Mass Media Use to Learn About COVID-19 and the Non-intention to Be Vaccinated Against COVID-19 in Latin America and Caribbean Countries.

Background: The Latin American and Caribbean (LAC) region has been one of the regions most affected by the COVID-19 pandemic, with countries presenting some of the highest numbers of cases and deaths from this disease in the world. Despite this, vaccination intention is not homogeneous in the region, and no study has evaluated the influence of the mass media on vaccination intention. The objective of this study was to evaluate the association between the use of mass media to learn about COVID-19 and the non-intention of vaccination against COVID-19 in LAC countries. Methods: An analysis of secondary data from a Massachusetts Institute of Technology (MIT) survey was conducted in collaboration with Facebook on people's beliefs, behaviors, and norms regarding COVID-19. Crude and adjusted prevalence ratios (aPR) with their respective 95% confidence intervals (95%CI) were calculated to evaluate the association between the use of mass media and non-vaccination intention using generalized linear models of the Poisson family with logarithmic link. Results: A total of 350,322 Facebook users over the age of 18 from LAC countries were included. 50.0% were men, 28.4% were between 18 and 30 years old, 41.4% had a high school education level, 86.1% lived in the city and 34.4% reported good health condition. The prevalence of using the mass media to learn about COVID-19 was mostly through mixed media (65.8%). The non-intention of vaccination was 10.8%. A higher prevalence of not intending to be vaccinated against COVID-19 was found in those who used traditional media (aPR = 1.36; 95%CI: 1.29-1.44; p < 0.001) and digital media (aPR = 1.70; 95%CI: 1.24-2.33; p = 0.003) compared to those using mixed media. Conclusion: We found an association between the type of mass media used to learn about COVID-19 and the non-intention of vaccination. The use of only traditional or digital information sources were associated with a higher probability of non-intention to vaccinate compared to the use of both sources.

Beneficial and Harmful Effects of Monoclonal Antibodies for the Treatment and Prophylaxis of COVID-19: Systematic Review and Meta-Analysis.

BACKGROUND: We systematically assessed beneficial and harmful effects of monoclonal antibodies for coronavirus disease 2019 (COVID-19) treatment, and prophylaxis in individuals exposed to severe acute respiratory syndrome coronavirus 2. METHODS: We searched 5 engines and 3 registries until November 3, 2021 for randomized controlled trials evaluating monoclonal antibodies vs control in hospitalized or non-hospitalized adults with COVID-19, or as prophylaxis. Primary outcomes were all-cause mortality, COVID-19-related death, and serious adverse events; hospitalization for non-hospitalized; and development of symptomatic COVID-19 for prophylaxis. Inverse variance random effects models were used for meta-analyses. Grading of Recommendations, Assessment, Development, and Evaluations methodology was used to assess certainty of evidence. RESULTS: Twenty-seven randomized controlled trials were included: 20 in hospitalized patients (n = 8253), 5 in non-hospitalized patients (n = 2922), and 2 in prophylaxis (n = 2680). In hospitalized patients, monoclonal antibodies slightly reduced mechanical ventilation (relative risk [RR] 0.74; 95% confidence interval [CI], 0.60-0.9; I2 = 20%, low certainty of evidence) and bacteremia (RR 0.77; 95% CI, 0.64-0.92; I2 = 7%, low certainty of evidence); evidence was very uncertain about the effect on adverse events (RR 1.31; 95% CI, 1.02-1.67; I2 = 77%, very low certainty of evidence). In non-hospitalized patients, monoclonal antibodies reduced hospitalizations (RR 0.30; 95% CI, 0.17-0.53; I2 = 0%, high certainty of evidence) and may slightly reduce serious adverse events (RR 0.47; 95% CI, 0.22-1.01; I2 = 33%, low certainty of evidence). In prophylaxis studies, monoclonal antibodies probably reduced viral load slightly (mean difference -0.8 log10; 95% CI, -1.21 to -0.39, moderate certainty of evidence). There were no effects on other outcomes. CONCLUSIONS: Monoclonal antibodies had limited effects on most of the outcomes in COVID-19 patients, and when used as prophylaxis. Additional data are needed to determine their efficacy and safety.

C-Reactive Protein-to-Albumin Ratio and Clinical Outcomes in COVID-19 Patients: A Systematic Review and Meta-Analysis.

C-reactive protein-to-albumin ratio (CAR) is an independent risk factor in cardiovascular, cerebrovascular, and infectious diseases. Through this study, we investigated the CAR values with respect to the severity and mortality of COVID-19 patients. We performed a systematic review and meta-analysis to retrieve studies that evaluated CAR values upon hospital admission in relation to the severity or mortality of COVID-19 patients. We adopted a random-effect model to calculate the pooled mean difference (MD) and their 95% confidence intervals (CI). Quality assessment was appraised using a Newcastle-Ottawa scale and publication bias was assessed using the Begg-test and funnel plot. We equally performed a subgroup analysis using study location and a sensitivity analysis only with studies with low risk of bias. We analyzed 32 studies (n = 12445). Severe COVID-19 patients had higher on-admission CAR values than non-severe COVID-19 patients (MD: 1.69; 95% CI: 1.35-2.03; p < 0.001; I2 = 89%). Non-survivor patients with COVID-19 had higher CAR values than survivor patients (MD: 2.59; 95% CI: 1.95-3.23; p < 0.001; I2 = 92%). In sensitivity analysis, the relationship remained with a decreasing of heterogeneity for severity (MD: 1.22; 95% CI: 1.03-1.40; p < 0.001; I2 = 13%) and for mortality (MD: 2.99; 95% CI: 2.47-3.51; p < 0.001; I2 = 0%). High CAR values were found in COVID-19 patients who developed severe disease or died.

Prevalence of parents' non-intention to vaccinate their children and adolescents against COVID-19: A comparative analysis in Colombia and Peru.

We aimed to estimate the prevalence and factors associated with parents' non-intention to vaccinate their children and adolescents against COVID-19 in Colombia and Peru. We performed a secondary analysis using a database generated by the University of Maryland and Facebook (Facebook, Inc). We Included adult (18 and over) Facebook users residing in LAC who responded to the survey between May 20, and November 5, 2021. We Included sociodemographic characteristics, comorbidities, mental health, economic and food insecurity, compliance with mitigation strategies against COVID-19, and practices related to vaccination against this disease. We estimated crude (cPR) and adjusted (aPR) prevalence ratios with their respective 95 %CI. We analyzed a sample of 44,678 adults from Colombia and 24,302 from Peru. The prevalence of parents' non-intention to vaccinate their children and adolescents against COVID-19 was 7.41 % (n = 3,274) for Colombia and 6.64 % (n = 1,464) for Peru. In Colombia, age above 35 years old, compliance with physical distancing, use of masks, having economic insecurity, anxiety symptoms, having a chronic condition or more comorbidities, and being vaccinated were associated with a higher probability of vaccinating children and adolescents against COVID-19. In Peru, female gender, compliance with physical distancing, use of masks, having economic insecurity, anxiety symptoms, having a chronic condition or more comorbidities, having had COVID-19, and being vaccinated were associated with a higher probability of vaccinating children against COVID-19. Living in a town, a village, or a rural area was associated with a higher prevalence of non-intention to vaccinate children and adolescents against COVID-19. About 9 out of 10 parents in Colombia and Peru intend to vaccinate their children and adolescents against COVID-19. This intention is associated with some factors which are similar between the two countries, as well as other factors and variations among the different regions of each country.

Efficacy of early treatment with hydroxychloroquine in people with mild to moderate COVID-19: a systematic review and meta-analysis.

Introduction: No early treatment intervention for COVID-19 has proven effective to date. We systematically reviewed the efficacy of hydroxychloroquine as early treatment for COVID-19. Material and methods: Randomized controlled trials (RCTs) evaluating hydroxychloroquine for early treatment of COVID-19 were searched in five engines and preprint websites until September 14, 2021. Primary outcomes were hospitalization and all-cause mortality. Secondary outcomes included COVID-19 symptom resolution, viral clearance, and adverse events. Inverse variance random-effects meta-analyses were performed and quality of evidence (QoE) per outcome was assessed with GRADE methods. Results: Five RCTs (n = 1848) were included. The comparator was placebo in four RCTs and usual care in one RCT. The RCTs used hydroxychloroquine total doses between 1,600 and 4,400 mg and had follow-up times between 14 and 90 days. Compared to the controls, early treatment with hydroxychloroquine did not reduce hospitalizations (RR = 0.80, 95% CI: 0.47-1.36, I 2 = 2%, 5 RCTs, low QoE), all-cause mortality (RR = 0.77, 95% CI: 0.16-3.68, I 2 = 0%, 5 RCTs, very low QoE), symptom resolution (RR = 0.94, 95% CI: 0.77-1.16, I 2 = 71%, 3 RCTs, low QoE) or viral clearance at 14 days (RR = 1.02, 95% CI: 0.82-1.27, I 2 = 65%, 2 RCTs, low QoE). There was a larger non-significant increase of adverse events with hydroxychloroquine vs. controls (RR = 2.17, 95% CI: 0.86-5.45, I 2 = 92%, 5 RCTs, very low QoE). Conclusions: Hydroxychloroquine was not efficacious as early treatment for COVID-19 infections in RCTs with low to very low quality of evidence for all outcomes. More RCTs are needed to elucidate the efficacy of hydroxychloroquine as early treatment intervention.

Mass Media Use to Learn About COVID-19 and the Non-intention to Be Vaccinated Against COVID-19 in Latin America and Caribbean Countries

Background The Latin American and Caribbean (LAC) region has been one of the regions most affected by the COVID-19 pandemic, with countries presenting some of the highest numbers of cases and deaths from this disease in the world. Despite this, vaccination intention is not homogeneous in the region, and no study has evaluated the influence of the mass media on vaccination intention. The objective of this study was to evaluate the association between the use of mass media to learn about COVID-19 and the non-intention of vaccination against COVID-19 in LAC countries. Methods An analysis of secondary data from a Massachusetts Institute of Technology (MIT) survey was conducted in collaboration with Facebook on people's beliefs, behaviors, and norms regarding COVID-19. Crude and adjusted prevalence ratios (aPR) with their respective 95% confidence intervals (95%CI) were calculated to evaluate the association between the use of mass media and non-vaccination intention using generalized linear models of the Poisson family with logarithmic link. Results A total of 350,322 Facebook users over the age of 18 from LAC countries were included. 50.0% were men, 28.4% were between 18 and 30 years old, 41.4% had a high school education level, 86.1% lived in the city and 34.4% reported good health condition. The prevalence of using the mass media to learn about COVID-19 was mostly through mixed media (65.8%). The non-intention of vaccination was 10.8%. A higher prevalence of not intending to be vaccinated against COVID-19 was found in those who used traditional media (aPR = 1.36;95%CI: 1.29–1.44;p < 0.001) and digital media (aPR = 1.70;95%CI: 1.24–2.33;p = 0.003) compared to those using mixed media. Conclusion We found an association between the type of mass media used to learn about COVID-19 and the non-intention of vaccination. The use of only traditional or digital information sources were associated with a higher probability of non-intention to vaccinate compared to the use of both sources.

Consumption of Herbal Supplements or Homeopathic Remedies to Prevent COVID-19 and Intention of Vaccination for COVID-19 in Latin America and the Caribbean.

Users of complementary and alternative medicine (CAM) have a lower intention to receive vaccines. Furthermore, Latin America and the Caribbean (LAC) region are among the most affected areas by the COVID-19 pandemics and present a high proportion of CAM users. Therefore, this study evaluates the association between the consumption of herbal supplements or homeopathic remedies to prevent COVID-19 and the intention to vaccinate against COVID-19 in the LAC region. We conducted a secondary data analysis of a Massachusetts Institute of Technology (MIT) survey with Facebook to assess COVID-19 beliefs, behaviours, and norms. Crude and adjusted prevalence ratios (aPR) with their respective 95% confidence intervals (95% CI) were calculated using generalized linear models of the Poisson family with the log link function. The prevalence of the use of products to prevent COVID-19 was the following: consumption of herbal supplements (7.2%), use of homeopathic remedies (4.8%), and consumption of garlic, ginger, and lemon (11.8%). An association was found between using herbal supplements (19.0% vs. 12.8%; aPR = 1.44; 95% CI: 1.30-1.58), the use of homeopathic remedies (20.3% vs. 12.3%; aPR = 1.58; 95% CI: 1.25-1.98), and the consumption of garlic, ginger, and lemon (18.9% vs. 11.9%; aPR = 1.55; 95% CI: 1.50-1.61) and non-intention to vaccinate against COVID-19. In the LAC population, there is an association between using herbal supplements, using homeopathic remedies and consuming garlic, ginger, and lemon to prevent infection by COVID-19 and non-intention to vaccinate against this disease. Therefore, it is necessary to design targeted strategies for groups that consume these products as preventive measures against COVID-19 to increase vaccination coverage and expand the information regarding transmission and prevention strategies for SARS-CoV-2.

Efficacy and harms of tocilizumab for the treatment of COVID-19 patients: A systematic review and meta-analysis.

INTRODUCTION: We systematically assessed benefits and harms of tocilizumab (TCZ), which is an antibody blocking IL-6 receptors, in hospitalized COVID-19 patients. METHODS: Five electronic databases and two preprint webpages were searched until March 4, 2021. Randomized controlled trials (RCTs) and inverse probability treatment weighting (IPTW) cohorts assessing TCZ effects in hospitalized, COVID-19 adult patients were included. Primary outcomes were all-cause mortality, clinical worsening, clinical improvement, need for mechanical ventilation, and adverse events (AE). Inverse variance random-effects meta-analyses were performed with quality of evidence (QoE) evaluated using GRADE methodology. RESULTS: Nine RCTs (n = 7,021) and nine IPTW cohorts (n = 7,796) were included. TCZ significantly reduced all-cause mortality in RCTs (RR 0.89, 95%CI 0.81-0.98, p = 0.03; moderate QoE) and non-significantly in cohorts (RR 0.67, 95%CI 0.44-1.02, p = 0.08; very low QoE) vs. control (standard of care [SOC] or placebo). TCZ significantly reduced the need for mechanical ventilation (RR 0.80, 95%CI 0.71-0.90, p = 0.001; moderate QoE) and length of stay (MD -1.92 days, 95%CI -3.46 to -0.38, p = 0.01; low QoE) vs. control in RCTs. There was no significant difference in clinical improvement or worsening between treatments. AEs, severe AEs, bleeding and thrombotic events were similar between arms in RCTs, but there was higher neutropenia risk with TCZ (very low QoE). Subgroup analyses by disease severity or risk of bias (RoB) were consistent with main analyses. Quality of evidence was moderate to very low in both RCTs and cohorts. CONCLUSIONS: In comparison to SOC or placebo, TCZ reduced all-cause mortality in all studies and reduced mechanical ventilation and length of stay in RCTs in hospitalized COVID-19 patients. Other clinical outcomes were not significantly impacted. TCZ did not have effect on AEs, except a significant increased neutropenia risk in RCTs. TCZ has a potential role in the treatment of hospitalized COVID-19 patients.

Gender Differences in Depressive and Anxiety Symptoms During the First Stage of the COVID-19 Pandemic: A Cross-Sectional Study in Latin America and the Caribbean.

Background: Previous studies have suggested that the pandemic impact on mental health could vary according to gender. We aimed to evaluate the gender influence in the prevalence of depressive and anxiety symptoms in Latin American and the Caribbean (LAC) countries in the first stage of the COVID-19 pandemic. Methods: We conducted a secondary analysis employing the Facebook-COVID-19 Symptom Survey developed by the University of Maryland. We categorized gender as men, women, and non-binary. The outcomes were the presence of anxiety or depressive symptoms, measured with two adapted questions extracted from the Kessler Psychological Distress Scale (K10). We used generalized linear models from the Poisson family, considering the survey's complex sampling. We calculated crude and adjusted prevalence ratios (PR) with their 95% confidence intervals (95% CI) and explored interactions with gender using the adjusted Wald test. Results: We included 1,338,320 adults from LAC countries; 48.0, 50.6, and 1.4% were men, women, and non-binary participants, respectively. The overall prevalence of anxiety or depressive symptoms was 44.8 and 46.6%, respectively. We found interactions between gender and the rest of the independent variables. In the non-binary group, the association between age and anxiety symptomatology was lost after an age of 55 years. Furthermore, whereas living in a town was associated with a lower prevalence of anxiety and depression symptomatology in men and women, this did not happen among non-binary individuals. Compliance with physical distancing was associated with a lower prevalence of anxiety and depression symptomatology among women (anxiety: PRa = 0.98; 95% CI = 0.97-0.99; p < 0.001, depression: PRa = 0.96; 95% CI = 0.95-0.97; p < 0.001) and only anxiety in non-binary participants (anxiety: PRa = 0.92; 95% CI = 0.88-0.98; p = 0.005). This was not evidenced among men participants (anxiety: PRa = 0.99; 95% CI = 0.96-1.01; p = 0.199, depression: PRa = 0.98; 95% CI = 0.96-1.00; p = 0.084). In addition, compliance with handwashing was associated with a higher prevalence of anxiety symptomatology among men (PRa = 1.06; 95% CI = 1.05-1.11; p < 0.001) and women participants (PRa = 1.03; 95% CI = 1.01-1.05; p = 0.016). Conclusion: Approximately 4 out of 10 participants had anxiety or depressive symptoms. Women and non-binary gender people had more symptoms of anxiety or depression. The factors associated with these symptoms varied according to gender. It is essential to evaluate gender-related strategies to improve mental health during the COVID-19 pandemic.

Ivermectin for the Treatment of Coronavirus Disease 2019: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

BACKGROUND: We systematically assessed benefits and harms of the use of ivermectin (IVM) in patients with coronavirus disease 2019 (COVID-19). METHODS: Published and preprint randomized controlled trials (RCTs) assessing the effects of IVM on adult patients with COVID-19 were searched until 22 March 2021 in 5 engines. Primary outcomes were all-cause mortality rate, length of hospital stay (LOS), and adverse events (AEs). Secondary outcomes included viral clearance and severe AEs (SAEs). The risk of bias (RoB) was evaluated using the Cochrane Risk of Bias 2.0 tool. Inverse variance random effect meta-analyses were performed, with quality of evidence (QoE) evaluated using GRADE methods. RESULTS: Ten RCTs (n = 1173) were included. The controls were the standard of care in 5 RCTs and placebo in 5. COVID-19 disease severity was mild in 8 RCTs, moderate in 1, and mild and moderate in 1. IVM did not reduce all-cause mortality rates compared with controls (relative risk [RR], 0.37 [95% confidence interval, .12-1.13]; very low QoE) or LOS compared with controls (mean difference, 0.72 days [95% confidence interval, -.86 to 2.29 days]; very low QoE). AEs, SAEs, and viral clearance were similar between IVM and control groups (low QoE for all outcomes). Subgroups by severity of COVID-19 or RoB were mostly consistent with main analyses; all-cause mortality rates in 3 RCTs at high RoB were reduced with IVM. CONCLUSIONS: Compared with the standard of care or placebo, IVM did not reduce all-cause mortality, LOS, or viral clearance in RCTs in patients with mostly mild COVID-19. IVM did not have an effect on AEs or SAEs and is not a viable option to treat patients with COVID-19.

Prevalence and factors associated with the intention to be vaccinated against COVID-19 in Peru. / Prevalencia y factores asociados a la intención de vacunarse contra la COVID-19 en el Perú.

OBJECTIVES: To estimate the prevalence and factors associated with the intention to be vaccinated (ITV) against COVID-19 in Peru. MATERIALS AND METHODS: Analytical cross-sectional study using the survey conducted by the University of Maryland, USA, on Facebook. The dependent variable is the ITV. Crude and adjusted prevalence ratios (PR) were calculated, with their 95% confidence intervals (95% CI) using generalized linear models of the Poisson family, in order to evaluate the association of sociodemographic variables, compliance with community mitigation strategies, symptoms of COVID-19, mental health and acceptance of vaccination before the recommendation (AVR) by various actors and health authorities, with the ITV. RESULTS: Data from 17,162 adults were analyzed. The overall prevalence of the ITV was 74.9%. A lower prevalence of the ITV was associated with the female sex (PR=0.95; 95% CI: 0.94-0.97), living in a town (PR=0.95; 95% CI: 0.91-0.99) or village or other rural area (PR=0.90; 95% CI: 0.86-0.93) and the AVR of politicians (PR=0.89; 95% CI: 0.87-0.92). Conversely, having COVID-19 symptoms (PR=1.06; 95% CI: 1.03-1.09), economic insecurity (PR=1.04; 95% CI: 1.01-1.06), fears of becoming seriously ill or that a family member becomes seriously ill from COVID-19 (PR=1.49; 95% CI: 1.36-1.64) and the AVR of family and friends (PR=1.10; 95% CI: 1.08-1.12), healthcare workers (PR=1.29; 95% CI: 1.26-1.32), World Health Organization (PR=1.34; 95% CI: 1.29-1.40) and government officials (PR=1.18; 95% CI: 1.15-1.22) was associated with a higher prevalence of the ITV. CONCLUSIONS: Three-quarters of the respondents had the ITV. There are potentially modifiable factors that could improve vaccine acceptance.

OBJETIVOS: Estimar la prevalencia y los factores asociados a la intención de vacunación (IDV) contra la COVID-19 en el Perú. MATERIALES Y MÉTODOS: Estudio transversal analítico utilizando una encuesta realizada por la Universidad de Maryland, EUA, en Facebook. La variable dependiente fue la IDV. Se calcularon razones de prevalencia (RP) crudas y ajustadas, con sus intervalos de confianza al 95% (IC95%), mediante modelos lineales generalizados de la familia Poisson para evaluar la asociación de variables sociodemográficas, el cumplimiento de estrategias comunitarias de mitigación, los síntomas de la COVID-19, la salud mental y la aceptación de la vacunación ante la recomendación (AVR) por diversos actores y autoridades sanitarias. RESULTADOS: Se analizaron los datos de 17 162 adultos. La prevalencia general de la IDV fue del 74,9%. Se asociaron a una menor prevalencia de la IDV ser de sexo femenino (RP = 0,95; IC95%: 0,94-0,97), vivir en un pueblo (RP = 0,95; IC95%: 0,91-0,99) o en una aldea u otra área rural (RP = 0,90; IC95%: 0,86-0,93) y la AVR de políticos (RP = 0,89; IC95%: 0,87-0,92). Contrariamente, tener síntomas de COVID-19 (RP = 1,06; IC95%: 1,03-1,09), inseguridad económica (RP = 1,04; IC95%: 1,01-1,06), miedo a enfermar o que un familiar enferme de COVID-19 (RP = 1,49; IC95%: 1,36-1,64) y la AVR de familiares y amigos (RP = 1,10; IC95%: 1,08-1,12), trabajadores de la salud (RP = 1,29; IC95%: 1,26-1,32), la Organización Mundial de la Salud (RP = 1,34; IC95%: 1,29-1,40) y funcionarios del gobierno (RP = 1,18; IC95%: 1,15-1,22) se asociaron con mayor prevalencia de IDV. CONCLUSIONES: Tres cuartas partes de los encuestados manifiestan IDV. Existen factores potencialmente modificables que podrían mejorar la aceptación de la vacuna.

COVID-19 symptomatology and compliance with community mitigation strategies in Latin America early during the COVID-19 pandemic.

INTRODUCTION: Community mitigation strategies (CMS) have demonstrated to be effective in the reduction of transmission and incidence of COVID-19, especially in the population with symptoms associated with the disease. The aim of this study was to evaluate the association between the presence of COVID-19 symptoms and adherence to CMS in Latin American adults. METHODS: We carried out a secondary analysis of a database developed by the University of Maryland and Facebook social network during the COVID-19 pandemic. We included Latin American adults that used the Facebook platform and participated in a survey conducted from April 23 to May 23, 2020. The principal outcome variable was reported compliance with the three main CMS (physical distancing, use of face masks, and hand washing). The exposure variable included symptoms suspicious for COVID-19 defined as the presence of three or more symptoms of an acute clinical case of COVID-19. We performed generalized linear models of the Poisson family with a logarithmic link function to evaluate the association between the presence of COVID-19 symptoms and reported compliance with CMS. We calculated crude and adjusted prevalence ratios (PR) with their 95% confidence intervals (95%CI). RESULTS: We analyzed 1,310,690 adults from Latin America; 48.1% were male and 42.9% were under 35 years of age. The prevalence of suspicious symptoms of COVID-19 was 18.5% and reported compliance with the three CMS was 45.3%. The countries with the highest proportion of reported compliance with the three CMS were Peru, Bolivia and Panama, while those with the lowest reported compliance were Costa Rica, Nicaragua and Honduras. In the adjusted model, people with suspicious symptoms for COVID-19 had a 14% lower compliance with the three CMS (aPR = 0.86; 95%CI: 0.85-0.87; p < 0.001). CONCLUSIONS: Less than half of the participants complied with the CMS, and those presenting suspicious symptoms for COVID-19 had lower reported compliance with the three CMS.

Prevalence and Factors Associated with Parents' Non-Intention to Vaccinate Their Children and Adolescents against COVID-19 in Latin America and the Caribbean.

We aimed to estimate the prevalence and factors associated with parents' non-intention to vaccinate their children and adolescents against COVID-19 in Latin America and the Caribbean (LAC). We performed a secondary analysis using a database generated by the University of Maryland and Facebook (Facebook, Inc., Menlo Park, CA, USA). We included adult (18 and over) Facebook users residing in LAC who responded to the survey between 20 May 2021 and 14 July 2021. We included sociodemographic characteristics, comorbidities, mental health, economic and food insecurity, compliance with mitigation strategies against COVID-19, and practices related to vaccination against this disease. We estimated the crude (cPR) and adjusted (aPR) prevalence ratios with their respective 95%CI. We analyzed a sample of 227,740 adults from 20 LAC countries. The prevalence of parents' non-intention to vaccinate their children and adolescents against COVID-19 was 7.8% (n = 15,196). An age above 35 years old, educational level above college, compliance with physical distancing, use of masks, having economic insecurity, having had COVID-19, anxiety symptoms, depressive symptoms, having a chronic condition or two or more comorbidities, and being vaccinated were associated with a lower prevalence of non-intention to vaccinate children and adolescents against COVID-19. Living in a town, a village, or a rural area was associated with a higher prevalence of non-intention to vaccinate children and adolescents against COVID-19. Approximately nine out of ten parents in LAC intended to vaccinate their children and adolescents against COVID-19. Our results allow for understanding parents' intentions to vaccinate children and adolescents and help promote and develop education strategies for national vaccination plans against COVID-19.

Prevalence and factors associated with food insecurity in Latin America and the Caribbean during the first wave of the COVID-19 pandemic.

OBJECTIVE: We assessed the prevalence of food insecurity (FI) and its associated factors in Latin American and the Caribbean (LAC) early during the COVID-19 pandemic. METHODS: We performed secondary data analysis of a survey conducted by Facebook and the University of Maryland. We included adults surveyed from April to May 2020. FI was measured by concerns about having enough to eat during the following week. Sociodemographic, mental health, and COVID-19-related variables were collected. We performed generalized Poisson regressions models considering the complex sampling design. We estimated crude and adjusted prevalence ratios with their 95% confidence intervals. RESULTS: We included 1,324,272 adults; 50.5% were female, 42.9% were under 35 years old, 78.9% lived in a city, and 18.6% had COVID-19 symptoms. The prevalence of food insecurity in LAC was 75.7% (n = 1,016,841), with Venezuela, Nicaragua, and Haiti with 90.8%, 86.7%, and 85.5%, respectively, showing the highest prevalence. Gender, area of residence, presence of COVID-19 symptoms, and fear of getting seriously ill or that a family member gets seriously ill from COVID-19 were associated with a higher prevalence of food insecurity. In contrast, increasing age was associated with a lower prevalence. CONCLUSION: The prevalence of food insecurity during the first stage of the COVID-19 pandemic in LAC was high and was associated with sociodemographic and COVID-19-related variables.

Efficacy and harms of convalescent plasma for treatment of hospitalized COVID-19 patients: a systematic review and meta-analysis.

INTRODUCTION: We systematically reviewed benefits and harms of convalescent plasma (CP) in hospitalized COVID-19 patients. MATERIAL AND METHODS: Randomized controlled trials (RCTs) and observational studies assessing CP effects on hospitalized, adult COVID-19 patients were searched until November 24, 2020. We assessed risk of bias (RoB) using Cochrane RoB 2.0 and ROBINS-I tools. Inverse variance random effect meta-analyses were performed. Quality of evidence was evaluated using GRADE methodology. Primary outcomes were all-cause mortality, clinical improvement, and adverse events. RESULTS: Five RCTs (n = 1067) and 6 cohorts (n = 881) were included. Three and 1 RCTs had some concerns and high RoB, respectively; and there was serious RoB in all cohorts. Convalescent plasma did not reduce all-cause mortality in RCTs of severe (RR = 0.60, 95% CI: 0.33-1.10) or moderate (RR = 0.60, 95% CI: 0.09-3.86) COVID-19 vs. standard of care (SOC); CP reduced all-cause mortality vs. SOC in cohorts (RR = 0.66, 95% CI: 0.49-0.91). Convalescent plasma did not reduce invasive ventilation vs. SOC in moderate disease (RR = 0.85, 95% CI: 0.47-1.55). In comparison to placebo + SOC, CP did not affect all-cause mortality (RR = 0.75, 95% CI: 0.48-1.16) or clinical improvement (HR = 1.07, 95% CI: 0.82-1.40) in severe patients. Adverse and serious adverse events were scarce, similar between CP and controls. Quality of evidence was low or very low for most outcomes. CONCLUSIONS: In comparison to SOC or placebo + SOC, CP did not reduce all-cause mortality in RCTs of hospitalized COVID-19 patients. Convalescent plasma did not have an effect on other clinical or safety outcomes. Until now there is no good quality evidence to recommend CP for hospitalized COVID-19 patients.

Cross-sectional analysis of COVID-19 vaccine intention, perceptions and hesitancy across Latin America and the Caribbean.

BACKGROUND: Determinants of vaccine acceptance are multifactorial, complex, and in most cases, context-dependent. We determined the prevalence of COVID-19 vaccination intention (VI) and fear of its adverse effects (FAE) as well as their associated factors in Latin America and the Caribbean (LAC). METHODS: We conducted a secondary cross-sectional analysis of a database collected by the University of Maryland and Facebook. We included participants aged 18 and over from LAC surveyed, January 15 to February 1, 2021. We evaluated VI, FAE, sociodemographic characteristics, COVID-19 symptomatology, compliance with community mitigation strategies, food and economic insecurity, mental health evaluation and the influence in VI when recommended by different stakeholders. We calculated crude and adjusted prevalence ratios with their 95%CIs. RESULTS: We analyzed 472,521 responses by Latin American adults, finding a VI and FAE prevalence of 80.0% and 81.2%, respectively. We found that female and non-binary genders were associated with a lower probability of VI and a higher probability of FAE. Besides, living in a town, village or rural area and economic insecurity was associated with a higher FAE probability. The fears of becoming seriously ill, a family member becoming seriously ill from COVID-19 and having depressive symptoms were associated with a higher probability of VI and FAE. CONCLUSION: Eight out of 10 adults in LAC have VI and FAE. The factors identified are useful for the development of communication strategies to reduce FAE frequency. It is necessary to guarantee mass vaccination and support the return of economic activities.

Statins reduce mortality in patients with COVID-19: an updated meta-analysis of 147 824 patients.

OBJECTIVES: There is conflicting evidence about the efficacy of statin use in regard to clinical outcomes in patients with coronavirus disease 2019 (COVID-19). A systematic review and meta-analysis was performed to examine the effect of statin use on mortality in COVID-19 patients. METHODS: The electronic databases were searched, from inception to March 3, 2021. Unadjusted and adjusted effect estimates with their 95% confidence intervals (95% CI) were pooled using random-effects models. RESULTS: Twenty-five cohort studies involving 147 824 patients were included. The mean age of the patients ranged from 44.9 to 70.9 years; 57% of patients were male and 43% were female. The use of statins was not associated with mortality when applying the unadjusted risk ratio (uRR 1.16, 95% CI 0.86-1.57; 19 studies). In contrast, meta-analyses of the adjusted odds ratio (aOR 0.67, 95% CI 0.52-0.86; 11 studies) and adjusted hazard ratio (aHR 0.73, 95% CI 0.58-0.91; 10 studies) showed that statins were independently associated with a significant reduction in mortality. Subgroup analyses showed that only chronic use of statins significantly reduced mortality according to the adjusted models. CONCLUSIONS: The use of statins was found to be associated with a lower risk of mortality in COVID-19 patients based on adjusted effects of cohort studies. However, randomized controlled trials are still needed to confirm these findings.

Prognostic value of neutrophil-to-lymphocyte ratio in COVID-19 patients: A systematic review and meta-analysis.

BACKGROUND: Neutrophil-to-lymphocyte ratio (NLR) is an accessible and widely used biomarker. NLR may be used as an early marker of poor prognosis in patients with COVID-19. OBJECTIVE: To evaluate the prognostic value of the NLR in patients diagnosed with COVID-19. METHODS: We conducted a systematic review and meta-analysis. Observational studies that reported the association between baseline NLR values (ie, at hospital admission) and severity or all-cause mortality in COVID-19 patients were included. The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS). Random effects models and inverse variance method were used for meta-analyses. The effects were expressed as odds ratios (ORs) and their 95% confidence intervals (CIs). Small study effects were assessed with the Egger's test. RESULTS: We analysed 61 studies (n = 15 522 patients), 58 cohorts, and 3 case-control studies. An increase of one unit of NLR was associated with higher odds of severity (OR 6.22; 95%CI 4.93 to 7.84; P < .001) and higher odds of all-cause mortality (OR 12.6; 95%CI 6.88 to 23.06; P < .001). In our sensitivity analysis, we found that 41 studies with low risk of bias and moderate heterogeneity (I2  = 53% and 58%) maintained strong association between NLR values and both outcomes (severity: OR 5.36; 95% CI 4.45 to 6.45; P < .001; mortality: OR 10.42 95% CI 7.73 to 14.06; P = .005). CONCLUSIONS: Higher values of NLR were associated with severity and all-cause mortality in hospitalised COVID-19 patients.