CRISPR­based diagnostic approaches: Implications for rapid management of future pandemics (Review).

Sudden viral outbreaks have increased in the early part of the 21st century, such as those of severe acute respiratory syndrome coronavirus (SARS­CoV), Middle East respiratory syndrome corona virus, and SARS­CoV­2, owing to increased human access to wildlife habitats. Therefore, the likelihood of zoonotic transmission of human­associated viruses has increased. The emergence of severe acute respiratory syndrome coronavirus 2 in China and its spread worldwide within months have highlighted the need to be ready with advanced diagnostic and antiviral approaches to treat newly emerging diseases with minimal harm to human health. The gold­standard molecular diagnostic approaches currently used are time­consuming, require trained personnel and sophisticated equipment, and therefore cannot be used as point­of­care devices for widespread monitoring and surveillance. Clustered regularly interspaced short palindromic repeats (CRISPR)­associated (Cas) systems are widespread and have been reported in bacteria, archaea and bacteriophages. CRISPR­Cas systems are organized into CRISPR arrays and adjacent Cas proteins. The detection and in­depth biochemical characterization of class 2 type V and VI CRISPR­Cas systems and orthologous proteins such as Cas12 and Cas13 have led to the development of CRISPR­based diagnostic approaches, which have been used to detect viral diseases and distinguish between serotypes and subtypes. CRISPR­based diagnostic approaches detect human single nucleotide polymorphisms in samples from patients with cancer and are used as antiviral agents to detect and destroy viruses that contain RNA as a genome. CRISPR­based diagnostic approaches are likely to improve disease detection methods in the 21st century owing to their ease of development, low cost, reduced turnaround time, multiplexing and ease of deployment. The present review discusses the biochemical properties of Cas12 and Cas13 orthologs in viral disease detection and other applications. The present review expands the scope of CRISPR­based diagnostic approaches to detect diseases and fight viruses as antivirals.

Insights from establishing a high throughput viral diagnostic laboratory for SARS-CoV-2 RT-PCR testing facility: challenges and experiences.

Background: The World Health Organization declared the coronavirus disease 2019 (COVID-19) a global pandemic on 11 March 2020. Identifying the infected people and isolating them was the only measure that was available to control the viral spread, as there were no standardized treatment interventions available. Various public health measures, including vaccination, have been implemented to control the spread of the virus worldwide. India, being a densely populated country, required laboratories in different zones of the country with the capacity to test a large number of samples and report test results at the earliest. The Indian Council of Medical Research (ICMR) took the lead role in developing policies, generating advisories, formulating guidelines, and establishing and approving testing centers for COVID-19 testing. With advisories of ICMR, the National Institute of Cancer Prevention and Research (NICPR) established a high-throughput viral diagnostic laboratory (HTVDL) for RT-PCR-based diagnosis of SARS-CoV-2 in April 2020. HTVDL was established during the first lockdown to serve the nation in developing and adopting rapid testing procedures and to expand the testing capacity using "Real-Time PCR." The HTVDL provided its testing support to the national capital territory of Delhi and western Uttar Pradesh, with a testing capacity of 6000 tests per day. The experience of establishing a high-throughput laboratory with all standard operating procedures against varied challenges in a developing country such as India is explained in the current manuscript which will be useful globally to enhance the knowledge on establishing an HTVDL in pandemic or non-pandemic times.

Reporting adverse events of ChAdOx1 nCoV-19 coronavirus vaccine (Recombinant) among the vaccinated healthcare professionals: A cross-sectional survey.

Background & objectives: The safety of the ChAdOx1 nCoV-19 vaccine is a cause of concern for many who have been vaccinated. The people have multiple concerns and fear regarding the adverse events of the vaccine. Thus, this study was undertaken to establish the safety profile of ChAdOx1 nCoV-19 Corona Virus Vaccine (Recombinant) among the healthcare professionals. Methods: This was a descriptive cross-sectional survey. After taking clearance from the institutional ethics committee 1500 healthcare professionals, who had their vaccination in the past two weeks were selected. They were provided with an online survey proforma regarding adverse events following immunization (AEFIs) of COVID-19 vaccine developed using google forms with an informed consent form affixed to it. Results: A total of 1036 individuals participated in the study. The mean and median (inter quartile range) age of the participants was 37.7 ±11.25 and 35 (29-46) yr, respectively. Of these, 52.1 per cent were female, 29.3 per cent were doctors, 33.4 per cent were nurses and 9.5 per cent were paramedical staff. Forty six per cent participants experienced one or more minor AEFIs such as pain, tenderness, redness, etc. at the injection site. Fatigue (31.75%), generalized feeling of unwell (28.57%), muscle pain (23.16%) and fever (21.71%) were the most commonly reported systemic AEFIs followed by headache (20.07%), dizziness (10.03%) and joint pains (15.25%). Most of them experienced these AEFIs within 24 h of the first dose of administration. About 42 per cent of the participants took oral antipyretics/analgesics for managing the AEFIs. Interpretation & conclusions: ChAdOx1 nCoV-19 Corona Virus Vaccine was found to be associated with mild local and systemic AEFIs that were more common after the first dose as compared to the second dose. There adverse events could be dealt with oral over-the-counter medications, with no requirement of hospitalization.

Substantial changes in Gaseous pollutants and health effects during COVID-19 in Delhi, India.

Background: Coronavirus disease has affected the entire population worldwide in terms of physical and environmental consequences. Therefore, the current study demonstrates the changes in the concentration of gaseous pollutants and their health effects during the COVID-19 pandemic in Delhi, the national capital city of India. Methodology: In the present study, secondary data on gaseous pollutants such as nitrogen dioxide (NO2), carbon monoxide (CO), sulfur dioxide (SO2), ammonia (NH3), and ozone (O3) were collected from the Central Pollution Control Board (CPCB) on a daily basis. Data were collected from January 1, 2020, to September 30, 2020, to determine the relative changes (%) in gaseous pollutants for pre-lockdown, lockdown, and unlockdown stages of COVID-19. Results: The current findings for gaseous pollutants reveal that concentration declined in the range of 51%-83% (NO), 40%-69% (NOx), 31%-60% (NO2), and 25%-40% (NH3) during the lockdown compared to pre-lockdown period, respectively. The drastic decrease in gaseous pollutants was observed due to restricted measures during lockdown periods. The level of ozone was observed to be higher during the lockdown periods as compared to the pre-lockdown period. These gaseous pollutants are linked between the health risk assessment and hazard identification for non-carcinogenic. However, in infants (0-1 yr), Health Quotient (HQ) for daily and annual groups was found to be higher than the rest of the exposed group (toddlers, children, and adults) in all the periods. Conclusion: The air quality values for pre-lockdown were calculated to be "poor category to "very poor" category in all zones of Delhi, whereas, during the lockdown period, the air quality levels for all zones were calculated as "satisfactory," except for Northeast Delhi, which displayed the "moderate" category. The computed HQ for daily chronic exposure for each pollutant across the child and adult groups was more than 1 (HQ > 1), which indicated a high probability to induce adverse health outcomes.

Procalcitonin as a predictive marker in COVID-19: A systematic review and meta-analysis.

BACKGROUND: Coronavirus disease 2019 has emerged as a global pandemic causing millions of critical cases and deaths. Early identification of at-risk patients is crucial for planning triage and treatment strategies. METHODS AND FINDINGS: We performed this systematic review and meta-analysis to determine the pooled prognostic significance of procalcitonin in predicting mortality and severity in patients with COVID-19 using a robust methodology and clear clinical implications. DESIGN: We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane Handbook for Systematic Reviews of Interventions guidelines. We included thirty-two prospective and retrospective cohort studies involving 13,154 patients. RESULTS: The diagnostic odds ratio of procalcitonin for predicting mortality were estimated to be 11 (95% CI: 7 to 17) with sensitivity, specificity, and summary area under the curveof 0.83 (95% CI: 0.70 to 0.91), 0.69 (95% CI: 0.58 to 0.79), and 0.83 (95% CI: 0.79 to 0.86) respectively. While for identifying severe cases of COVID-19, the odds ratio was 8.0 (95% CI 5.0 to 12.0) with sensitivity, specificity, and summary area under the curve of 0.73 (95% CI 0.67 to 0.78), 0.74 (0.66 to 0.81), and 0.78 (95% CI 0.74 to 0.82) respectively. CONCLUSION: Procalcitonin has good discriminatory power for predicting mortality and disease severity in COVID-19 patients. Therefore, procalcitonin measurement may help identify potentially severe cases and thus decrease mortality by offering early aggressive treatment.

Blockchain Powered Vaccine Efficacy for Pharma Sector.

Infectious and contagious diseases exist in humanity for many centuries which causes a curb in the growth of the population. Immunization plays a vital role to prevent mortality and morbidity against infectious diseases. COVID-19 pandemic continues to rage the urgency of developing a vaccine that should ensure the safety, efficacy, swift and fair deployment, implementation, and monitoring of vaccines across the globe. In the present context, the vaccine production to immunization campaign is a critical challenge. Therefore, an effective vaccine supply chain mechanism is required to address issues such as counterfeit vaccines, reduce vaccine wastages, and vaccine record fraud. In this paper, a blockchain-enabled vaccine supply chain is proposed to ensure the correctness, transparency, trust, and immutable log and improve the efficiency of vaccine distribution in the cold chain. The uniqueness of the proposed system is to provide distributed system to verify the reliability and efficacy of the vaccine from production to end beneficiaries' feedback about the vaccine. Our proposed system gives a clear view to the users as well as to the healthcare provider about the vaccination and ensures the anticounterfeit vaccine. The proposed system minimizes counterfeit vaccines and records, provides transparent communication between stakeholders in the supply chain, and improves the security of the vaccine supply chain and immutable feedback system about the vaccine.

Effect of COVID-19-induced lockdown on NO2 pollution using TROPOMI and ground-based CPCB observations in Delhi NCR, India.

The present study investigates the reduction in nitrogen dioxide (NO2) levels using satellite-based (Sentinel-5P TROPOMI) and ground-based (Central Pollution Control Board) observations of 2020. The lockdown duration, monthly, seasonal and annual changes in NO2 were assessed comparing the similar time period in 2019. The study also examines the role of atmospheric parameters like wind speed, air temperature, relative humidity, solar radiation and atmospheric pressure in altering the monthly and annual values of the pollutant. It was ascertained that there was a mean reduction of ~ 61% (~ 66.5%), ~ 58% (~ 51%) in daily mean NO2 pollution during lockdown phase 1 when compared with similar period of 2019 and pre-lockdown phase in 2020 from ground-based (satellite-based) measurements. April month with ~ 57% (~ 57%), summer season with ~ 48% (~ 32%) decline and an annual reduction of ~ 20% (~ 18%) in tropospheric NO2 values were observed (p < 0.001) compared to similar time periods of 2019. It was assessed that the meteorological parameters remained almost similar during various parts of the year in 2019 and 2020, indicating a negligent role in reducing the values of atmospheric pollution, particularly NO2 in the study area. It was concluded that the halt in anthropogenic activities and associated factors was mainly responsible for the reduced values in the Delhi conglomerate. Similar work can be proposed for other pollutants to holistically describe the pollution scenario as an aftermath of COVID-19-induced lockdown.

A Regional Pooling Intervention in a High-Throughput COVID-19 Diagnostic Laboratory to Enhance Throughput, Save Resources and Time Over a Period of 6 Months.

An effective and rapid diagnosis has great importance in tackling the ongoing COVID-19 pandemic through isolation of the infected individuals to curb the transmission and initiation of specialized treatment for the disease. It has been proven that enhanced testing capacities contribute to efficiently curbing SARS-CoV-2 transmission during the initial phases of the outbreaks. RT-qPCR is considered a gold standard for the diagnosis of COVID-19. However, in resource-limited countries expenses for molecular diagnosis limits the diagnostic capacities. Here, we present interventions of two pooling strategies as 5 sample pooling (P-5) and 10 sample pooling (P-10) in a high-throughput COVID-19 diagnostic laboratory to enhance throughput and save resources and time over a period of 6 months. The diagnostic capacity was scaled-up 2.15-folds in P-5 and 1.8-fold in P-10, reagents (toward RNA extraction and RT-qPCR) were preserved at 75.24% in P-5 and 86.21% in P-10, and time saved was 6,290.93 h in P-5 and 3147.3 h in P-10.

The Impact of Social Isolation Due to COVID-19 on Symptom Progression in People With Dementia: Findings of the SOLITUDE Study.

Background: People with dementia (PWD) are vulnerable to abrupt changes to daily routines. The lockdown enforced on the 23rd of March 2020 in the UK to contain the expansion of the COVID-19 pandemic limited opportunities for PWD to access healthcare services and socialise. The SOLITUDE study explored the potential long-term effects of lockdown on PWD's symptoms and carers' burden. Methods: Forty-five carers and 36 PWD completed a telephone-based assessment at recruitment (T0) and after 3 (T1) and 6 months (T2). PWD completed measures validated for telephonic evaluations of cognition and depression. Carers completed questionnaires on their burden and on PWD's health and answered a customised interview on symptom changes observed in the initial months of lockdown. Longitudinal changes were investigated for all outcome variables with repeated-measures models. Additional post hoc multiple regression analyses were carried out to investigate whether several objective factors (i.e., demographics and time under social restrictions) and carer-reported symptom changes observed following lockdown before T0 were associated with all outcomes at T0. Results: No significant changes were observed in any outcomes over the 6 months of observations. However, post hoc analyses showed that the length of social isolation before T0 was negatively correlated with episodic and semantic memory performance at T0. Carers reporting worsening of neuropsychiatric symptoms and faster disease progression in PWD also reported higher burden. Moreover, carer-reported worsening of cognitive symptoms was associated with poorer semantic memory at T0. Conclusion: PWD's symptoms and carers' burden remained stable over 6 months of observation. However, the amount of time spent under social restrictions before T0 appears to have had a significant detrimental impact on cognitive performance of patients. In fact, carer-reported cognitive decline during social isolation was consistent with the finding of poorer semantic memory, a domain sensitive to progression in Alzheimer's disease. Therefore, the initial stricter period of social isolation had greater detrimental impact on patients and their carers, followed then by a plateau. Future interventions may be designed to maintain an optimal level of social and cognitive engagement for PWD in challenging times, to prevent abrupt worsening of symptoms and associated detrimental consequences on patients' carers.

Sensing and 3D printing technologies in personalized healthcare for the management of health crises including the COVID-19 outbreak.

A major threat that has surrounded human civilization since the beginning of the year 2020 is the outbreak of coronavirus disease 2019 (COVID-19). It has been declared a pandemic by the World Health Organization and significantly affected populations globally, causing medical and economic despair. Healthcare chains across the globe have been under grave stress owing to shortages of medical equipments necessary to address a pandemic. Furthermore, personal protective equipment supplies, mandatory for healthcare staff for treating severely ill patients, have been in short supply. To address the necessary requisites during the pandemic, several researchers, hospitals, and industries collaborated to meet the demand for these medical equipments in an economically viable manner. In this context, 3D printing technologies have provided enormous potential in creating personalized healthcare equipment, including face masks, face shields, rapid detection kits, testing swabs, biosensors, and various ventilator components. This has been made possible by capitalizing on centralized large-scale manufacturing using 3D printing and local distribution of verified and tested computer-aided design files. The primary focus of this study is, "How 3D printing is helpful in developing these equipments, and how it can be helpful in the development and deployment of various sensing and point-of-care-testing (POCTs) devices for the commercialization?" Further, the present study also takes care of patient safety by implementing novel 3D printed health equipment used for COVID-19 patients. Moreover, the study helps identify and highlight the efforts made by various organizations toward the usage of 3D printing technologies, which are helpful in combating the ongoing pandemic.

Attitude and Perception of Nursing Personnel Involved in Real Time Remote Audio-Visual Aided (RT-RAVA) Monitoring of Doffing for the Prevention of Covid-19 Infection among the Health Care Workers.

The study was carried out to explore the attitude and perception of observers involved in monitoring of doffing through Real Time Remote Audio-Visual aided (RT-RAVA), the first well-sophisticated surveillance system. A 21-item online-survey proforma was used to collect the data amongst 150 nursing personnel. 3/4th of the participants strongly agreed that they helped in reducing the doffing errors through RT-RAVA doffing. 97.3% perceived that the system is highly effective in reducing the infection during doffing. There was significant correlation between attitude and perception of the observers. The system was perceived as highly effective and was recommended for doffing.

The impact of social isolation due to the COVID-19 pandemic on patients with dementia and caregivers.

OBJECTIVE: Social distancing to limit COVID-19 transmission has led to extensive lifestyle changes, including for people with dementia (PWD). The aim of this study, therefore, was to assess the impact of lockdown on the mental health of PWD and their carers. METHODS: Forty-five carers of PWD completed a telephone interview during the baseline assessment of the SOLITUDE study to gather information on life conditions and changes in symptoms of PWD during lockdown. Associations between changes in symptoms of PWD and carers' concerns and mental health were investigated. RESULTS: About 44% of carers experienced anxiety and irritability and reported changes in behavioural and cognitive symptoms in PWD. These changes were associated with worse carers' mental health and concerns about faster disease progression (χ2 = 13.542, p < 0.001). CONCLUSION: COVID-19-related social isolation has had a negative impact on patients' and carers' mental health. Potential long-term neurocognitive consequences require further investigation.

Study protocol: SOcial LImitations Turn Up DEmentia (SOLITUDE)—Impact of COVID-19 social isolation on patients’ cognition and mental health and on carers’ wellbeing

Background Social isolation and loneliness are both known to exert detrimental effects on mental health and cognitive functioning, as well as on medial temporal lobe volume in older adults. Reduced social interactions have also been found to increase the risk of cognitive decline and dementia in older people. Since restrictions to social contacts have been imposed to tackle the current Coronavirus Disease 2019 (COVID-19) pandemic, this study aims to investigate the long-term impact of the resulting social isolation on people with mild dementia and their carers. Method This study has been implemented using a multi-centre longitudinal observational design to monitor mental health (9-item Patient Health Questionnaire and Neuropsychiatric Inventory Questionnaire), cognitive performance (telephone Mini-Mental State Examination and Telephone Assessment of Cognitive Function) and quality of life (Quality of Life in Alzheimer's Disease) of patients with mild dementia due to neurodegenerative aetiologies, as well as carers? burden (12-item Zarit Burden Interview). Additionally, a structured interview is included to assess the potential impact of social isolation on everyday functioning of patients and carers. Participants are assessed telephonically at three time-points: baseline and two follow-ups after 3 and 6 months. Result Six centres across the UK have confirmed capacity and capability to recruit up to eighty participants. Between September and December 2020, twenty-nine participants have been recruited across different sites and completed the baseline assessment. Moreover, nine participants have already completed the 3-month follow-up. Conclusion This study (predicted completion date: July 2021) is expected to provide valuable insights into the potential long-term consequences of lockdown measures on people with dementia and their carers. Moreover, it will enable the identification of potential risk/protective factors for decline in mental health and cognition due to extensive changes in patients? social environment. Findings from the SOLITUDE study may inform preventative and management strategies for decline in mental function targeting people with dementia, who may be the most affected by social isolation and loneliness.

Blockchain-based online education content ranking.

Nowadays, internet technology plays a vital role in all the fields of our daily lives ranging from the world economy, professional careers, higher education, and almost all the spheres that are deeply impacted. In the current situation, due to COVID19, the dependence on the Internet for almost everything, including learning, getting daily needs, etc., is heavily dependent on the Internet. Online learning is made possible by the Internet, and today most students, educators, researchers are leveraging online learning platforms to enhance their knowledge at their own pace. Generally, the quality of the E-learning courses is evaluated with the help of the courses' review and rating mechanisms. In the present context, review systems are centralized, storing highly valuable information at one location and are liable to manipulation, hacking, and tampering. In this paper, the Blockchain-based Online Education Content Ranking system is proposed for an online review and ranking system that offers a decentralized trustworthy system, ensuring the integrity of the rating and the independence and integrity of content reviews by Subject Matter Experts (SME).

Blockchain-based online education content ranking

Nowadays, internet technology plays a vital role in all the fields of our daily lives ranging from the world economy, professional careers, higher education, and almost all the spheres that are deeply impacted. In the current situation, due to COVID19, the dependence on the Internet for almost everything, including learning, getting daily needs, etc., is heavily dependent on the Internet. Online learning is made possible by the Internet, and today most students, educators, researchers are leveraging online learning platforms to enhance their knowledge at their own pace. Generally, the quality of the E-learning courses is evaluated with the help of the courses’ review and rating mechanisms. In the present context, review systems are centralized, storing highly valuable information at one location and are liable to manipulation, hacking, and tampering. In this paper, the Blockchain-based Online Education Content Ranking system is proposed for an online review and ranking system that offers a decentralized trustworthy system, ensuring the integrity of the rating and the independence and integrity of content reviews by Subject Matter Experts (SME).

Spatio-temporal variation in fine particulate matter and effect on air quality during the COVID-19 in New Delhi, India.

Novel Coronavirus disease has affected almost all the countries; which leads to the pandemic, impacting adversely on environment. The impact on environment during pre-and during lockdowns needs an attention to correlate the pollutants from industrial emissions and other factors. Therefore, the current study demonstrates the changes in fine particulate matter PM2.5, PM10 and effect on air quality during lockdown. The highest reduction was observed in lockdown I (25 March - 14 April) as compared to others lockdowns (between 15 April and 31st May 2020) due to the complete shutdown of industrial, transport, and construction activities. A significant reduction in PM2.5 and PM10 from 114.27 µg/m3 and 194.48 µg/m3 for pre-lockdown period to 41.41 µg/m3 and 86.81 µg/m3 for lockdown I was observed. The levels of air quality index fall under satisfactory category for lockdown I whereas satisfactory to moderate category for other lockdowns. The present study revealed a strong correlation between PM2.5 and PM10 levels during the pre-lockdown period (0.71) and through lockdown IV (0.76), which indicate that change in the PM10 level influences the PM2.5 level greatly. The findings of the present study could be scaled up nationwide and might be useful in formulating air pollution reduction policies in the future.

Impact of COVID-19 on liver transplant recipients-A systematic review and meta-analysis.

BACKGROUND: Immunosuppression and comorbidities increase the risk of severe coronavirus disease-2019 (COVID-19) in solid organ transplant (SOT) recipients. The outcomes of COVID-19 in liver transplant (LT) recipients remain unclear. We aimed to analyse the outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in LT recipients. METHODS: The electronic databases were searched for articles published from 1 December 2019 to 20 May 2021 with MeSH terms COVID-19, SARS-CoV-2, and liver transplantation. Studies reporting outcomes in more than 10 LT recipients were included for analysis. LT vs non-LT patients with COVID-19 infection were compared for all-cause mortality, which was the primary outcome studied. We also evaluated the relation between the timing of COVID-19 infection post-LT (< one year vs > one year) and mortality. FINDINGS: Eighteen articles reporting 1,522 COVID-19 infected LT recipients were included for the systematic review. The mean age (standard deviation [SD]) was 60·38 (5·24) years, and 68·5% were men. The mean time (SD) to COVID-19 infection was 5·72 (1·75) years. Based on 17 studies (I2 = 7·34) among 1,481 LT recipients, the cumulative incidence of mortality was 17·4% (95% confidence interval [CI], 15·4-19·6). Mortality was comparable between LT (n = 610) and non-LT (n = 239,704) patients, based on four studies (odds ratio [OR], 0·8 [0·6-1·08]; P = 0·14). Additionally, there was no significant difference in mortality between those infected within one year vs after one year of LT (OR, 1·5 [0·63-3·56]; P = 0·35). The cumulative incidence of graft dysfunction was 2·3% (1·3-4·1). Nearly 23% (20·71-25) of the LT patients developed severe COVID-19 infection. Before infection, 71% and 49% of patients were on tacrolimus and mycophenolate mofetil, respectively. Immunosuppression was modified in 55·9% (38·1-72·2) patients after COVID-19 infection. INTERPRETATION: LT and non-LT patients with COVID-19 have a similar risk of adverse outcomes.

Clinical features and outcomes of COVID-19 in older adults: a systematic review and meta-analysis.

BACKGROUND: Few studies have focused on exploring the clinical characteristics and outcomes of COVID-19 in older patients. We conducted this systematic review and meta-analysis to have a better understanding of the clinical characteristics of older COVID-19 patients. METHODS: A systematic search of PubMed and Scopus was performed from December 2019 to May 3rd, 2020. Observational studies including older adults (age ≥ 60 years) with COVID-19 infection and reporting clinical characteristics or outcome were included. Primary outcome was assessing weighted pooled prevalence (WPP) of severity and outcomes. Secondary outcomes were clinical features including comorbidities and need of respiratory support. RESULT: Forty-six studies with 13,624 older patients were included. Severe infection was seen in 51% (95% CI- 36-65%, I2-95%) patients while 22% (95% CI- 16-28%, I2-88%) were critically ill. Overall, 11% (95% CI- 5-21%, I2-98%) patients died. The common comorbidities were hypertension (48, 95% CI- 36-60% I2-92%), diabetes mellitus (22, 95% CI- 13-32%, I2-86%) and cardiovascular disease (19, 95% CI - 11-28%, I2-85%). Common symptoms were fever (83, 95% CI- 66-97%, I2-91%), cough (60, 95% CI- 50-70%, I2-71%) and dyspnoea (42, 95% CI- 19-67%, I2-94%). Overall, 84% (95% CI- 60-100%, I2-81%) required oxygen support and 21% (95% CI- 0-49%, I2-91%) required mechanical ventilation. Majority of studies had medium to high risk of bias and overall quality of evidence was low for all outcomes. CONCLUSION: Approximately half of older patients with COVID-19 have severe infection, one in five are critically ill and one in ten die. More high-quality evidence is needed to study outcomes in this vulnerable patient population and factors affecting these outcomes.