one patient (0.7%) was admitted for evaluations of decreased fetal movements. Conclusion. Administration of monoclonal antibodies against SARS-CoV-2 was well tolerated during pregnancy. Only 4 out of 141 (2.8%) had mild to moderate infusion-related reactions. The 30-day pregnancy adverse outcomes observed were well below the mean background rate. There was no reported mortality among MAB recipients and only one patient was hospitalized for mild COVID19 infection.
ABSTRACT
Background. Over 600,000 SARS-CoV-2 infections and 20,000 deaths have occurred among users of the Veterans Health Administration, the US's largest integrated health care system. We explored early outcomes of SARS-COV-2 infection in Veterans. Methods. An ongoing, prospective longitudinal cohort study of Veterans ages >= 18 enrolled 1,826 participants (29.0% inpatient;49.1% vaccinated;68.3% SARS-CoV-2-positive;85.0% male, mean age = 57.1 years) seeking inpatient or outpatient care after SARS-CoV-2 testing at 15 Department of Veterans Affairs medical centers in July 2020 to February 13, 2022. Using multivariable regression, we estimated relationships of baseline demographic characteristics, COVID-19 vaccination, and clinical history to illness severity and cumulative length of hospital stay within 60 days of study entry. Illness severity was defined by a Veterans Affairs adaptation of the WHO COVID-19 severity scale and included 4 levels (mild, moderate, severe, or death). We derived the Charlson co-morbidity index (CCI) and other baseline characteristics from electronic health data and study questionnaires, and reported qualitative SARS-CoV-2 IgG responses using inpatients' study-collected blood specimens. Results. High CCI scores (>= 5) occurred in 47 (42.7%) vaccinated SARS-CoV-2-positive inpatients and 47 (21.2%) unvaccinated. Severe illness occurred in 17 (15.5%) vaccinated inpatients, 37 (16.7%) unvaccinated inpatients, 4 (0.9%) vaccinated outpatients, and 3 (0.7%) unvaccinated outpatients. Eleven (10%) of 110 vaccinated SARS-CoV-2-positive inpatients died, as did 15 (6.8%) of the 222 unvaccinated. In SARS-CoV-2-positive inpatients, a one-step higher CCI was associated with more severe illness (aOR 1.10, 95%CI 1.01-1.20) and more hospitalization days (aIRR 1.06, 95% CI 1.03-1.10), adjusting for vaccination status. Respectively, 93% of vaccinated and 63% of unvaccinated SARS-CoV-2 positive inpatients with baseline antibody results had an anti-spike IgG response. Conclusion. In an ongoing longitudinal cohort study of COVID-19 in US Veterans, comorbidity burden was higher among vaccinated than unvaccinated inpatients and was associated with more severe illness and hospitalization days, independent of vaccination status.
ABSTRACT
Background. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infected patients experience systemic inflammation and respiratory distress, which appears to be associated with increased cytokine release. During the peak of coronavirus disease 2019 (COVID-19), tocilizumab was used to treat critically ill patients with potential cytokine storm. However, tocilizumab has an increased risk of developing serious infections. Methods. This retrospective observational chart review was approved by Institutional Review Board and evaluated patients admitted from March to November 2020, who were SARS-CoV-2 positive and received tocilizumab for the treatment group and no tocilizumab for the control group. The primary endpoint is usage of antimicrobials. The secondary endpoints are development and outcomes of secondary infections and hospital length of stay and mortality. Chi-square test was used for categorical data and Mann-Whitney test was used for continuous data. Results. A total of 160 patients were included in analysis, with 80 in each arm. 60% of patients in the treatment group required antibiotics compared to 35% in the control group (p = 0.0015), with the highest usage of anti-MRSA coverage, betalactams, cephalosporins, and carbapenems in both groups. Antifungal therapy was required in 21.3% of patients in the tocilizumab group compared to 6.3% in the control group (p = 0.0059), with echinocandins being the most used class in both groups. The median days of antimicrobial use in the tocilizumab group was 14 (IQR 7, 24.5) compared to 9 (IQR 6.5, 19) in the control group (p = 0.3346). In the treatment group, 60% of patients developed a secondary infection compared to 35% of patients in the control group (p < 0.0017). Secondary infection treatment failure was observed in 75% of tocilizumab patients compared to 60.7% of control patients (p = 0.1910). In hospital mortality was 50% in patients who received tocilizumab compared to 27.5% in the control group (p < 0.0039). Conclusion. Patients on tocilizumab received more antimicrobials, but with a similar spectrum of antimicrobial coverage. Patients who received tocilizumab had higher odds of developing secondary infections and expiring during their hospital stay. There were similar durations of antimicrobial therapy and treatment outcomes.