Potential impact of COVID-19 on drugs of abuse consumption.

To the Editors, Tzeferakos et al. highlighted that drugs of abuse consumption may have substantially varied during the coronavirus disease 2019 (COVID-19) pandemic.1 To provide additional insights on this matter, we accessed Google Trends (Google Inc. Mountain View, CA, US) using the keywords "cannabis," "cocaine," and "heroin" under the specification "drug" (and thereby overcoming potential language differences), setting the geographical location to either "United States" (US) or "worldwide", within the past 5 years (i.e., from July 2017 to July 2022). The weekly Google Trends score for these search terms, thus reflecting their Web popularity and consumption,2 was downloaded into a Microsoft Excel file (Microsoft, Redmond, WA, United States). We divided the search period into "pre-COVID" (between July 2017 and February 2020) and COVID (between March 2020 and July 2022). The weekly Google Trends scores, mirroring the weekly local volume of Google search for the given terms, were reported as median and interquartile range (IQR), whilst their differences were compared with Mann-Whitney test (Analyse-it Software Ltd, Leeds, UK). The study was conducted in accordance with the Declaration of Helsinki, under the terms of relevant local legislation. The results of this infodemiological analysis are shown in figure 1. During the COVID-19 pandemic, the volume of Google searches for all the three terms "cannabis," "cocaine," and "heroin" decrease substantially compared to the pre-COVID period both in the US and worldwide. Specifically, the weekly Google Trends score in the US declined from 64 (IQR, 60-66) to 62 (IQR, 58-64; -3%, p=0.003) for cannabis, from 57 (IQR, 54-60) to 46 (IQR, 45-48; -19%, p<0.001) for cocaine, and from 39 (IQR, 35-43) to 27 (IQR, 25-28; -32%, p<0.001) for heroin, respectively. An even sharper decline in the weekly Google Trends score for cannabis was noted setting the location to "worldwide", since the median weekly Google Trends score declined from 61 (IQR, 58-63) to 54 (IQR, 51-56; -11%; p<0.001), whilst the variation of the other two search terms exactly mirrored that seen in the use, i.e., from 63 (IQR, 61-66) to 51 (IQR, 49-53; -19%, p<0.001) for cocaine and from 44 (IQR, 38-48) to 30 (IQR, 27-33; -32%, p<0.001) for heroin, respectively. Several lines of evidence now attest that COVID-19 is generating a dramatic psychological burden, increasing the risk of developing important threat appraisals,3 and thus potentially paving the way to enhanced use of drugs of abuse. Unlike this preamble, however, the results of our infodemiological analysis seemingly attest that the use of the three mostly widespread addictive drugs may have instead significantly declined both worldwide and in the US during the COVID-19 pandemic. Besides the objective problems of obtaining these drugs during periods of social restrictions and lockdown,4 the availability of several drugs and medicines has been jeopardized throughout the ongoing COVID-19 pandemic, thus providing a possible explanation to our findings.

The general interest in running and walking has increased during the COVID-19.

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Correlation between relative age-standardized mortality rates and COVID-19 mortality over time in Italy.

BACKGROUND AND AIM: This study was planned to estimate the contribution of coronavirus disease 2019 (COVID-19) related mortality on excess deaths recorded in Italy since the beginning of the pandemic. METHODS: Official data on weekly number of COVID-19 related deaths in Italy were retrieved from the website of the Italian Ministry of Health, whilst information on weekly relative age-standardised mortality rates (rASMRs) in Italy during the COVID-19 pandemic was downloaded from the UK Office for National Statistics website. Univariate and multivariate correlation was conducted to explore the association between these two variables throughout the pandemic. RESULTS: Significant univariate correlation was found between rASMR and number of official COVID-19 related deaths throughout the pandemic period. Such correlation was especially high during predominance of pre-Alpha and Alpha variants, remained significant during Delta variant predominance, but become no longer significant during Omicron variant predominance. In multivariable analysis, we estimated that COVID-19 may have contributed to 72% of the excess mortality recorded in Italy throughout the pandemic. The impact was higher during pre-Alpha and Alpha periods (i.e., 78% and 89%, respectively), decreased to 41% during Delta variant predominance, and became no longer significant after emergence of the Omicron variant. CONCLUSIONS: These results would suggest that COVID-19 may have largely contributed to excess mortality in Italy until the recent emergence of the Omicron variant, by which time previous loss of vulnerable people and radical changes in delivering healthcare may have paradoxically contributed to improve the cumulative death rate in the country.

Efficacy of the Second COVID-19 Vaccine Booster Dose in the Elderly.

BACKGROUND: We analyzed coronavirus disease 2019 (COVID-19) vaccine efficacy in older persons who received the second booster compared to unvaccinated people and those receiving only a single COVID-19 vaccine booster. METHODS: We collected information on vaccine efficacy from the ongoing Italian nationwide COVID-19 vaccination campaign in subjects aged 80 years or older from official data published by the Italian National Institute of Health. RESULTS: The second vaccine booster maintained high effectiveness against adverse COVID-19 outcomes such as hospitalization, intensive care unit admission and death (i.e., between 77 and 86%), and also showed around 10% higher efficacy than the single booster. Nonetheless, the efficacy of the second vaccine booster declined over time, decreasing by 33-46% when assessed at >120 days from administration. CONCLUSIONS: The results of our ad interim analysis of the ongoing Italian nationwide COVID-19 vaccination campaign suggest that regular boosting with COVID-19 vaccines may be advisable in older persons.

Improving Nasal Protection for Preventing SARS-CoV-2 Infection.

Airborne pathogens, including SARS-CoV-2, are mainly contracted within the airway pathways, especially in the nasal epithelia, where inhaled air is mostly filtered in resting conditions. Mucosal immunity developing after SARS-CoV-2 infection or vaccination in this part of the body represents one of the most efficient deterrents for preventing viral infection. Nonetheless, the complete lack of such protection in SARS-CoV-2 naïve or seronegative subjects, the limited capacity of neutralizing new and highly mutated lineages, along with the progressive waning of mucosal immunity over time, lead the way to considering alternative strategies for constructing new walls that could stop or entrap the virus at the nasal mucosa surface, which is the area primarily colonized by the new SARS-CoV-2 Omicron sublineages. Among various infection preventive strategies, those based on generating physical barriers within the nose, aimed at impeding host cell penetration (i.e., using compounds with mucoadhesive properties, which act by hindering, entrapping or adsorbing the virus), or those preventing the association of SARS-CoV-2 with its cellular receptors (i.e., administering anti-SARS-CoV-2 neutralizing antibodies or agents that inhibit priming or binding of the spike protein) could be considered appealing perspectives. Provided that these agents are proven safe, comfortable, and compatible with daily life, we suggest prioritizing their usage in subjects at enhanced risk of contagion, during high-risk activities, as well as in patients more likely to develop severe forms of SARS-CoV-2 infection.

The Global Impact of COVID-19 on Threat Appraisals.

We planned an infodemiological analysis to estimate the global impact of coronavirus disease 2019 (COVID-19) on threat appraisals. We accessed Google Trends using the search terms "Anxiety", "Distress", "Fear", "Rumination", "Stress" and "Worry" within the "topic" domain, setting the geographical location to "worldwide", between July 2017 and July 2022. The weekly Google Trends score for the six search terms, thus, mirroring Web popularity and probable prevalence, was compared between the two search periods, "pre-COVID" (between July 2017 and February 2020) and COVID (between March 2020 and July 2022), thus, reflecting the volume of searches before and during the ongoing COVID-19 pandemic. The median weekly Google Trends score of all these search terms significantly increased during the COVID-19 pandemic, i.e., anxiety by 22%, distress by 13%, fear by 9%, rumination by 18%, stress by 13% and worry by 20%. With variable strength, the weekly Google Trends scores of each search term were found to be significantly associated (all p < 0.001). We can, hence, conclude that the enhanced burden of threat appraisals observed after SARS-CoV-2 spread leads the way to establish preventive, diagnostic and therapeutic measures in order to limit the unfavorable mental health consequences caused by the ongoing COVID-19 pandemic.

Regional Association between Mean Air Temperature and Case Numbers of Multiple SARS-CoV-2 Lineages throughout the Pandemic.

The association between mean air temperature and new SARS-CoV-2 case numbers throughout the ongoing coronavirus disease 2019 (COVID-19) pandemic was investigated to identify whether diverse SARS-CoV-2 lineages may exhibit diverse environmental behaviors. The number of new COVID-19 daily cases in the province of Verona was obtained from the Veneto Regional Healthcare Service, whilst the mean daily air temperature during the same period was retrieved from the Regional Agency for Ambient Prevention and Protection of Veneto. A significant inverse correlation was found between new COVID-19 daily cases and mean air temperature in Verona up to Omicron BA.1/BA.2 predominance (correlation coefficients between -0.79 and -0.41). The correlation then became positive when the Omicron BA.4/BA.5 lineages were prevalent (r = 0.32). When the median value (and interquartile range; IQR) of new COVID-19 daily cases recorded during the warmer period of the year in Verona (June-July) was compared across the three years of the pandemic, a gradual increase could be seen over time, from 1 (IQR, 0-2) in 2020, to 22 (IQR, 11-113) in 2021, up to 890 (IQR, 343-1345) in 2022. These results suggest that measures for preventing SARS-CoV-2 infection should not be completely abandoned during the warmer periods of the year.

Evolution of throat symptoms during the COVID-19 pandemic in the US.

OBJECTIVES: SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) structure and host tropism have changed over time, and so has the involvement of throat structures. This infodemiological analysis is hence aimed at investigating the evolution of throat symptoms during the COVID-19 pandemic in the US. METHODS: We searched Google Trends using the medical search terms "ageusia", "hoarseness", "dysphonia", "pharyngitis" and "laryngitis", setting geographical location to "United States", within the past 5 years. The weekly Google Trends score for these symptoms, which reflects their national Web popularity, was divided in three parts, as "pre-COVID" (July 2017 to February 2020), COVID-19 "pre-Omicron" (March 2020 to November 2021), and COVID-19 "Omicron" (December 2021 to July 2022), and then compared. RESULTS: The volume of searches for ageusia increased in the pre-Omicron period and remained significantly higher also during Omicron prevalence, though a significant decrease (∼30%) occurred with Omicron lineages compared to previous strains. The Google searches for hoarseness and dysphonia were relatively similar between the pre-COVID and pre-Omicron periods, but then significantly increased during Omicron predominance. The Google searches for pharyngitis and laryngitis decreased in the pre-Omicron period, but then considerably increased following Omicron emergence. Omicron endemic spread could be significantly and independently predicted by the volume of searches for pharyngitis, laryngitis and hoarseness. CONCLUSIONS: The epidemiological burden of throat symptoms has considerably changed after Omicron emergence, with a lower likelihood of developing chemosensory dysfunctions and enhanced risk of throat involvement.