Association of Sources of COVID-19 Information with Vaccine Uptake, Preventive Behaviors, and Perceived Severity of COVID-19

Objective To investigate the association of using informal sources and reliance on multiple sources of information with actual COVID-19 vaccine uptake, the number of doses of vaccine received, COVID-19 testing, essential preventive measures, and perceived severity of COVID-19. Design Retrospective cross-sectional study. Setting and Participants Our study sample consisted of 9,584 community-dwelling Medicare beneficiaries, representing a weighted 50,029,030 beneficiaries from the Winter 2021 Medicare Current Beneficiary Survey COVID-19 Supplement. Methods Two key independent variables were whether a respondent relied on a formal source (i.e., traditional news, government guidance, or health care providers) or an informal source (i.e., social media, Internet, or friends/family) the most for the COVID-19 information and the total number of information sources a respondent relied on. Results Compared to beneficiaries relying on formal sources of information, those relying on informal sources of information were less likely to receive COVID-19 vaccine (odds ratio [OR], 0.65;95% confidence interval [CI], 0.56-0.75) and COVID-19 testing (OR, 0.85;95% CI, 0.74-0.98), to engage in preventive behaviors (OR, 0.61;95% CI, 0.50-0.74), to have high perception of COVID-19 severity, and were more likely to be unvaccinated versus 2 doses of vaccine (relative risk ratio [RRR], 1.64;95% CI, 1.41-1.91). Relying on more information sources was significantly associated with higher odds of actual vaccine uptake (OR, 1.21;95% CI, 1.17-1.26), COVID-19 testing (OR, 1.11;95% CI, 1.07-1.15), engagement of essential preventive behaviors (OR, 1.33;95% CI, 1.25-1.42), having high perception of COVID-19 severity, and with lower likelihood of being unvaccinated versus 2 doses of vaccine (RRR, 0.82;0.79-0.85). Conclusions and Implications The COVID-19 pandemic has made communicating information about coronavirus more important than ever. Our findings suggest that information from formal sources with expertise and more balanced sources of information were key to effective communication to prevent from COVID-19 infection among older adults.

Pseudoknot-targeting Cas13b combats SARS-CoV-2 infection by suppressing viral replication.

CRISPR-Cas13-mediated viral genome targeting is a novel strategy for defending against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. Here, we generated mRNA-encoded Cas13b targeting the open reading frame 1b (ORF1b) region to effectively degrade the RNA-dependent RNA polymerase gene. Of the 12 designed CRISPR RNAs (crRNAs), those targeting the pseudoknot site upstream of ORF1b were found to be the most effective in suppressing SARS-CoV-2 propagation. Pseudoknot-targeting Cas13b reduced expression of the spike protein and attenuated viral replication by 99%. It also inhibited the replication of multiple SARS-CoV-2 variants, exhibiting broad potency. We validated the therapeutic efficacy of this system in SARS-CoV-2-infected hACE2 transgenic mice, demonstrating that crRNA treatment significantly reduced viral titers. Our findings suggest that the pseudoknot region is a strategic site for targeted genomic degradation of SARS-CoV-2. Hence, pseudoknot-targeting Cas13b could be a breakthrough therapy for overcoming infections by SARS-CoV-2 or other RNA viruses.

COVID-19 drugs: potential interaction with ATP-binding cassette transporters P-glycoprotein and breast cancer resistance protein.

Background: The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2, has resulted in acute respiratory distress, fatal systemic manifestations (extrapulmonary as well as pulmonary), and premature mortality among many patients. Therapy for COVID-19 has focused on the treatment of symptoms and of acute inflammation (cytokine storm) and the prevention of viral infection. Although the mechanism of COVID-19 is not fully understood, potential clinical targets have been identified for pharmacological, immunological, and vaccinal approaches. Area covered: Pharmacological approaches including drug repositioning have been a priority for initial COVID-19 therapy due to the time-consuming nature of the vaccine development process. COVID-19 drugs have been shown to manage the antiviral infection cycle (cell entry and replication of proteins and genomic RNA) and anti-inflammation. In this review, we evaluated the interaction of current COVID-19 drugs with two ATP-binding cassette transporters [P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP)] and potential drug-drug interactions (DDIs) among COVID-19 drugs, especially those associated with P-gp and BCRP efflux transporters. Expert opinion: Overall, understanding the pharmacodynamic/pharmacokinetic DDIs of COVID-19 drugs can be useful for pharmacological therapy in COVID-19 patients.

Did Massachusetts COVID-19 vaccine lottery increase vaccine uptake?

OBJECTIVE: We evaluated whether the Massachusetts COVID-19 vaccine lottery increased vaccine uptake. METHODS: We analyzed data from the Centers for Disease Control and Prevention COVID-19 Vaccine Tracker to identify total number of adults aged 18 to 64 who received at least first dose of the COVID-19 vaccine or who were fully vaccinated in Massachusetts, Connecticut, Rhode Island, New Jersey, and Vermont during the study period of March 6 -July 31, 2021. Each of the five states contributed 148 days of a daily report on cumulative number of vaccinated people, comprising 740 state-days as the total sample size. We conducted multivariable, state-day level difference-in-differences (DID) regression using a negative binomial regression model that compared the change in outcomes for Massachusetts to those of four geographically adjacent comparison states without the lotteries, before and after the Massachusetts vaccine lottery announcement (June 15, 2021). Our analyses controlled for key state-level characteristics obtained from the American Community Survey as well as day fixed-effects to capture secular trends in the outcomes. RESULTS: Massachusetts COVID-19 vaccine lottery was not associated with a significant increase in the number of adults aged 18 to 64 who were fully vaccinated or received at least one dose of the vaccine, compared with other states [Full dose, incidence rate ratio (IRR): 1.04, 95% confidence interval (CI): 0.97 to 1.11, P > 0.05; At least one dose, IRR: 0.99, 95% CI: 0.93 to 1.06, P > 0.05]. CONCLUSIONS: There was insufficient evidence to conclude that Massachusetts COVID-19 vaccine lottery was associated with increased number of adult COVID-19 vaccinations.

Trem2 deficiency impairs recovery and phagocytosis and dysregulates myeloid gene expression during virus-induced demyelination.

BACKGROUND: Triggering receptor expressed on myeloid cells 2 (Trem2) plays a protective role in neurodegenerative diseases. By contrast, Trem2 functions can exacerbate tissue damage during respiratory viral or liver infections. We, therefore, investigated the role of Trem2 in a viral encephalomyelitis model associated with prominent Th1 mediated antiviral immunity leading to demyelination. METHODS: Wild-type (WT) and Trem2 deficient (Trem2-/-) mice were infected with a sublethal glia tropic murine coronavirus (MHV-JHM) intracranially. Disease progression and survival were monitored daily. Leukocyte accumulation and pathological features including demyelination and axonal damage in spinal cords (SC) were determined by flow cytometry and tissue section immunofluorescence analysis. Expression of select inflammatory cytokines and chemokines was measured by RT-PCR and global myeloid cell gene expression in SC-derived microglia and infiltrated bone-marrow-derived macrophages (BMDM) were determined using the Nanostring nCounter platform. RESULTS: BMDM recruited to SCs in response to infection highly upregulated Trem2 mRNA compared to microglia coincident with viral control. Trem2 deficiency did not alter disease onset or severity, but impaired clinical recovery after onset of demyelination. Disease progression in Trem2-/- mice could not be attributed to altered virus control or an elevated proinflammatory response. A prominent difference was increased degenerated myelin not associated with the myeloid cell markers IBA1 and/or CD68. Gene expression profiles of SC-derived microglia and BMDM further revealed that Trem2 deficiency resulted in impaired upregulation of phagocytosis associated genes Lpl and Cd36 in microglia, but a more complex pattern in BMDM. CONCLUSIONS: Trem2 deficiency during viral-induced demyelination dysregulates expression of other select genes regulating phagocytic pathways and lipid metabolism, with distinct effects on microglia and BMDM. The ultimate failure to remove damaged myelin is reminiscent of toxin or autoimmune cell-induced demyelination models and supports that Trem2 function is regulated by sensing tissue damage including a dysregulated lipid environment in very distinct inflammatory environments.

COVID-19 drugs: potential interaction with ATP-binding cassette transporters P-glycoprotein and breast cancer resistance protein

Background The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2, has resulted in acute respiratory distress, fatal systemic manifestations (extrapulmonary as well as pulmonary), and premature mortality among many patients. Therapy for COVID-19 has focused on the treatment of symptoms and of acute inflammation (cytokine storm) and the prevention of viral infection. Although the mechanism of COVID-19 is not fully understood, potential clinical targets have been identified for pharmacological, immunological, and vaccinal approaches. Area covered Pharmacological approaches including drug repositioning have been a priority for initial COVID-19 therapy due to the time-consuming nature of the vaccine development process. COVID-19 drugs have been shown to manage the antiviral infection cycle (cell entry and replication of proteins and genomic RNA) and anti-inflammation. In this review, we evaluated the interaction of current COVID-19 drugs with two ATP-binding cassette transporters [P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP)] and potential drug-drug interactions (DDIs) among COVID-19 drugs, especially those associated with P-gp and BCRP efflux transporters. Expert opinion Overall, understanding the pharmacodynamic/pharmacokinetic DDIs of COVID-19 drugs can be useful for pharmacological therapy in COVID-19 patients.

A Study on the COVID-19 Preventive Behaviors of Automobile Manufacturing Workers in South Korea.

The present study used a cross-sectional, descriptive survey design to investigate the influencing factors of COVID-19-related infection prevention behaviors of workers in the automobile manufacturing sector. An online survey was conducted on 157 workers in the automobile manufacturing sector of a company in Korea. We analyzed the collected data using SPSS to test whether there were significant differences in COVID-19 risk perception, crisis communication, health literacy, and infection prevention behaviors according to the general characteristics of the participants. An independent sample t-test and a one-way analysis of variance (ANOVA) were performed. A Pearson's correlation analysis was performed to identify the correlations among COVID-19 risk perception, crisis communication, health literacy, and infection prevention behaviors. Multiple regression analysis was performed to identify the influencing factors of COVID-19 infection prevention behaviors. The regression model was found to be significant, and the employment period at current job, COVID-19 prevention education, source of information, COVID-19 risk perception, crisis communication, and health literacy were also found to be significant. Among the demographic variables, employment period at current job of 5-10 years showed a higher level of infection prevention behaviors than that of <5 years. Moreover, the level of infection prevention behaviors was also significantly higher when COVID-19-related information was acquired through the KDCA/health center. Higher COVID-19 risk perception, crisis communication, and health literacy were associated with significantly higher levels of infection prevention behaviors. Therefore, based on the results, health managers need to develop programs and educate and improve information comprehension and crisis communication skills in order to promote workers' infection prevention behaviors of emerging infectious diseases in an era of global change.

Age-Specific Characteristics of Adult and Pediatric Respiratory Viral Infections: A Retrospective Single-Center Study.

This study aimed to identify age-specific characteristics of respiratory viral infections. Hospitalized patients with confirmed viral respiratory infections were included in the sample. The patients were divided into the pediatric group (<19 years old) and the adult group (≥19 years old). The groups were then subdivided based on age: 0-6, 7-12, 13-18, 19-49, 50-64, and ≥65 years old. These groups were compared to evaluate the differences in the pattern of respiratory viral infections. Among a total of 4058 pediatric patients (mean age 3.0 ± 2.9 years, n = 1793 females), 2829 (48.9%) had mono-infections, while 1229 (51.1%) had co-infections. Co-infections were the most common in the 0-6-year-old group (31.6%). Among 1550 adult patients (mean age 70.2 ± 15.3 years, n = 710 females), 1307 (85.6%) had mono-infections and 243 (14.4%) had co-infections. Co-infections were most common in the ≥65-year-old group (16.8%). Viral infection and co-infection rates decreased with age in pediatric patients but increased with increasing age in adults. In pediatric patients, the rates of viral infections and co-infections were high; the rate of co-infections was higher in younger patients. In adult patients, the rates of viral infections and co-infections were lower than those in pediatric patients; the rate of co-infections was higher in older patients.

Smartphone Use Type, Fear of Missing Out, Social Support, and Smartphone Screen Time Among Adolescents in Korea: Interactive Effects.

This study aims to examine the relationship between intrapersonal factors, interpersonal factors, smartphone screen time, and the moderating roles of interpersonal factors, on the basis of the ecological model. This study is a cross-sectional and descriptive study. A total of 428 participants from four public middle schools were selected through convenience sampling (55.1% female; Mean age 13.0 ± 0.78). Data were collected through self-report questionnaires that contained questions about sociodemographic characteristics, intrapersonal factors (types of smartphone use, Fear of missing out-FoMO), interpersonal factors (support from parents, teachers, and peers), and smartphone screen time. The collected data were analysed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficients, and hierarchical regression. The daily smartphone screen time was 4.05 ± 2.16 h. Results showed that social media (ß = 0.155), games (ß = 0.140), and FoMO (ß = 0.227) were positively associated with smartphone screen time, while educational videos (ß = -0.130) and parental support (ß = -0.212) were negatively associated with smartphone screen time. Peers support moderated the association between games and smartphone screen time. Parental support moderated the association between educational videos, videos/movies/TV, and smartphone screen time. The findings highlight the direct and interactive roles of intrapersonal and interpersonal factors in predicting adolescents' smartphone screen time. Based on this study, the intrapersonal and interpersonal factors of adolescents should be comprehensively considered to intervene in their proper smartphone use.

Length of Stay in ICU of Covid-19 patients in England, March - May 2020.

INTRODUCTION: Length of Stay (LoS) in Intensive Care Units (ICUs) is an important measure for planning beds capacity during the Covid-19 pandemic. However, as the pandemic progresses and we learn more about the disease, treatment and subsequent LoS in ICU may change. OBJECTIVES: To investigate the LoS in ICUs in England associated with Covid-19, correcting for censoring, and to evaluate the effect of known predictors of Covid-19 outcomes on ICU LoS. DATA SOURCES: We used retrospective data on Covid-19 patients, admitted to ICU between 6 March and 24 May, from the "Covid-19 Hospitalisation in England Surveillance System" (CHESS) database, collected daily from England's National Health Service, and collated by Public Health England. METHODS: We used Accelerated Failure Time survival models with Weibull and log-normal distributional assumptions to investigate the effect of predictors, which are known to be associated with poor Covid-19 outcomes, on the LoS in ICU. RESULTS: Patients admitted before 25 March had significantly longer LoS in ICU (mean = 18.4 days, median = 12), controlling for age, sex, whether the patient received Extracorporeal Membrane Oxygenation, and a co-morbid risk factors score, compared with the period after 7 April (mean = 15.4, median = 10). The periods of admission reflected the changes in the ICU admission policy in England. Patients aged 50-65 had the longest LoS, while higher co-morbid risk factors score led to shorter LoS. Sex and ethnicity were not associated with ICU LoS. CONCLUSIONS: The skew of the predicted LoS suggests that a mean LoS, as compared with median, might be better suited as a measure used to assess and plan ICU beds capacity. This is important for the ongoing second and any future waves of Covid-19 cases and potential pressure on the ICU resources. Also, changes in the ICU admission policy are likely to be confounded with improvements in clinical knowledge of Covid-19.

Traditional Korean Medicine Home Care for the Older Adults during the COVID-19 Pandemic in South Korea.

OBJECTIVES: The aim of this study was to examine the status of community care services regarding traditional Korean medicine (TKM) for older adults and raise awareness on current opinions and services of TKM institutions. METHODS: The National Development Institute of Korean Medicine conducted a survey of 16 local governments by sending official letters through an electronic document system from October 2020 to November 2020. The survey items included basic demographic information and information about TKM service. RESULTS: Eleven (68.8%) of the 16 local governments provided TKM home care services. A total of 136 TKM clinics provided home care services for 598 older adults with musculoskeletal disorders. The number of TKM services provided in five or more local governments were cupping 11 (100.0%), acupuncture 11 (100.0%), education and consulting 10 (90.9%), and moxibustion 9 (81.8%). Moreover, pain (recorded on visual analogue scale) and quality of life significantly improved following TKM services (p < 0.001). CONCLUSIONS: Covered under medical policy, TKM homecare services could function as a viable alternative for continued medical care disrupted during the coronavirus disease 19 pandemic. In addition, standardisation and legalisation of these services could ensure and improve their efficiency.

Hospital length of stay for COVID-19 patients: Data-driven methods for forward planning.

BACKGROUND: Predicting hospital length of stay (LoS) for patients with COVID-19 infection is essential to ensure that adequate bed capacity can be provided without unnecessarily restricting care for patients with other conditions. Here, we demonstrate the utility of three complementary methods for predicting LoS using UK national- and hospital-level data. METHOD: On a national scale, relevant patients were identified from the COVID-19 Hospitalisation in England Surveillance System (CHESS) reports. An Accelerated Failure Time (AFT) survival model and a truncation corrected method (TC), both with underlying Weibull distributions, were fitted to the data to estimate LoS from hospital admission date to an outcome (death or discharge) and from hospital admission date to Intensive Care Unit (ICU) admission date. In a second approach we fit a multi-state (MS) survival model to data directly from the Manchester University NHS Foundation Trust (MFT). We develop a planning tool that uses LoS estimates from these models to predict bed occupancy. RESULTS: All methods produced similar overall estimates of LoS for overall hospital stay, given a patient is not admitted to ICU (8.4, 9.1 and 8.0 days for AFT, TC and MS, respectively). Estimates differ more significantly between the local and national level when considering ICU. National estimates for ICU LoS from AFT and TC were 12.4 and 13.4 days, whereas in local data the MS method produced estimates of 18.9 days. CONCLUSIONS: Given the complexity and partiality of different data sources and the rapidly evolving nature of the COVID-19 pandemic, it is most appropriate to use multiple analysis methods on multiple datasets. The AFT method accounts for censored cases, but does not allow for simultaneous consideration of different outcomes. The TC method does not include censored cases, instead correcting for truncation in the data, but does consider these different outcomes. The MS method can model complex pathways to different outcomes whilst accounting for censoring, but cannot handle non-random case missingness. Overall, we conclude that data-driven modelling approaches of LoS using these methods is useful in epidemic planning and management, and should be considered for widespread adoption throughout healthcare systems internationally where similar data resources exist.

Hierarchical Modelling of COVID-19 Death Risk in India in the Early Phase of the Pandemic.

We improve upon the modelling of India's pandemic vulnerability. Our model is multidisciplinary and recognises the nested levels of the epidemic. We create a model of the risk of severe COVID-19 and death, instead of a model of transmission. Our model allows for socio-demographic-group differentials in risk, obesity and underweight people, morbidity status and other conditioning regional and lifestyle factors. We build a hierarchical multilevel model of severe COVID-19 cases, using three different data sources: the National Family Health Survey for 2015/16, Census data for 2011 and data for COVID-19 deaths obtained cumulatively until June 2020. We provide results for 11 states of India, enabling best-yet targeting of policy actions. COVID-19 deaths in north and central India were higher in areas with older and overweight populations, and were more common among people with pre-existing health conditions, or who smoke, or who live in urban areas. Policy experts may both want to 'follow World Health Organisation advice' and yet also use disaggregated and spatially specific data to improve wellbeing outcomes during the pandemic. The future uses of our innovative data-combining model are numerous.

Dans le contexte du développement international, on peut améliorer la modélisation de la vulnérabilité à une pandémie en combinant différentes disciplines, en combinant des données et en reconnaissant les nombreux niveaux imbriqués de l'épidémie. Des modèles de transmission ont été élaborés à l'échelle nationale ou pour plusieurs pays. A l'inverse, nous construisons un modèle permettant de prendre en compte les différents niveaux de risque selon les groupes sociaux, ainsi que le conditionnement des facteurs régionaux et des facteurs liés au mode de vie. La forme grave de la COVID-19 est notre résultat clé innovant. Nous utilisons trois sources de données simultanément: l'enquête nationale sur la santé des familles en Inde, le recensement de la population indienne de 2011 et les décès liés à l'épidémie de COVID-19. Nous fournissons des résultats pour 11 États en Inde, ce qui permet un meilleur ciblage des actions politiques. Les utilisations futures de ces modèles sont nombreuses. Dans le nord et le centre de l'Inde, les décès liés à la COVID-19 étaient plus nombreux dans les régions avec populations âgées et populations en surpoids. Ces décès étaient plus fréquents chez les personnes ayant déjà des problèmes de santé, ou chez celles qui fument ou qui vivent dans les zones urbaines. Les experts en politiques publiques pourront souhaiter à la fois « suivre les conseils de l'Organisation mondiale de la santé ¼ tout en utilisant des données désagrégées et spatiales pour améliorer les résultats en matière de bien-être pendant la pandémie.

Immunization with RBD-P2 and N protects against SARS-CoV-2 in nonhuman primates.

Since the emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), various vaccines are being developed, with most vaccine candidates focusing on the viral spike protein. Here, we developed a previously unknown subunit vaccine comprising the receptor binding domain (RBD) of the spike protein fused with the tetanus toxoid epitope P2 (RBD-P2) and tested its efficacy in rodents and nonhuman primates (NHPs). We also investigated whether the SARS-CoV-2 nucleocapsid protein (N) could increase vaccine efficacy. Immunization with N and RBD-P2 (RBDP2/N) + alum increased T cell responses in mice and neutralizing antibody levels in rats compared with those obtained using RBD-P2 + alum. Furthermore, in NHPs, RBD-P2/N + alum induced slightly faster SARS-CoV-2 clearance than that induced by RBD-P2 + alum, albeit without statistical significance. Our study supports further development of RBD-P2 as a vaccine candidate against SARS-CoV-2. Also, it provides insights regarding the use of N in protein-based vaccines against SARS-CoV-2.