Mapping the long-term associations between air pollutants and COVID-19 risks and the attributable burdens in the continental United States.

Numerous studies have investigated the associations between COVID-19 risks and long-term exposure to air pollutants, revealing considerable heterogeneity and even contradictory regional results. Studying the spatial heterogeneity of the associations is essential for developing region-specific and cost-effective air-pollutant-related public health policies for the prevention and control of COVID-19. However, few studies have investigated this issue. Using the USA as an example, we constructed single/two-pollutant conditional autoregressions with random coefficients and random intercepts to map the associations between five air pollutants (PM2.5, O3, SO2, NO2, and CO) and two COVID-19 outcomes (incidence and mortality) at the state level. The attributed cases and deaths were then mapped at the county level. This study included 3108 counties from 49 states within the continental USA. The county-level air pollutant concentrations from 2017 to 2019 were used as long-term exposures, and the county-level cumulative COVID-19 cases and deaths through May 13, 2022, were used as outcomes. Results showed that considerably heterogeneous associations and attributable COVID-19 burdens were found in the USA. The COVID-19 outcomes in the western and northeastern states appeared to be unaffected by any of the five pollutants. The east of the USA bore the greatest COVID-19 burdens attributable to air pollution because of its high pollutant concentrations and significantly positive associations. PM2.5 and CO were significantly positively associated with COVID-19 incidence in 49 states on average, whereas NO2 and SO2 were significantly positively associated with COVID-19 mortality. The remaining associations between air pollutants and COVID-19 outcomes were not statistically significant. Our study provided implications regarding where a major concern should be placed on a specific air pollutant for COVID-19 control and prevention, as well as where and how to conduct additional individual-based validation research in a cost-effective manner.

Using a novel two-stage strategy to characterize the spatial distribution of associations between temperature and COVID-19: A case study in the continental United States.

BACKGROUND: Numerous studies have studied the association between daily average temperature (DAT) and daily COVID-19 confirmed cases, which show considerable heterogeneity, even opposite results, among different regions. Such heterogeneity suggests that characterizing the association on a large area scale would ignore the local variation, even obtain false results in some local regions. So, characterizing the spatial distribution of heterogeneous DAT-COVID-19 associations and exploring the causes plays an important role on making temperature-related region-specific intervention measures and early-warning systems. METHODS: Aiming to characterize the spatial distribution of associations between DAT and COVID-19 confirmed cases in the continental United States, we proposed a novel two-stage strategy. In the first stage, we used the common stratified distributed lag nonlinear model to obtain the rough state-specific associations. In the second stage, conditional autoregression was used to spatially smooth the rough estimations. Furtherly, based on the idea, two modified strategies were used to investigate the time-varying associations and the modification effects derived from the vaccination campaign. RESULTS: Around one-third of states exhibit no significant association between DAT and daily confirmed COVID-19 cases. Most of the remaining states present a low risk at low DAT and a high risk at high DAT, but several states present opposite associations. The average association curve presents a 'S' shape with positive association between -8 - 18 °C and keeping flat out of the range. An increased vaccination coverage rate will increase the risk when DAT < 12 °C, but slightly affect the risk when DAT > 12 °C. CONCLUSION: A considerable spatial heterogeneity of DAT-COVID-19 associations exists in America and the average association curve presents a 'S' shape. The vaccination campaign significantly modifies the association when DAT is low, but only make a slight modification when DAT is high.

Therapeutic experience of an 89-year-old high-risk patient with incarcerated cholecystolithiasis: A case report and literature review.

BACKGROUND: The global pandemic of coronavirus disease 2019 pneumonia poses a particular challenge to the emergency surgical treatment of elderly patients with high-risk acute abdominal diseases. Elderly patients are a high-risk group for surgical treatment. If the incarceration of gallstones cannot be relieved, emergency surgery is unavoidable. CASE SUMMARY: We report an 89-year-old male patient with acute gangrenous cholecystitis and septic shock induced by incarcerated cholecystolithiasis. He had several coexisting, high-risk underlying diseases, had a history of radical gastrectomy for gastric cancer, and was taking aspirin before the operation. Nevertheless, he underwent emergency laparoscopic cholecystectomy, with maintenance of postoperative heart and lung function, successfully recovered, and was discharged on day 8 after the operation. CONCLUSION: Emergency surgery for elderly patients with acute abdominal disease is safe and feasible during the coronavirus disease 2019 pandemic, the key is to abide strictly by the hospital's epidemic prevention regulations, fully implement the epidemic prevention procedure for emergency surgery, fully prepare before the operation, accurately perform the operation, and carefully manage the patient postoperatively.