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Aims: We have shown previously in 93 individuals with type 1 diabetes using the FreeStyle Libre flash glucose monitor that the week after their first Covid-19 vaccination, the percent 'time in target range 3.9-10mmol/ l' (%TTR) average went from 55.2%-> 52.4% (effect size -5.1%) with 58% of people recording a fall. 47 (50%) people with HbA1c < 56mmol/mol %TTR went from 69.3-> 63.5 (-8.3%) and 24 (25%) people using insulin+oral treatment 56.7%-> 50.7% (-10.1%). We have now repeated the exercise after the most recent Covid-19 vaccination. Method(s): FreeStyle Libre data and medical records of the same patients from the previous study were examined for the week before and week after their most recent Covid-19 vaccination. () in the results section show change in %TTR as % of the prior value to show effect size. TTR% results from 2 weeks before and after were also considered. Result(s): Median time between vaccines was 38 weeks IQR (37-40). After the latest vaccination average %TTR average went from 51.1%-> 49.8% (-2.5%) with a reduction found in 54% of patients. Impact on the 39 patients with HbA1c < 56mmol/mol -% TTR from 66.2%-> 61.8% (-6.5%) and the 20 (25%) patients using insulin+oral %TTR from 48.2%-> 47.1% (-2.2%). 65% of the patients whose %TTR fell previously, fell again after this vaccination. Fortnight average %TTR 53.5%-> 52.1% (-2.7%) whereas in the previous study across fortnight %TTR 55.4%-> 54.0% (-2.4%). Conclusion(s): The perturbation effect on blood glucose with 1st Covid-19 vaccination was seen again in the latest vaccination but reduced in magnitude, confirming that a significant group of type 1 diabetes individuals' glycaemic control is still being impacted by the Covid-19 vaccination.
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Accurate data on health and economic outcomes are needed to evaluate policy responses to COVID-19. A potentially comprehensive health indicator is excess deaths, which shows the gap between all-cause deaths and deaths to be expected under normal circumstances. New Zealand's public health community has seized upon an excess deaths series that seemingly shows negative cumulative excess mortality in the first three years of COVID-19 - in other words, fewer deaths than expected. This is a flawed measure because it ignores changes in population growth. There was a rapid rise in deaths in New Zealand in the 2015-19 period, due to immigration-driven population growth rates of two percent per annum. This growth came almost to a standstill after the border closed in March 2020 so methods of extrapolating from the past to predict future deaths, to ascertain if actual deaths exceed the projection, must take account of this sharp change in population growth rates. Rather than New Zealand being unique, in having negative cumulative excess deaths in the COVID-19 era, as claimed by public health commentators, cumulative deaths are about four percent above expected deaths once population changes are accounted for. Several developed countries had better outcomes according to this indicator.
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As COVID-19 runs rampant across the globe, devastating many industries, entertainment has been particularly hard-hit. But Korean entertainment companies have adapted quickly to both generate income and connect fans with their favourite artists in new ways, the culmination of years of work to expand digital outreach, ensuring the industry is poised to make the switch when COVID hit. With a variety of live and pre-filmed interactive events and concerts, global K-pop fans ironically have more opportunity to participate directly in more events than ever before. But while online content has expanded access in many ways, it has also highlighted what it means to be a fan and to participate in a highly online, global fandom. This chapter uses a series of in-depth interviews with international K-pop fans who have participated in new, online forms of K-pop content to explore how the COVID-19 crisis has shifted priorities and access for fans. © 2023 selection and editorial matter, Sojin Lim;individual chapters, the contributors
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There is an ongoing debate regarding the economic consequences of public policies designed to curb public health crises, such as the COVID-19 pandemic. Many opponents of such policies claim that their economic costs may outweigh their health benefits. In this paper, we use synthetic control analysis to determine the impact of stay-at-home orders on weekly new jobless claims during the initial phase of the COVID-19 pandemic. Our analysis reveals that while new jobless claims spike following the stay-at-home orders, similar spikes are observed within our synthetic control. Specifically, we find that stay-at-home orders account for only 32 percent of the increase in new jobless claims, with the majority of the increase being driven by factors outside of the policy, such as the general spread of the virus and waning consumer confidence. © 2022, Academy of Economics and Finance.
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INTRODUCTION: Since early 2020 the whole world has been challenged by the SARS-CoV-2 virus (COVID-19), its successive variants and the associated pandemic caused. We have previously shown that for people living with type 2 diabetes (T2DM), the risk of being admitted to hospital or dying following a COVID-19 infection progressively decreased through the first months of 2021. In this subsequent analysis we have examined how the UK COVID-19 vaccination programme impacted differentially on COVID-19 outcomes in people with T1DM or T2DM compared to appropriate controls. METHODS: T1DM and T2DM affected individuals were compared with their matched controls on 3:1 ratio basis. A 28-day hospital admission or mortality was used as the binary outcome variable with diabetes status and vaccination for COVID-19 as the main exposure variables. RESULTS: A higher proportion of T1DM individuals vs their controls was found to be vaccinated at the point of their first recorded positive COVID-19 test when compared to T2DM individuals vs their controls. Regarding the 28-day hospital admission rate, there was a greater and increasing protective effect of subsequent vaccination dosage (one, two or three) in mitigating the effects of COVID-19 infection versus no vaccination in T1DM than in T2DM individuals when compared with matched controls. Similar effects were observed in T2DM for death. Across both diabetes and non-diabetes individuals, those at greater socio-economic disadvantage were more likely to test positive for COVID-19 in the early phase of the pandemic. For T2DM individuals socio-economic disadvantage was associated with a greater likelihood of hospital admission and death, independent of vaccination status. Age and male sex were also independently associated with 28-day hospital admission in T2DM and to 28-day mortality, independent of vaccination status. African ethnicity was also an additional factor for hospital admission in people with T2DM. CONCLUSION: A beneficial effect of COVID-19 vaccination was seen in mitigating the harmful effects of COVID-19 infection; this was manifest in reduced hospital admission rate in T1DM individuals with a lesser effect in T2DM when compared with matched controls, regarding both hospital admission and mortality. Socio-economic disadvantage influenced likelihood of COVID-19 confirmed infection and the likelihood of hospital admission/death independent of the number of vaccinations given in T2DM.
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Introduction At present, vaccines form the only mode of prophylaxis against COVID-19. The time needed to achieve mass global vaccination and the emergence of new variants warrants continued research into other COVID-19 prevention strategies. The severity of COVID-19 infection is thought to be associated with the initial viral load, and for infection to occur, viruses including SARS-CoV-2 must first penetrate the respiratory mucus and attach to the host cell surface receptors. Carrageenan, a sulphated polysaccharide extracted from red edible seaweed, has shown efficacy against a wide range of viruses in clinical trials through the prevention of viral entry into respiratory host cells. Carrageenan has also demonstrated in vitro activity against SARS-CoV-2. Methods and analysis A single-centre, randomised, double-blinded, placebo-controlled phase III trial was designed. Participants randomised in a 1:1 allocation to either the treatment arm, verum Coldamaris plus (1.2 mg iota-carrageenan (Carragelose®), 0.4 mg kappa-carrageenan, 0.5% sodium chloride and purified water), or placebo arm, Coldamaris sine (0.5% sodium chloride) spray applied daily to their nose and throat for 8 weeks, while completing a daily symptom tracker questionnaire for a total of 10 weeks. Primary outcome Acquisition of COVID-19 infection as confirmed by a positive PCR swab taken at symptom onset or seroconversion during the study. Secondary outcomes include symptom type, severity and duration, subsequent familial/household COVID-19 infection and infection with non-COVID-19 upper respiratory tract infections. A within-trial economic evaluation will be undertaken, with effects expressed as quality-adjusted life years. Discussion This is a single-centre, phase III, double-blind, randomised placebo-controlled clinical trial to assess whether carrageenan nasal and throat spray reduces the risk of development and severity of COVID-19. If proven effective, the self-administered prophylactic spray would have wider utility for key workers and the general population. Trial registration NCT04590365;ClinicalTrials.gov NCT04590365. Registered on 19 October 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06685-z.
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The rollout of booster doses of COVID-19 vaccines to the general population is controversial. The ratio of vaccine risk to benefits likely has swung more towards risk than during the original randomized trials, due to dose-dependent adverse events and to fixation of immune responses on a variant no longer circulating, yet the evidence underpinning mass use of boosters is weaker than was the evidence for the original vaccine rollout. In light of an unsatisfactory risk-evidence situation, aggregate weekly data on excess mortality in New Zealand are used here to study the impacts of rolling out booster doses. Instrumental variables estimates using a plausible source of exogenous variation in the rate of booster dose rollout indicate 16 excess deaths per 100,000 booster doses, totaling over 400 excess deaths from New Zealand's booster rollout to date. The value of statistical life of these excess deaths is over $1.6 billion. The age groups most likely to use boosters had 7-10 percentage point rises in excess mortality rates as boosters were rolled out while the age group that is mostly too young for boosters saw no rise in excess mortality.
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It is reported that the rapid, targeted partnership response from the Australian Centre for International Agricultural Research (ACIAR) is supporting research projects that build resilience and respond to challenges the COVID-19 pandemic has presented to agriculture in partner countries. The ACIAR Alumni Research Support Facility (ARSF) has supported 66 alumni to undertake research to help with the pandemic recovery. Starting in 2020 and continuing in 2021, the ARSF projects cover a range of topics designed to address issues of importance to communities in the partner countries.
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Background: Management of acute respiratory distress in patients with COVID-19 has changed over the course of the pandemic. The impact of length of time on High Flow Nasal Cannula (HFNC) prior to mechanical ventilation is unknown. Methods: This is a multi-center retrospective chart review of COVID-positive hospitalized patients, who received mechanical ventilation from March 2020- October 2021. The primary outcome variable was survival to discharge, variables collated included patient demographics, vital signs, comorbidities, including the Charlson comorbidity index (CCI), as well as critical care therapeutic and diagnostic interventions. Results: All COVID-19 positive patients, with respiratory failure who underwent mechanical ventilation across study sites were included (N=709), of which 318 (45%) were accrued in March-May 2020. Patients had an average age of 62 (SD=15) years, majority male (67%), and an average CCI of 3.65 (SD=3.11). The unadjusted mortality for mechanically ventilated patients in our cohort was 56% (n=397). 169 (54%) of the remaining 312 were discharged home. Mortality varied over the study period, with the highest noted Nov 1st 2020 - Jan.31st 2021 (N=141, 69.8%) compared to other time periods (47-53%, p<0.0001). Notably at this time patients had the longest duration of pre-intubation high-flow oxygen support (mean 6.3 days vs. 4.2 days overall), the highest rate of Non-Invasiave Positive Pressure Ventilation (NIPPV) utilization (49% vs. 33% overall) and the lowest PaO2 to FiO2 ratio (mean 125 vs. 139 overall) (p<0.01). Duration of HFNC was independently associated with a higher risk of post-intubation mortality: OR (95% CI) = 3.1 (1.8-5.4) for 3-7 days, 7.2 (3.8-13.7) for ≥8 days (reference: 1-2 days) (p<0.0001) (accounting for age, gender, BMI and CCI). Furthermore, the magnitude of this association was found to vary between age groups: for 3-7 days duration (ref: 1-2 days), OR = 4.8 (1.9 - 12.1) in ≥65 years old vs. 2.1 (1.0 - 4.6) in <65 years old. Notably, at 8 days or more of HFNC, the association with age was reversed for ≥8 days duration (ref: 1-2 days): OR = 5.3 (2.0 - 13.9) in ≥65 years old vs. 8.6 (3.7 - 20.0) for <65 years old. Conclusion: The prolonged use of high flow oxygenation prior to mechanical intubation increased the risk of mortality, particularly in young patients use of HFNC for 8 days or more was associated with significantly higher mortality.
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Introduction: In this study we set out to determine the relative likelihood of death following covid-19 infection in people with type 2 diabetes when compared to those without type 2 diabetes. Methods: Analysis of digital health record data was performed relating to people living in the Greater Manchester conurbation (population 2.82 million) who had a recorded diagnosis of type 2 diabetes and subsequent covid-19 confirmed infection. Each individual with type 2 diabetes (n = 13,807) was matched with three covid-19 infected non-diabetes controls (n = 39583). Results: For type 2 diabetes individuals, their mortality rate after a covid-19 positive test was 7.7% vs 6.0% in matched controls;the relative risk (RR) of death was 1.28. From univariate analysis performed within type 2 diabetes individuals, likelihood of death following covid-19 recorded infection was lower in people taking metformin, sodium glucose cotransporter-inhibitor 2(SGLT-2i) or glucagon-like peptide-1( GLP-1) agonist. A lower estimated glomerular filtration rate (eGFR) was associated with a higher mortality rate, as was hypertension history. Likelihood of death following covid-19 infection was also higher in those people with diagnosis of COPD/severe enduring mental illness, and in people taking aspirin/ clopidogrel/insulin. Smoking in people with type 2 diabetes significantly increased mortality rate. In combined analysis of type 2 diabetes patients/controls, multiple regression modelling indicated that factors independently relating to higher likelihood of death (accounting for 26% of variance) were: type 2 diabetes/age/ malegender/social deprivation (higher Townsend index). Conclusion: Following confirmed infection with covid- 19 a number of factors are associated with mortality in type 2 diabetes individuals. Prescription of metformin, SGLT-2is or GLP-1 agonists + non-smoking status associated with reduced risk of death for people with type 2 diabetes. Age/male sex/social disadvantage associated with an increased risk of death.
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One in three individuals have a >10% reduction in time in range in the week following COVID-19 vaccination.
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INTRODUCTION: Research is ongoing to increase our understanding of how much a previous diagnosis of type 2 diabetes mellitus (T2DM) affects someone's risk of becoming seriously unwell following a COVID-19 infection. In this study we set out to determine the relative likelihood of death following COVID-19 infection in people with T2DM when compared to those without T2DM. This was conducted as an urban population study and based in the UK. METHODS: Analysis of electronic health record data was performed relating to people living in the Greater Manchester conurbation (population 2.82 million) who had a recorded diagnosis of T2DM and subsequent COVID-19 confirmed infection. Each individual with T2DM (n = 13,807) was matched with three COVID-19-infected non-diabetes controls (n = 39,583). Data were extracted from the Greater Manchester Care Record (GMCR) database for the period 1 January 2020 to 30 June 2021. Social disadvantage was assessed through Townsend scores. Death rates were compared in people with T2DM to their respective non-diabetes controls; potential predictive factors influencing the relative likelihood of admission were ascertained using univariable and multivariable logistic regression. RESULTS: For individuals with T2DM, their mortality rate after a COVID-19 positive test was 7.7% vs 6.0% in matched controls; the relative risk (RR) of death was 1.28. From univariate analysis performed within the group of individuals with T2DM, the likelihood of death following a COVID-19 recorded infection was lower in people taking metformin, a sodium-glucose cotransporter 2 inhibitor (SGLT2i) or a glucagon-like peptide 1 (GLP-1) agonist. Estimated glomerular filtration rate (eGFR) and hypertension were associated with increased mortality and had odds ratios of 0.96 (95% confidence interval 0.96-0.97) and 1.92 (95% confidence interval 1.68-2.20), respectively. Likelihood of death following a COVID-19 infection was also higher in those people with a diagnosis of chronic obstructive pulmonary disease (COPD) or severe enduring mental illness but not with asthma, and in people taking aspirin/clopidogrel/insulin. Smoking in people with T2DM significantly increased mortality rate (odds ratio of 1.46; 95% confidence interval 1.29-1.65). In a combined analysis of patients with T2DM and controls, multiple regression modelling indicated that the factors independently relating to a higher likelihood of death (accounting for 26% of variance) were T2DM, age, male gender and social deprivation (higher Townsend score). CONCLUSION: Following confirmed infection with COVID-19 a number of factors are associated with mortality in individuals with T2DM. Prescription of metformin, SGLT2is or GLP-1 agonists and non-smoking status appeared to be associated with a reduced the risk of death for people with T2DM. Age, male sex and social disadvantage are associated with an increased risk of death.
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INTRODUCTION: Since early 2020 the whole world has been challenged by the SARS-CoV-2 virus and the associated global pandemic (Covid-19). People with diabetes are particularly at high risk of becoming seriously unwell after contracting this virus. METHODS: This population-based study included people living in the Greater Manchester conurbation who had a recorded diagnosis of type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) and subsequent Covid-19 infection. Each individual with T1DM (n = 862) or T2DM (n = 13,225) was matched with three Covid-19-infected non-diabetes controls. RESULTS: For individuals with T1DM, hospital admission rate in the first 28 days after a positive Covid-19 test was 10% vs 4.7% in age/gender-matched controls [relative risk (RR) 2.1]. For individuals with T2DM, hospital admission rate after a positive Covid-19 test was 16.3% vs 11.6% in age/gender-matched controls (RR 1.4). The average Townsend score was higher in T2DM (1.8) vs matched controls (0.4), with a higher proportion of people with T2DM observed in the top two quintiles of greatest disadvantage (p < 0.001). For Covid-19-infected individuals with T1DM, factors influencing admission likelihood included age, body mass index (BMI), hypertension, HbA1c, low HDL-cholesterol, lower estimated glomerular filtration rate (eGFR), chronic obstructive pulmonary disease (COPD) and being of African/mixed ethnicity. In Covid-19-infected individuals with T2DM, factors related to a higher admission rate included age, Townsend index, comorbidity with COPD/asthma and severe mental illness (SMI), lower eGFR. Metformin prescription lowered the likelihood. For multivariate analysis in combined individuals with T2DM/controls, factors relating to higher likelihood of admission were having T2DM/age/male gender/diagnosed COPD/diagnosed hypertension/social deprivation (higher Townsend index) and non-white ethnicity (all groups). CONCLUSION: In a UK population we have confirmed a significantly higher likelihood of admission in people with diabetes following Covid-19 infection. A number of factors mediate that increased likelihood of hospital admission. For T2DM, the majority of factors related to increased admission rate are common to the general population but more prevalent in T2DM. There was a protective effect of metformin in people with T2DM.
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AIMS: Evidence suggests that some people with type 1 diabetes mellitus (T1DM) experience temporary instability of blood glucose (BG) levels after COVID-19 vaccination. We aimed to assess this objectively. METHODS: We examined the interstitial glucose profile of 97 consecutive adults (age ≥ 18 years) with T1DM using the FreeStyle Libre® flash glucose monitor in the periods immediately before and after their first COVID-19 vaccination. The primary outcome measure was percentage (%) interstitial glucose readings within the target range 3.9-10 mmol/L for 7 days prior to the vaccination and the 7 days after the vaccination. Data are mean ± standard error. RESULTS: There was a significant decrease in the % interstitial glucose on target (3.9-10.0) for the 7 days following vaccination (mean 52.2% ± 2.0%) versus pre-COVID-19 vaccination (mean 55.0% ± 2.0%) (p = 0.030). 58% of individuals with T1DM showed a reduction in the 'time in target range' in the week after vaccination. 30% showed a decrease of time within the target range of over 10%, and 10% showed a decrease in time within target range of over 20%. The change in interstitial glucose proportion on target in the week following vaccination was most pronounced for people taking metformin/dapagliflozin + basal bolus insulin (change -7.6%) and for people with HbA1c below the median (change -5.7%). CONCLUSION: In T1DM, we have shown that initial COVID-19 vaccination can cause temporary perturbation of interstitial glucose, with this effect more pronounced in people talking oral hypoglycaemic medication plus insulin, and when HbA1c is lower.
Subject(s)
COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , Diabetes Mellitus, Type 1/blood , Glycemic Control , Vaccination , Adolescent , Adult , Aged , Blood Glucose/analysis , Blood Glucose/metabolism , Blood Glucose Self-Monitoring , COVID-19/epidemiology , Cohort Studies , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 1/therapy , Female , Glycated Hemoglobin/analysis , Glycated Hemoglobin/metabolism , Glycemic Control/methods , Glycemic Control/statistics & numerical data , Humans , Male , Middle Aged , Treatment Outcome , United Kingdom/epidemiology , Vaccination/methods , Vaccination/statistics & numerical data , Young AdultABSTRACT
The COVID-19 pandemic forced higher-education institutions to close campuses and pivot all face-to-face (F2F) instruction online. This transition to Crisis Distance Education (CDE) was unprecedented in scope and speed as it was implemented globally. We surveyed students in a large, introductory-level biology course to understand their opinions about the curricular changes we implemented, usefulness of resources we provided, and the extent to which they felt supported by course personnel during the transition to CDE. The survey included both Likert-scale and open-ended questions. In general, students had a positive opinion of the transition, particularly the option for synchronous or asynchronous participation in the remainder of the course. Students valued opportunities to communicate with course personnel, but gave mixed responses for whether more or less communication was desired. Students reported high use of graded resources, but low use of ungraded resources. Our results suggest that when faced with an unexpected transition to CDE, it is important to maintain regular, supportive, and synchronous communication, but also remain flexible for asynchronous participation. Grades and immediate point rewards were important factors motivating student use of e-resources and maintaining student engagement. These factors are important considerations when shifting instruction to CDE for a limited or extended time.