Co-morbidity associated with development of severe COVID-19 before vaccine availability: a retrospective cohort study in the first pandemic year among the middle-aged and elderly in Jönköping county, Sweden.

BACKGROUND: In preparation of future pandemics, it is important to recognise population-level determinants associated with development of severe illness before efficient vaccines and evidence-based therapeutic measures are available. The aim of this study was to identify pre-pandemic diagnoses recorded in a middle-aged and elderly population that were associated with development of severe COVID-19 during the first pandemic year. METHODS: A cohort study design was used. Severe COVID-19 was defined as a course of illness that resulted in hospital admission or death. A retrospective analysis was performed that comprised all individuals aged 39 years and older (N = 189,951) living in Jönköping County, Sweden. All diagnosed morbidity recorded in contacts with health care during the pre-pandemic year 2019 was used to identify which diagnoses that were associated with development of severe COVID-19 in the first pandemic year 2020. The analyses were performed separately for each diagnosis using binary logistic regression with adjustment for sex and age. RESULTS: Severe COVID-19 was suffered by 0.67% (N = 1,280) of the middle-aged and elderly population in the first pandemic year. Individuals previously diagnosed with dementia, cerebral palsy, kidney failure, type 2 diabetes mellitus, hypertension, and obesity were at higher risk of developing severe COVID-19. For patients with Type 2 diabetes mellitus, the odds ratio (OR) was 2.18 (95% confidence interval, 1.92-2.48). Type 1 diabetes mellitus was not associated with increased risk. CONCLUSION: Diagnoses suggesting service provision at long-term healthcare facilities and co-morbidity with components of the metabolic syndrome were associated with an increased risk of developing severe COVID-19 in a middle-aged and elderly population before vaccines were available.

Fatalism, beliefs, and behaviors during the COVID-19 pandemic.

Little is known about how people's beliefs concerning the Coronavirus Disease 2019 (COVID-19) influence their behavior. To shed light on this, we conduct an online experiment ( n = 3 , 610 ) with US and UK residents. Participants are randomly allocated to a control group or to one of two treatment groups. The treatment groups are shown upper- or lower-bound expert estimates of the infectiousness of the virus. We present three main empirical findings. First, individuals dramatically overestimate the dangerousness and infectiousness of COVID-19 relative to expert opinion. Second, providing people with expert information partially corrects their beliefs about the virus. Third, the more infectious people believe that COVID-19 is, the less willing they are to take protective measures, a finding we dub the "fatalism effect". We develop a formal model that can explain the fatalism effect and discuss its implications for optimal policy during the pandemic.

Fatalism, beliefs, and behaviors during the COVID-19 pandemic

Little is known about how people’s beliefs concerning the Coronavirus Disease 2019 (COVID-19) influence their behavior. To shed light on this, we conduct an online experiment (

Endothelial glycocalyx damage in patients with severe COVID-19 on mechanical ventilation - A prospective observational pilot study.

BACKGROUND: Coronavirus disease (COVID-19) associated endotheliopathy and microvascular dysfunction are of concern. OBJECTIVE: The objective of the present single-center observational pilot study was to compare endothelial glycocalyx (EG) damage and endotheliopathy in patients with severe COVID-19 (COVID-19 group) with patients with bacterial pneumonia with septic shock (non-COVID group). METHODS: Biomarkers of EG damage (syndecan-1), endothelial cells (EC) damage (thrombomodulin), and activation (P-selectin) were measured in blood on three consecutive days from admission to the intensive care unit (ICU). The sublingual microcirculation was studied by Side-stream Dark Field (SDF) imaging with automatic assessment. RESULTS: We enrolled 13 patients in the non-COVID group (mean age 70 years, 6 women), and 15 in the COVID-19 group (64 years old, 3 women). The plasma concentrations of syndecan-1 were significantly higher in the COVID-19 group during all three days. Differences regarding other biomarkers were not statistically significant. The assessment of the sublingual microcirculation showed improvement on Day 2 in the COVID-19 group. Plasma levels of C-reactive protein (CRP) were significantly higher on the first two days in the COVID-19 group. Plasma syndecan-1 and CRP were higher in patients suffering from severe COVID-19 pneumonia compared to bacterial pneumonia patients. CONCLUSIONS: These findings support the role of EG injury in the microvascular dysfunction in COVID-19 patients who require ICU.

Fatalism, Beliefs, and Behaviors During the COVID-19 Pandemic

Little is known about how people’s beliefs concerning the Coronavirus Disease 2019 (COVID-19) influence their behavior. To shed light on this, we conduct an online experiment (n = 3,610) with US and UK residents. Participants are randomly allocated to a control group or to one of two treatment groups. The treatment groups are shown upperor lower-bound expert estimates of the infectiousness of the virus. We present three main empirical findings. First, individuals dramatically overestimate the dangerousness and infectiousness of COVID-19 relative to expert opinion. Second, providing people with expert information partially corrects their beliefs about the virus. Third, the more infectious people believe that COVID-19 is, the less willing they are to take protective measures, a finding we dub the “fatalism effect”. We develop a formal model that can explain the fatalism effect and discuss its implications for optimal policy during the pandemic.

Anthropological foundations of public health; the case of COVID 19.

OBJECTIVES: The complex societal spread of COVID-19 in the U.S. indicates a need to recognize sociocultural forces to best understand and respond to the pandemic. This essay describes four principles of anthropology and sister disciplines that underlie the theory and practice of public health. METHODS: Research following anthropological and related approaches is reviewed to provide examples of the four principles from COVID-19 in the U.S. RESULTS: 1. What counts as sickness, disease, injury, pathology, is fundamentally a matter of historically situated social ideas and values. 2. The ways in which societies are organized is a fundamental source of pathologies and their distributions within societies. 3. Conversely, health conditions can substantially alter the organization of societies. 4. Public health responses are social processes that affect intervention outcomes. CONCLUSIONS: Anthropological approaches are recommended to address several facets of public health practice: problem analysis, intervention design, evaluation, and the public health enterprise itself.

Estimating the COVID-Related Deaths Attributable to President Trump's Early Pronouncements About Masks.

The goal of this analysis is to estimate the proportion of COVID-19 deaths attributable to President Donald Trump's early pronouncements about voluntary mask use and his intention not to use masks. Data from available research were used to estimate parameters for the calculation of population attributable risk for COVID-19 deaths reported to date. Assuming Trump's pronouncement to have caused 25%, 50%, and 75% of the non-use of masks, estimates of Trump-attributable COVID-19 deaths to date would be, respectively, 4,244, 8,356, or 12,202. The effects of presidential pronouncements on health-related matters may have large public health consequences. Pronouncements of national leaders should be based on the best available science.