COVID-19 cases associated with testing policies in 34 highly democratic countries, 2020-2022 (preprint)

COVID-19 testing policies varied in time from testing only the symptomatic, testing the symptomatic and persons at higher risk of severe disease, on-demand testing for people who wanted one, and two periods of government-imposed mass testing in Slovakia. Using Poisson regression, this study examines the associations of COVID-19 cases during the times that the noted policies were in effect in 34 countries rated highest on democracy scores. Statistically corrected for other risk factors, increases in negative tests were associated with subsequent surges in cases when on-demand testing was promoted, particularly when coupled with poor contact tracing. Mass testing in Slovakia was associated with reduced spread of the virus for short periods but was deemed unsustainable. The data support the hypothesis that on-demand testing resulted in the unanticipated consequence of increased travel and increased exposure of travelers to the virus.

Did long COVID increase road deaths in the U.S.? (preprint)

Objective To examine data on COVID-19 disease associated with a 10 percent increase in U.S. road deaths from 2020 to 2021 that raises the question of the potential effect of pandemic stress and neurological damage from COVID-19 disease. Methods Poisson regression was used to estimate the association of recent COVID-19 cases, accumulated cases, maximum temperatures, truck registrations, and gasoline prices with road deaths monthly among U.S. states in 2021. Using the regression coefficients, changes in each risk factor from 2020 to 2021 were used to calculate expected deaths in 2021 if each factor had remained the same as in 2020. Results Corrected for the other risk factors, road deaths were associated with accumulated COVID-19 cases but not cases in the previous month More than 20,700 road deaths were associated with the changes in accumulated COVID-19 cases but were substantially offset by about 19,100 less-than-expected deaths associated with increased gasoline prices. Conclusions While more research is needed, the data are sufficient to warn people with long COVID to minimize driving.

Histoplasmosis and SARS-CoV-2 infection in a critically ill patient

Introduction: Histoplasmosis is caused by the dimorphic fungus Histoplasma capsulatum, whose clinical manifestations range from asymptomatic to disseminated and highly fatal disease. Objective: To present the case of a patient diagnosed with disseminated histoplasmosis and SARS-CoV-2 infection. Clinical case: The case of a 79-year-old man is presented with a history of systemic arterial hypertension and type 2 diabetes mellitus. He was admitted for a week with nonproductive cough, dyspnea, and fatigue on moderate exertion, and reported having a positive antigen test for SARS-CoV-2. During hospitalization, he presented clinical deterioration, needing mechanical ventilation due to respiratory infection associated with COVID-19. Despite this, he presented lymphadenopathy, hepatosplenomegaly, and umbilicated skin-colored papules suggestive of disseminated fungal infection. Suspecting co-infection, infection by Histoplasma capsulatum was confirmed by means of mini-bronchoalveolar lavage and antifungal treatment was initiated;however, the patient presented persistent clinical deterioration and died. Conclusion: Cases of co-infections with COVID-19 in patients without chronic diseases or immunosuppressive states are rare, their diagnosis being a challenge for medical personnel and requiring consideration of pulmonary fungal infections such as cryptococcosis or histoplasmosis in associated respiratory failure. to SARS-CoV-2 infection. © 2023, Editorial Ciencias Medicas. All rights reserved.

The impact of COVID-19 on alcohol sales and consumption in the United States: A retrospective, observational analysis.

Understanding the COVID-19 pandemic's effect on alcohol sales and consumption is critical in mitigating alcohol abuse and morbidity. We sought to determine how the onset of the COVID-19 pandemic and changes in viral incidence affected alcohol sales and consumption in the United States. We conducted a retrospective observational analysis regressing National Institute on Alcohol Abuse and Alcoholism (NIAAA) alcohol sales data and Behavioral Risk Factor Surveillance System (BRFSS) survey data for 14 states for 2017 to 2020 with COVID-19 incidence in 2020 in the United States. The onset of the pandemic was associated with higher monthly alcohol sales per capita of 1.99 standard drinks (95% Confidence Interval: 0.63 to 3.34, p = 0.007). Increases of one COVID-19 case per 100 were associated with lower monthly alcohol sales per capita of 2.98 standard drinks (95% CI: -4.47 to -1.48, p = 0.001) as well as broad decreases in alcohol consumption, notably 0.17 fewer days per month with alcohol use (95% CI: -0.31 to -0.23, p = 0.008) and 0.14 fewer days per month of binge drinking (95% CI: -0.23 to -0.052, p < 0.001). The COVID-19 pandemic is associated with increased monthly average alcohol purchases, but higher viral incidence is linked to lower alcohol purchases and consumption. Continued monitoring is needed to mitigate the effects of higher population alcohol use during the pandemic.

Low-dose radiotherapy to the lungs using an interventional radiology C-arm fluoroscope: Monte Carlo treatment planning and dose measurements in a postmortem subject.

Objective.The goal of this study was to use Monte Carlo (MC) simulations and measurements to investigate the dosimetric suitability of an interventional radiology (IR) c-arm fluoroscope to deliver low-dose radiotherapy to the lungs.Approach.A previously-validated MC model of an IR fluoroscope was used to calculate the dose distributions in a COVID-19-infected patient, 20 non-infected patients of varying sizes, and a postmortem subject. Dose distributions for PA, AP/PA, 3-field and 4-field treatments irradiating 95% of the lungs to a 0.5 Gy dose were calculated. An algorithm was created to calculate skin entrance dose as a function of patient thickness for treatment planning purposes. Treatments were experimentally validated in a postmortem subject by using implanted dosimeters to capture organ doses.Main results.Mean doses to the left/right lungs for the COVID-19 CT data were 1.2/1.3 Gy, 0.8/0.9 Gy, 0.8/0.8 Gy and 0.6/0.6 Gy for the PA, AP/PA, 3-field, and 4-field configurations, respectively. Skin dose toxicity was the highest probability for the PA and lowest for the 4-field configuration. Dose to the heart slightly exceeded the ICRP tolerance; all other organ doses were below published tolerances. The AP/PA configuration provided the best fit for entrance skin dose as a function of patient thickness (R2 = 0.8). The average dose difference between simulation and measurement in the postmortem subject was 5%.Significance.An IR fluoroscope should be capable of delivering low-dose radiotherapy to the lungs with tolerable collateral dose to nearby organs.

Staying Ahead of the Curve: Mitigating Disruptions Through Business Continuity Planning in the Academic Library Setting

Organizations of all sizes and forms have been immensely challenged by the Covid-19 global crisis and libraries are not exempted. The pandemic is just one of the many faces of disruptions that could either make or break an entity. To help mitigate the potentially destructive impacts and risks associated with various disruptive incidents, a sound business continuity plan (BCP) must be prepared ahead. This research aims to come up with a proposed BCP for the a university library in response to major disruptions such as natural calamity, pandemic, man-made threats, and the like. This paper utilized a descriptive research design in the form of a quantitative method. The authors devised a modified survey questionnaire composed of open and closed-ended questions in order to explore the organization's business impact analysis. This study will be beneficial to the library department and its mother institution to continue in delivering its core services albeit with the uncertainties and threat scenarios. Additionally, this paper will also serve as a guide for library managers who are planning to devise a BCP on their respective libraries.

Protracted headache after COVID-19: A case series of 31 patients from a tertiary headache center.

BACKGROUND: Headache can be a prominent feature of Post-Acute Sequelae of SARS-Cov2 infection (PASC) and previous studies have centered around PASC headaches that have resolved within a month of infection. METHODS: We performed a retrospective chart review of 31 adults evaluated at the Stanford Headache Clinic between September 2020 and January 2022 who developed new or worsening headaches after COVID-19 infection that were unresolved at time of evaluation for demographics, medical history, and headache diagnosis. RESULTS: Headache had been present for a mean duration of 7.4±4.8 months after infection. Notably, 25/31 (81%) had a previous history of headache. The specific features of the headache varied considerably, but 23/31 (74%) met International Classification of Headache Disorders, Third Edition (ICHD-3) criteria for migraine, with 20/31 (65%) meeting ICHD-3 criteria for chronic migraine, while only 5/31 (16%) met these criteria before COVID infection. Additionally, full-time employment decreased from 25/31 (81%) to 17/31 (55%). Prior to establishing care at our clinic, 13/18 (72%) of the patients who were started on preventive medications currently indicated for migraine management, reported a decrease in frequency and/or severity of headaches. CONCLUSIONS: Our study presents a group of patients with protracted headache after COVID-19 infection that includes both patients with a previously lower headache burden who largely exhibited chronification from episodic to chronic migraine, as well as patients with no previous history of headache who meet ICHD-3 criteria for headache attributed to a systemic viral illness, mostly with a migrainous phenotype.

Attributions of responsibility in multilevel states

In this chapter we explore attribution of responsibility in multilevel systems from a threefold perspective. First, we explore individuals’ knowledge on who is responsible for what, the empirical challenges to measure it and its effects upon electoral accountability. Second, we shift the focus towards politicians and explore the blame attribution game in federal entities. We argue that, under some circumstances, politicians’ blame shifting strategies might help to achieve good policy outcomes. Finally, we analyse the role of group identities in biasing individuals’ attribution of responsibility. Using experimental evidence based on the Spanish case we show the impact of partisan identities in the assignment of responsibility for the management of the Covid19 pandemic. We also provide an original empirical analysis that shows that increasing polarization in Spain has resulted in a more prominent use of partisan cues in the assignment of responsibilities. © Ignacio Lago 2021.

Required COVID-19 Vaccination Certification to Attend Certain U.S. Professional Football Games in Fall 2021: A Natural Experiment (preprint)

Four U.S. National Football League teams required vaccination certification against the SARS-CoV-2 virus of attendees at home games during the 2021 season. Using daily data on confirmed cases and vaccinations in counties surrounding these stadiums and stadiums that did not require certification, this study estimates the effects of the certification policy. Ordinary least squares regression was used to estimate the change in community spread of the virus after home games and away games relative to weeks that the teams did not play (bye weeks). Compared to counties in metropolitan areas near stadiums with no certification requirement, counties near stadiums that had a vaccination requirement had significantly less cases 14 days after home games. In the six weeks leading up to the beginning of the season, percent vaccinated increased in counties that were near stadiums requiring vaccination certification only if the prevalent preseason vaccination rate was relatively low. Required vaccination certification at venues for large gatherings appear to slow virus spread generally in nearby communities and increases vaccination percentages in areas with lower prevalent vaccination percentages.

Antimicrobial use and abuse in COVID-19: When is its use justified?

The pandemic due to coronavirus disease 2019 (COVID-19) caused by the SARSCoV- 2 virus has created challenges for its diagnosis and treatment. To date, there is no specific antiviral therapy, this situation has pressured the clinician to offer alternative pharmacological therapies whose benefits may be overshadowed by their risks. Since the beginning of the pandemic, the use of empirical antibiotics has become popular in various treatment protocols worldwide, a treatment that is not recommended in national or international guidelines for the management of COVID-19. Current evidence shows a low incidence of bacterial coinfections, even in severe conditions. Administering an antibiotic incorrectly when there is no indication supported by clinical studies is associated with significant deleterious effects, such as increased mortality. Given the similarity of the infectious clinical picture of COVID-19 with an atypical bacterial pneumonia, ruling out an infectious process in a concise and timely manner is of great importance;for this, biochemical and imaging studies can be done, in addition to a good clinical integration of the patient's signs and symptoms. This review describes the collection of evidence on bacterial coinfections in COVID-19, the prescription of antibiotics in this disease, and the possible consequences.

Association of COVID-19 mortality with politics and on-demand testing in 217 U.S. counties.

BACKGROUND: Previous research found increased COVID-19 spread associated with politics and on-demand testing but not in the same study. The objective of this study is to estimate the contribution of each corrected for the other and a variety of known risk factors. METHODS: Using data from 217 U.S. counties of more than 50,000 population where testing data were available in April, 2021, the associations of COVID-19 deaths with politics, testing and other risk factors were examined by Poisson and least squares regression. RESULTS: Statistical controls for 15 risk factors failed to eliminate the association of COVID mortality risk with percent of vote for Donald Trump in 2016 or negative tests per population. Each is independently predictive of increased mortality. CONCLUSION: Apparently, many people who test negative for the SARS-CoV-2 virus engage in activities that increase their risk, a problem likely to increase with the availability of home tests. There is no association of negative tests with the Trump vote but, according to polling data, Trump voters' past resistance to public health recommendations has been extended to resistance to being vaccinated, threatening the goal of herd immunity.

A higher flexibility at the SARS-CoV-2 main protease active site compared to SARS-CoV and its potentialities for new inhibitor virtual screening targeting multi-conformers.

The main-protease (Mpro) catalyzes a crucial step for the SARS-CoV-2 life cycle. The recent SARS-CoV-2 presents the main protease (MCoV2pro) with 12 mutations compared to SARS-CoV (MCoV1pro). Recent studies point out that these subtle differences lead to mobility variances at the active site loops with functional implications. We use metadynamics simulations and a sort of computational analysis to probe the dynamic, pharmacophoric and catalytic environment differences between the monomers of both enzymes. So, we verify how much intrinsic distinctions are preserved in the functional dimer of MCoV2pro, as well as its implications for ligand accessibility and optimized drug screening. We find a significantly higher accessibility to open binding conformers in the MCoV2pro monomer compared to MCoV1pro. A higher hydration propensity for the MCoV2pro S2 loop with the A46S substitution seems to exercise a key role. Quantum calculations suggest that the wider conformations for MCoV2pro are less catalytically active in the monomer. However, the statistics for contacts involving the N-finger suggest higher maintenance of this activity at the dimer. Docking analyses suggest that the ability to vary the active site width can be important to improve the access of the ligand to the active site in different ways. So, we carry out a multiconformational virtual screening with different ligand bases. The results point to the importance of taking into account the protein conformational multiplicity for new promissors anti MCoV2pro ligands. We hope these results will be useful in prospecting, repurposing and/or designing new anti SARS-CoV-2 drugs.Communicated by Ramaswamy H. Sarma.

Drug design and repurposing with DockThor-VS web server focusing on SARS-CoV-2 therapeutic targets and their non-synonym variants.

The COVID-19 caused by the SARS-CoV-2 virus was declared a pandemic disease in March 2020 by the World Health Organization (WHO). Structure-Based Drug Design strategies based on docking methodologies have been widely used for both new drug development and drug repurposing to find effective treatments against this disease. In this work, we present the developments implemented in the DockThor-VS web server to provide a virtual screening (VS) platform with curated structures of potential therapeutic targets from SARS-CoV-2 incorporating genetic information regarding relevant non-synonymous variations. The web server facilitates repurposing VS experiments providing curated libraries of currently available drugs on the market. At present, DockThor-VS provides ready-for-docking 3D structures for wild type and selected mutations for Nsp3 (papain-like, PLpro domain), Nsp5 (Mpro, 3CLpro), Nsp12 (RdRp), Nsp15 (NendoU), N protein, and Spike. We performed VS experiments of FDA-approved drugs considering the therapeutic targets available at the web server to assess the impact of considering different structures and mutations to identify possible new treatments of SARS-CoV-2 infections. The DockThor-VS is freely available at www.dockthor.lncc.br .

Did people's behavior after receiving negative COVID-19 tests contribute to the spread?

BACKGROUND: Testing on demand for coronavirus disease (COVID-19) is hypothesized to increase spread of the virus as some persons who test negative falsely assume that they can engage in activities that increase spread. METHODS: Daily new COVID-19 hospitalization counts through 2020 from 25 countries that reported testing and hospitalizations were studied by regression of logarithms of new hospitalizations 14 days out against log(new hospitalizations on a given day), log(negative tests), log(positivity rate) and days since the first hospitalizations were reported. The regression coefficients were examined separately for periods in countries that were following three different testing policies. RESULTS: Corrected for the other factors, negative test numbers when tested on demand and tested if symptomatic only are associated with an increase in hospitalizations 14 days after the tests. When only the symptomatic and more vulnerable are tested, negative tests are associated with fewer hospitalizations 2 weeks out. CONCLUSIONS: A policy of testing only vulnerable populations, whether symptomatic or not, appears to avoid spreading the virus as a result of testing policy. False confidence of reduced risk among those who test negative may have contributed to the spread in countries that allowed testing on demand or testing only those who claimed to have symptoms.

Predictors of COVID-19-Confirmed Cases and Fatalities in 883 US Counties with a Population of 50,000 or More: Estimated Effect of Initial Prevention Policies.

Control of diseases transmitted from person to person may be more effectively and less economically damaging if preventive and ameliorative efforts are focused on the more vulnerable local areas rather than entire countries, provinces, or states. The spread of the COVID-19 virus is highly concentrated in urban US counties. Sixteen factors known or thought to be related to spread of the COVID-19 virus were studied by Poisson regression analysis of confirmed cases and deaths in 883 US counties with a population of 50,000 or more as of May 31, 2020. Evidence of crowding in homes, workplaces, religious gatherings, preexisting health conditions in the population, and local economic and demographic conditions, with one exception, was predictive of incidence and mortality. Based on the correlation of cases and deaths to length of stay-at-home orders, the orders were associated with about 52% reduced cases and about 55% reduced deaths from those expected without the orders.

Association of COVID-19 spread with on-demand testing (preprint)

Comparisons of COVID-19 testing policies in 99 countries indicate that testing on demand is associated with an increase in cases 14 days after the tests. Adjusted for number of new cases and the positivity rate, for each 10,000 negative tests on a given day there were 90-110 new cases in 14 days that would not have otherwise occurred. Approximately 3.1 million or 21 percent of new cases in periods of on-demand testing are likely due to that policy through early November 2020. During periods in a given country when only persons with symptoms were tested, or persons with symptoms and key vulnerable populations were tested, negative tests were associated with fewer new cases 14 days out. Apparently when tests are available on demand, those who test negative are engaging in activities that increase the risk of exposure.

Drug Design and Repurposing with DockThor-VS Web Server: Virtual Screening focusing on SARS-CoV-2 Therapeutic Targets and their Non-Synonym Variants (preprint)

The COVID-19 caused by the SARS-CoV-2 virus was declared as a pandemic disease in March 2020 by the World Health Organization (WHO). Structure-Based Drug Design strategies based on docking methodologies have been widely used for both new drug development and drug repurposing to find effective treatments against this disease. In this work, we present the developments implemented in the DockThor-VS web server to provide a virtual screening (VS) platform with curated structures of potential therapeutic targets from SARS-CoV-2 incorporating genetic information regarding relevant non-synonymous variations. The web server facilitates repurposing VS experiments providing curated libraries of currently available drugs on the market. Currently, DockThor-VS provides ready-for-docking 3D structures for wild type and selected mutations for Nsp3 (papain-like, PLpro domain), Nsp5 (Mpro, 3CLpro), Nsp12 (RdRp), Nsp15 (NendoU), N protein and Spike. We performed VS experiments of FDA-approved drugs considering the therapeutic targets available at the web server to assess the impact of considering different structures and mutations in the identification of possible new treatments of SARS-CoV-2 infections. The DockThor-VS is freely available at www.dockthor.lncc.br.