ABSTRACT
This chapter deals with the Russian Federation's management of the COVID-19 crisis in its foreign policy through health diplomacy. First, it looks at Russia's strategy globally and then focuses on two case studies: Belarus and Italy. As shown by the analysis of the case studies, there have been at least two main phases in Russia's external response to the pandemic. In the first phase, Russia used health diplomacy and helped other countries (e.g., Italy) struggling with the pandemic, seeking to rebrand itself as a benevolent actor and generous actor. In the second phase, Russia took part in the vaccine race. As a result, it became the first country to register a COVID-19 vaccine—despite accusations of disregarding scientific standards—to boast its scientific excellence internationally and boost national pride among its citizens. Finally, the chapter acknowledges the spillovers of Russia's invasion of Ukraine for its health and vaccine diplomacy. Indeed, Russian companies and institutions must face the consequences of the war, which can further dilapidate the reputation built in the first phase of COVID-19 spreading. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
ABSTRACT
Purpose: Kidney transplant recipients are at increased risk of severe disease and death caused by Coronavirus-19 infection. The role of immunosuppressive medications in the clinical presentation, disease course, and outcomes is not well understood. Methods: We analyzed kidney transplant recipients diagnosed with Coronarvirus-19 infection during the initial infection surge requiring hospitalization at two large transplant centers in New Orleans, LA, between February 1, 2020, and April 30, 2020. Patient presentation, clinical course, kidney transplant function, and postdischarge details were included in this analysis. Results: Twenty-three kidney transplant recipients hospitalized with Coronavirus-19 infection were included in the study. The majority of the patients were black (95.7%). Diabetes, hypertension, and obesity were present in at least 50% of the patients. The most common presenting symptom was fever, present in 52.2% of patients. All patients were managed with a reduction in immunosuppression. 60.9% of patients received azithromycin, 47.8% received hydroxychloroquine, 8.7% received remdesivir, and 8.7% received IV methylprednisolone pulse. The average length of stay was approximately 4.5 days (range 2 to 18 days). 73.9% of the patients sustained acute kidney injury, with an average peak serum creatinine of 3.81 mg/dL. 26% of the patients required renal replacement therapy. 77% of patients developed proteinuria (at least +1 proteinuria on urinalysis). 37.5% of patients required mechanical ventilation, and of these, 77.8% died. Overall, 30.4% of patients died of Coronavirus-19 infection-related complications during admission. Of the 16 patients discharged, the average serum creatinine during the first follow-up visit was 2.09 mg/dL compared with an average preadmission serum creatinine of 1.76 mg/dL. Conclusions: During the initial Coronavirus-19 infection surge in New Orleans, we noted that kidney transplant recipients had initial symptoms similar to the general population. However, we recorded a high incidence of acute kidney injury and the need for renal replacement therapy. Patients who required mechanical ventilation had a high mortality rate. There was an over-representation of black patients.
ABSTRACT
Background: Kidney transplant recipients (KTR) are at an increased risk of severe disease and death caused by coronavirus-19 infection. There is a paucity of information on the evolution of graft function among hospitalized KTRs who overcome the infection. Methods: The study included adult KTRs at a single transplant institute who were diagnosed with Coronovirus-19 virus and needed hospitalization between March 15, 2020 and January 15, 2021. We analyzed patient demographics, comorbid risk factors, and inpatient clinical course for patients that were able to recover from the infection. Kidney function was analyzed pre-infection, during initial hospitalization and up to 12 months post infection. Results: We identified 48 kidney transplant recipients who were diagnosed with Coronavirus-19 infection during the study period. Eighteen KTRs among these needed hospitalization for symptoms of fever and respiratory distress. Four patients died of Coronavirus-19 infection related complications and were excluded from the study. The 14 remaining patients in the study were predominantly black (78%), with a median time since transplant of 4 years. 64% of the patients developed AKI, with an average peak serum creatinine of 2.64 mg/dl and GFR of 34. The mean serum creatinine and GFR of the group were 2mg/dl and 44 at baseline (prior to infection). This represented an increase in their serum creatinine and GFR of 34% and 29% respectively. The median follow-up post infection was 7.5 months. Serum creatinine and GFR were 1.83 mg/dl and 48 at 3 months, and 2.2 mg/dl and 40 at 6 months post infection. New onset proteinuria was noted in 5 out of the 14 patients (36%), with complete resolution of same in all at 3 months follow up. 75% patients with AKI had complete recovery at 3 month follow-up. The mean baseline GFR of patients who had incomplete recovery was 32. There was only 1 graft loss and this was in a patient who had chronic rejection and had a baseline Cr of 3.8 mg/dl at time of coronavirus-19 infection. Conclusions: AKI is common among KTRs that are hospitalized with Covid-19 infection. Most of these recover, although we noted that patients with baseline lower kidney function (GFR < 32) and existing proteinuria had a lower recovery rate.