Covid-19 Vaccine Coverage among People with Hiv in the Vaccine Safety Datalink

Background: People with HIV (PWH) may be at increased risk for severe COVID-19 outcomes compared with people without HIV. However, COVID-19 vaccination coverage among PWH is largely unknown, especially among those with advanced HIV or comorbidities. Method(s): We conducted a cohort study to evaluate coverage of the initial COVID-19 vaccine primary series and factors associated with the completion in adult PWH (>=18 years) enrolled in 8 healthcare organizations participating in the Vaccine Safety Datalink (VSD) project during December 1, 2020- December 31, 2021. Completion of two doses of the Pfizer-BioNTech or Moderna mRNA COVID-19 vaccines or one dose of the single-dose Janssen COVID-19 vaccine was assessed. Multivariable analysis was conducted using a robust Poisson regression model to estimate the rate ratio (RR) for factors associated with primary series completion, accounting for follow-up time. Result(s): A total of 22,063 PWH were identified, among which 89% were male and 93% were viral suppressed (viral load, VL <=200 copies/ml). Chronic comorbid conditions were prevalent, with 25% having a Charlson comorbidity score of 1-2 and 13% having a score of 3 or greater. About 23% were overweight and 17% were obese. The majority (90%) completed the primary series and 1,782 PWH (8%) did not receive any dose during the study period. A rapid uptake was achieved within the 6 months after the national COVID-19 vaccination program launched on December 14, 2020. (Figure 1) PWH who received one dose of mRNA vaccine (i.e., partially vaccinated) were excluded (n=314) from the analysis for the primary series completion. Having received an influenza vaccination in the past 2 years was the strongest predictor of completion (RR=1.17, 95%CI: 1.15, 1.20). Males (RR= 1.06, 95%CI: 1.04-1.08) and those of Asian race (RR=1.05, 95%CI: 1.03-1.06, vs. White) were more likely to complete the primary series. However, PWH with baseline CD4 counts < 200 (RR=0.97, 95%CI: 0.94-0.99) and those failing to achieve viral suppression (VL= 201-10k: RR= 0.89, 95%CI: 0.85-0.94;VL >10k: RR= 0.92, 95%CI: 0.87-0.98) were less likely to complete the primary series. Body mass index, Charlson comorbidity score, and neighborhood household income level were not associated with completion. Conclusion(s): Coverage of the COVID-19 vaccine primary series was high in adult PWH in the VSD. However, targeted vaccination outreach is warranted for PWH with low CD4 counts and uncontrolled HIV viral load.

Extracorporeal membrane oxygenation in COVID-19-related acute respiratory distress syndrome-a Euroelso international survey

RATIONALE There is ongoing dispute whether COVID-19 related Acute Respiratory Distress Syndrome (CARDS) has unique physiology, setting it apart from 'classic' ARDS. While ECMO has proven valuable in the treatment of acute lung failure, little is known about when and how it should be used to support critically ill COVID-19 patients. METHODS We performed an international email survey to assess how ECMO providers worldwide have previously used ECMO during the treatment of critically ill patients with COVID-19. Questions targeted indications to begin ECMO, technical specifications, anticoagulation strategy and reasons for treatment discontinuation. RESULTS 276 centers worldwide responded that they employed ECMO for very severe COVID-19 cases, mostly in veno-venous configuration (87%). The most common reason to establish ECMO was isolated hypoxemic respiratory failure (50%), followed by a combination of hypoxemia and hypercapnia (39%). Only a small fraction of patients required veno-arterial cannulation due to heart failure (3%). Time on ECMO varied between less than two and more than four weeks. The main reason to discontinue ECMO treatment prior to patient's recovery was lack of clinical improvement (53%), followed by major bleeding, mostly intracranially (13%). Only 4% of respondents reported that triage situations, lack of staff or lack of oxygenators were responsible for the discontinuation of ECMO support. Most ECMO physicians (66% ± 26%) agreed that patients with COVID-19 induced ARDS benefitted from ECMO. Overall mortality of COVID-19 patients on ECMO was estimated to be about 55%, scoring higher than what has previously been reported for Influenza patients on ECMO (29-36%). Most ECMO providers agreed that, while COVID-19 patients were longer on ECMO compared to patients with ARDS of different origin, supposed hypercoagulation was hardly an issue during ECMO therapy and oxygenator change was not required more frequently than they were used to. CONCLUSION ECMO has been utilized successfully during the COVID-19 pandemic to stabilize CARDS patients in hypoxemic or hypercapnic lung failure, despite initial recommendations from scientific societies were mostly reluctant. Age and multimorbidity limited the use of ECMO. Triage situations were rarely a concern. ECMO providers stated that patients with severe COVID-19 benefitted from ECMO. An increasing use in patients with respiratory failure in a future stage of the pandemic may be expected. Early apprehensions that COVID-19 related hypercoagulation would result in severe thromboembolic complications during extracorporeal circulation were mostly mitigated judging from survey experience.

Complement c3 a-chain as an indicator of disease severity in COVID-19

INTRODUCTION: As we combat the novel coronavirus SARS-CoV-2, elucidating its immunological pathogenesis is vital for both understanding and treating the disease. A few case studies have suggested that the complement system may play an important role in the course of infection, but its specific role is unclear. Our group has shown that higher circulating levels of the complement C3, particularly C3 α-chain, can be a significant predictor of survival in septic shock patients. We therefore sought to investigate if a similar relationship could be seen in SARS-CoV-2. METHODS: Thirty-six COVID-19 patients were consented for this study. Serial blood samples were collected at different time points from 22 patients not in the ICU and 14 in the ICU at the time of collection. The plasma samples were analyzed using Western Blot for circulating C3 α-chain levels. Clinical data on hematologic, respiratory, renal and coagulation status were collected. The data were analyzed for differences in ICU and Non-ICU patients and for correlations of C3 α-chain levels and clinical parameters. RESULTS: In ICU patients, in mean levels of C3 α-chain had a statistically significant increase from Days 0-5 since admission to Days 16-20 (p = 0.042). C3 α-chain levels were positively correlated with time since admission (R = 0.5401, p = 0.0115). In ICU patients, C3 α-chain levels were negatively correlated with Creatinine levels (R = -0.4515, p<0.05), Neutrophil Percentage (R = -0.5525, p<0.001) and Absolute Count (R = -0.6297, p<0.001) and positively correlated with Lymphocyte Percentage (R= 0.6748, p<0.001). In Non-ICU patients, C3 α-chain levels were negatively correlated with Neutrophil Percentage (R = -0.4929, p<0.05), BUN levels (R = -0.5055, p<0.001), and positively correlated with Lymphocyte Percentage (R = 0.45, p<0.05) and Absolute Count (R = 0.6134, p<0.001) and platelet levels (R = 0.4636, p<0.05). CONCLUSIONS: In summary, levels of circulating C3 α- chain increased with time in ICU patients. C3 α-chain levels negatively correlated with renal injury markers and systemic neutrophil levels. Moreover, C3 α-chain levels positively correlated with circulating lymphocyte levels. These results indicate that native C3 is important in fighting against COVID-19 infection and may be a critical prognostic marker of disease progression.

Leading in an Unprecedented Global Crisis: The Heightened Importance of Versatility

Recent discussions of organizational performance have emphasized growing complexity and an accelerating pace of change and have called for new models of leadership for managing the paradoxes and dilemmas that they pose. The coronavirus/COVID-19 pandemic amplified these dynamics and created an opportunity to examine one of the newer models by comparing the effects of versatile leadership in precrisis and crisis conditions in a field study using a quasi-experimental design with matched samples. The results indicated strong positive relationships between versatile leadership and multiple measures of effectiveness in both conditions but showed significantly stronger relationships with team adaptability, team productivity, and overall effectiveness in the crisis condition. The implications of these findings are considered for leaders, organizations, and the professionals who study and advise them about dealing with crises specifically and with the paradoxical demands of disruptive change in general. © 2020 American Psychological Association.