Seasonal Influenza Vaccine and Frequency of adverse events in health workers receiving two doses of AstraZeneca vaccine: a retrospective cohort study (preprint)

Objectives Limited published study was found regarding the number of adverse reactions of the Covid-19 vaccine in relation with receiving seasonal influenza vaccine. The purpose of this study was to determine the relationship between receiving the seasonal influenza vaccine and the frequency of side effects of the AstraZeneca vaccine.Methods This retrospective cohort study was conducted on 780 Healthcare Workers (HWs). The interest outcome was the adverse reactions to the AstraZeneca vaccination. Generalized linear model was done to determine the relationship. Relative risk reduction (RRR) and number needed to vaccinate (NNV) indexes were also estimated.Results Majority (95.5%) of the HWs reported at least one side effect of AstraZeneca vaccine. The incidence risk ratio shows that the incidence of side effects decreased by 23% in HWs aged > 40 (compared to aged ≤ 40), 29% in male (compared to female), and 29% in the subjects who received influenza vaccine compared to people who have not received influenza vaccine. The estimation of RRR varied between 11%-69%. The NNV of influenza vaccine was 5–58 subjects.Conclusions Our findings quantitatively showed a range of risk of side effects caused by the AstraZeneca vaccine in relation to the seasonal influenza vaccine. In general, the high influenza vaccine coverage, older age, and male had a relatively protective effect against the number of side effects of the AstraZeneca vaccine.

Comparing the severity of Outcomes of SARS-CoV-2 between RT-PCR-positive and RT-PCR-negative Individuals in Iran Comparing the severity of Outcomes of SARS-CoV-2 between RT-PCR-positive and RT-PCR-negative Individuals in Iran (preprint)

The aim of this study was to compare the outcomes of SARS-CoV-2 RT-PCR-positive and RT-PCR negative Patients in Iran. This cohort study performed on 81393 patients with COVID-19 in six provinces of Iran during 2020. The studied variables include demographic and clinical. To examine the associations between RT-PCR test and death or ICU admission as dependent variable the multiple Bayesian logistic regression model was used by R software. 81393 individual (44.9 % female) with a mean age of 52.98 ± 20.8 years were included to the analysis. At all, 25434 tests (31.2 %) were positive RT-PCR, including 10772 men (44.9%) and 14662 women (55.1%). The multiple Bayesian logistic regression model showed a significant positive association between RT-PCR test results and COVID-19 mortality rate (OR: 1.46; 95% Crl: 1.29- 1.64). Also, males, older age, individual with chronic disease have higher risk of COVID-19 death, however, negative association observed between history of contact and COVID-19 death. We observed a significant inverse association between RT-PCR test results and ICU admission, while, the risk of ICU admission increased significantly by 1.2 times (95% Crl for odds ratio: 1.09, 1.34) among patients with negative RT-PCR test compared to positive RT-PCR test. People with positive RT-PCR test, male gender, older age, having a history of underlying disease have a higher risk of death and hospitalization in the ICU. Therefore, paying attention to these factors will be effective in reducing the risk of death and hospitalization in ICU.

The Association Between Healthcare Resources, Non-communicable Diseases, and Covid-19 Mortality: An Epidemiological Study of 139 Countries (preprint)

Background: To provide an overview of the worldwide association between hospital beds, the burden of non-communicable diseases (NCDs), and COVID-19 mortality.Methods: Data was extracted regarding COVID-19 deaths and cases from the Our World in Data as of March 23, 2021. The following data was obtained:1) NCDs disability-adjusted life years (DALYs), health-adjusted life expectancy, and the health access and quality index from the Global Burden of Disease study; 2) the number of hospital beds, physicians, nurses and midwives per population, and out-of-pocket payments from the WHO website. Using the multilevel generalized linear model, these variables’ independent associations with COVID-19 mortality rate ratio (MRR) was examined.Results: Hospital beds were associated with reduced COVID-19 mortality (MRR=0.47; 95% CI: 0.44 to 0.5) globally. During COVID-19 peak periods, despite a decreasing trend in COVID-19 MRR with increasing beds in high-income countries, the odds of mortality remained high even within the highest percentile of hospital beds (MRR=1.54 for 20th-40th and 1.06 for >60th bed percentile, respectively). On the contrary, in middle-income countries, an inverse association was observed between the number of hospital beds and COVID-19 mortality in both periods. NCD DALYs were associated with increased COVID-19 deaths, particularly during peak mortality periods in high-income countries. Death-to-case ratio increased by approximately two times during the peak vs non-peak mortality periods.Conclusions: COVID-19 is a syndemic interacting with non-communicable diseases and not only a pandemic. A comprehensive national healthcare plan against COVID-19 spread should include adequate measures to protect vulnerable patients with pre-existing chronic conditions.

The Association between Healthcare Resources, Non-Communicable Diseases, and COVID-19 Mortality: An Ecological Study of 162 Countries (preprint)

Background: To provide an overview of the worldwide association between hospital beds, the burden of non-communicable diseases (NCDs), and COVID-19 mortality.Methods: We extracted data regarding COVID-19 deaths and cases from the Our World in Data as of November 21, 2020. We also obtained the following data:1) NCDs disability-adjusted life years (DALYs), health-adjusted life expectancy, and the health access and quality index from the Global Burden of Disease study; 2) the number of hospital beds, physicians, nurses and midwives per population, and out-of-pocket payments from the WHO website; 3) income levels and population density from the World Bank database. Using the principal component approach and a multilevel generalised linear model, we examined these variables’ independent associations with COVID-19 mortality rate ratio (MRR).Findings: During the study period, 17.62 COVID-19 deaths per 100,000 population were reported globally (1.20 in low-, 13.43 in lower-middle-, 14.14 in upper-middle-, and 46.72 in high-income countries). Median age increased COVID-19 mortality. Hospital beds were associated with reduced COVID-19 mortality (MRR=0.62; 95% CI: 0.59, 0.64) globally. During COVID-19 peak periods, despite a decreasing trend in COVID-19 MRR with increasing beds in high-income countries, the odds of mortality remained high even within the highest percentile of hospital beds (MRR=2.99 for 20th - 40th and 1.51 for >60 th bed percentile, respectively). On the contrary, in middle-income countries, we observed an inverse association between the number of hospital beds and COVID-19 mortality in both periods. NCD DALYs were associated with increased COVID-19 deaths, particularly during peak mortality periods in high-income countries. Death-to-case ratio increased by approximately two times during the peak vs non-peak mortality periods.Interpretations: COVID-19 is a syndemic interacting with non-communicable diseases and not only a pandemic. A comprehensive national healthcare plan against COVID-19 spread should include adequate measures to protect vulnerable patients with pre-existing chronic conditions.Funding: None.Declaration of Interests: The authors declare no conflicts of interest to disclose.

Knowledge, Attitude and Behavior of Health Care Workers in the Prevention of COVID-19 (preprint)

Background Preserving the health of health care workers (HCWs) has now become one of the main concerns of all countries affected by the coronavirus. Maintaining the health of the hospital workers, especially the medical staff, requires knowledge and awareness, followed by proper behavior for disease prevention and transmission. The purpose of this study was to evaluate the knowledge, attitude and behavior of HCWs to ward patients with suspected or confirmed COVID-19.Methods A cross-sectional study was designed to assess the level of knowledge, attitude and behavior of 191 HCWs of Taleghani Hospital in Kermanshah toward patients with suspected or confirmed COVID-19. Responses to the checklists of demographic characteristics, knowledge, attitude, and behavior toward patients with COVID-19 were analyzed by SPSS 22.Results 191 subjects (118 females and 73 males) with a mean age of 34.7 ± 8.6 years participated in this study. The level of knowledge of HCWs in this study was excellent regarding the ways of transmitting the disease such as close contact with the patient with suspected Coronavirus (99%). According to their positions, participants had a significant difference in their knowledge of asymptomatic patients (P < 0.001). The study found that 14% of the HCWs did not have the necessary knowledge about the symptoms of COVID-19, indicating poor knowledge of the HCWs at the beginning of the disease epidemic. The results obtained from the evaluation of HCWs attitudes showed that some workers believed that protective and preventive measures should only be applied when managing people with severe symptoms (P < 0.001). Finally, there was a significant difference in behavior and adherence to protective and preventive measures between the participants when facing patients with severe symptoms and without symptoms of COVID-19 (P = 0.05).Conclusion Knowledge, attitude, and behavior toward COVID-19 infection and facing patients with severe and overt symptoms among health care workers in the hospital were Excellent, but these were insufficient for patients without obvious symptoms. These results suggest that additional training regarding subclinical cases of Coronavirus is needed for HCWs to protect them from contamination and prevent disease transmission to their colleagues and other patients as well.