Opinion and Sentiment Analysis of Palliative Care in the Era of COVID-19.

During the COVID-19 pandemic, the value of palliative care has become more evident than ever. The current study quantitatively investigated the perceptions of palliative care emerging from the pandemic experience by analyzing a total of 26,494 English Tweets collected between 1 January 2020 and 1 January 2022. Such an investigation was considered invaluable in the era of more people sharing and seeking healthcare information on social media, as well as the emerging roles of palliative care. Using a web scraping method, we reviewed 6000 randomly selected Tweets and identified four themes in the extracted Tweets: (1) Negative Impact of the Pandemic on Palliative Care; (2) Positive Impact of the Pandemic on Palliative Care; (3) Recognized Benefits of Palliative Care; (4) Myth of Palliative Care. Although a large volume of Tweets focused on the negative impact of COVID-19 on palliative care as expected, we found almost the same volume of Tweets that were focused on the positive impact of COVID-19 on palliative care. We also found a smaller volume of Tweets associated with myths about palliative care. Using these manually classified Tweets, we trained machine learning (ML) algorithms to automatically classify the remaining tweets. The automatic classification of Tweets was found to be effective in classifying the negative impact of the COVID-19.

Determinants of voluntary compliance: COVID-19 mitigation.

During the pre-vaccine period, the success of containing the spread of COVID-19 depends upon how communities respond to non-pharmaceutical mitigation policies such as social distancing, wearing of masks, retail and dining constraints, crowd limitation, and shelter-in-place orders. Of these policies, shelter-in-place and social distancing are of central importance. By using county-level mobility data as a measure of a community's voluntary compliance with social distancing policies, this study found that counties who received strong state social distancing policy directives and who had a high pro-social character showed lower mobility on retail and recreation mobility and grocery and pharmacy mobility (better social distancing) after states reopened from shelter-in-place orders. Counties that experienced a longer duration of shelter-in-place orders showed higher mobility (less social distancing), implying that the duration of the shelter-in-place order deteriorated social distancing response after reopening. This may be because reopening sent a "safe" signal to these counties or resulted in a response to the pent-up demand inducing higher mobility. The results indicate that implementing shelter-in-place and social distancing policies to slow down the transmission of COVID-19 were not necessarily effective in motivating a county to reduce mobility voluntarily. A county's pro-social character and the duration of shelter-in-place order should be considered when designing COVID-19 mitigation policies.

The Impact of the COVID-19 Pandemic on Kidney Transplant Candidate Waitlist Status across Demographic and Geographic Groups: A National Analysis of UNOS STAR Data.

The primary goal of this retrospective study is to understand how the COVID-19 pandemic differentially impacted transplant status across race, sex, age, primary insurance, and geographic regions by examining which candidates: (i) remained on the waitlist, (ii) received transplants, or (iii) were removed from the waitlist due to severe sickness or death on a national level. Methods: The trend analysis aggregated by monthly transplant data from 1 December 2019 to 31 May 2021 (18 months) at the transplant center level. Ten variables about every transplant candidate were extracted from UNOS standard transplant analysis and research (STAR) data and analyzed. Characteristics of demographical groups were analyzed bivariately using t-test or Mann-Whitney U test for continuous variables and using Chi-sq/Fishers exact tests for categorical variables. Results: The trend analysis with the study period of 18 months included 31,336 transplants across 327 transplant centers. Patients experienced a longer waiting time when their registration centers in a county where high numbers of COVID-19 deaths were observed (SHR < 0.9999, p < 0.01). White candidates had a more significant transplant rate reduction than minority candidates (-32.19% vs. -20.15%) while minority candidates were found to have a higher waitlist removal rate than White candidates (9.23% vs. 9.45%). Compared to minority patients, White candidates' sub-distribution hazard ratio of the transplant waiting time was reduced by 55% during the pandemic period. Candidates in the Northwest United States had a more significant reduction in the transplant rate and a greater increase in the removal rate during the pandemic period. Conclusions: Based on this study, waitlist status and disposition varied significantly based on patient sociodemographic factors. During the pandemic period, minority patients, those with public insurance, older patients, and those in counties with high numbers of COVID-19 deaths experienced longer wait times. In contrast, older, White, male, Medicare, and high CPRA patients had a statistically significant higher risk of waitlist removal due to severe sickness or death. The results of this study should be considered carefully as we approach a reopening world post-COVID-19, and further studies should be conducted to elucidate the relationship between transplant candidate sociodemographic status and medical outcomes during this era.

Regional poverty and infection disease: early exploratory evidence from the COVID-19 pandemic.

This paper examines the role of regional poverty on the COVID-19 pandemic in the USA. It also explores how the effects differ with the concentration of ethnic minorities. We find that poverty is a significant and consistent determinant of higher COVID-19 infections and fatalities. Prevalent poverty areas experienced higher infections due to economic structure that require hypermobility (high mobility and interpersonal interaction)-more physical human to human contact resulting in higher deaths from limited access to health services. These are also regions where minority groups are concentrated. Disproportionate infections and fatalities occurred within the black, Hispanic, and Asian population. Our evidence is robust to state fixed effects that capture local COVID-19 mitigation policies, multi-level hierarchical modeling, spatial autoregressive assessment, and large sets of county-level health, social, and economic factors. This paper contributes to the literature on health and economic disparities and their resulting consequences for infectious diseases.

Impact of proton pump inhibitors on the in-hospital outcome of COVID-19 patients: a retrospective study.

Background: Coronavirus disease 2019 (COVID-19) has triggered a global public health crisis. Proton pump inhibitors (PPIs) are one of the most commonly prescribed drugs. However, the effect of PPIs on the clinical outcomes of COVID-19 patients remains unclear. Methods: All COVID-19 patients admitted to the Wuhan Huoshenshan Hospital from February 2020 to April 2020 were retrospectively collected. Patients were divided into PPIs and non-PPIs groups. Logistic regression analyses were performed to explore the effects of PPIs on the outcomes of COVID-19 patients, including transfer to intensive care unit, mechanical ventilation, and death. Subgroup analyses were performed according to the presence of upper gastrointestinal symptoms potentially associated with acid and the routes, types, median total dosage, and duration of PPIs. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: Of the 3024 COVID-19 patients included, 694 and 2330 were in PPIs and non-PPIs groups, respectively. Univariate logistic regression analysis showed that PPIs significantly increased the risk of reaching the composite endpoint in COVID-19 patients (OR = 10.23, 95% CI = 6.90-15.16, p < 0.001). After adjusting for age, sex, comorbidities, other medications, and severe/critical COVID-19, PPIs were independently associated with an increased risk of reaching the composite endpoint (OR = 7.00, 95% CI = 4.57-10.71, p < 0.001). This association remained significant in patients with upper gastrointestinal symptoms and those who received an intravenous omeprazole alone, but not those who received oral lansoprazole or rabeprazole alone. It was not influenced by dosage or duration of PPIs. Conclusion: The use of intravenous PPIs alone during hospitalization may be associated with worse clinical outcome in COVID-19 patients.

Aerosolized Ad5-nCoV booster vaccination elicited potent immune response against the SARS-CoV-2 Omicron variant after inactivated COVID-19 vaccine priming (preprint)

The SARS-CoV-2 Omicron variant has become the dominant SARS-CoV-2 variant around the world and exhibits immune escape to current COVID-19 vaccines to some extent due to its numerous spike mutations. Here, we evaluated the immune responses to booster vaccination with intramuscular adenovirus-vectored vaccine (Ad5-nCoV), aerosolized Ad5-nCoV, a recombinant protein subunit vaccine (ZF2001) or homologous inactivated vaccine (CoronaVac) in those who received two doses of inactivated COVID-19 vaccines 6 months prior. We found that the Ad5-nCoV booster induced potent neutralizing activity against the wild-type virus and Omicron variant, while aerosolized Ad5-nCoV generated the greatest neutralizing antibody responses against the Omicron variant at day 28 after booster vaccination, at 14.1-fold that of CoronaVac, 5.6-fold that of ZF2001 and 2.0-fold that of intramuscular Ad5-nCoV. Similarly, the aerosolized Ad5-nCoV booster produced the greatest IFNgamma T-cell response at day 14 after booster vaccination. The IFNgamma T-cell response to aerosolized Ad5-nCoV was 12.8-fold for CoronaVac, 16.5-fold for ZF2001, and 5.0-fold for intramuscular Ad5-nCoV. Aerosolized Ad5-nCoV booster also produced the greatest spike-specific B cell response. Our findings suggest that inactivated vaccine recipients should consider adenovirus-vectored vaccine boosters in China and that aerosolized Ad5-nCoV may provide a more efficient alternative in response to the spread of the Omicron variant.

Implementing a Personalized Music Intervention for Persons Living With Dementia in Nursing Facilities

The Mason Music & Memory Initiative (M3I) team has implemented a personalized music intervention in nursing facilities across Virginia aiming to improve behavioral and psychological symptoms of persons living with dementia. This person-centered intervention uses a unique music playlist comprising songs, artists, and preferred musical genres. The preliminary findings from a randomized controlled trial will be reported, the purpose of which was to examine the intervention impact on nursing home residents’ mood and behavior. Based on the findings from 16 facilities with 158 residents who have completed the study, both quantitative and qualitative data indicate the positive effects on residents, including improved sleep and mood, as well as reduced agitation. The challenges in implementing intervention research in nursing facilities during the COVID-19 pandemic and the principles of telehealth and virtual support for facilities that were used to address those challenges will also be discussed.

Analysis of Symptomology, Infectiveness, and Reinfections between Male and Female COVID-19 Patients: Evidence from Japanese Registry Data

Background: Hokkaido was the first Japanese prefecture to be affected by COVID-19. Since the beginning of the pandemic, the Japanese government has been publishing the information of each individual who was tested positive for the virus. Method: The current study analyzed the 1269 SARS-CoV-2 cases confirmed in Hokkaido in order to examine sex-based differences in symptomology and infectiveness, as well as the status of reinfections and the viral transmission networks. Results: The majority of asymptomatic patients were females and older. Females were 1.3-fold more likely to be asymptomatic (p <0.001) while a decade of difference in age increased the likelihood of being asymptomatic by 1% (p <0.001). The data contained information up to quaternary viral transmission. The transmission network revealed that, although asymptomatic patients are more likely to transmit the virus, the individuals infected by asymptomatic cases are likely to be asymptomatic (p <0.001). Four distinct co-occurrences of symptoms were observed, including (i) fever/fatigue, (ii) pharyngitis/rhinitis, (iii) ageusia/anosmia, and (iv) nausea/vomiting/diarrhea. The presences of diarrhea (p = 0.05) as well as nausea/vomiting (p <0.001) were predictive of developing dyspnea, i.e., severe disease. About 1% of the patients experienced reinfection. Conclusions: Sex and symptomatology appear to play important roles in determining the levels of viral transmission as well as disease severity.

Gastrointestinal Bleeding, but Not Other Gastrointestinal Symptoms, Is Associated With Worse Outcomes in COVID-19 Patients.

Background: Patients with coronavirus disease 2019 (COVID-19) can present with gastrointestinal (GI) symptoms. However, the prevalence of GI symptoms and their association with outcomes remain controversial in COVID-19 patients. Methods: All COVID-19 patients consecutively admitted to the Wuhan Huoshenshan hospital from February 2020 to April 2020 were collected. Disease severity and outcomes were compared between COVID-19 patients with and without GI symptoms. Logistic regression analyses were performed to evaluate the association of GI symptoms with the composite endpoint and death in COVID-19 patients. A composite endpoint was defined as transfer to intensive care unit, requirement of mechanical ventilation, and death. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: Overall, 2,552 COVID-19 patients were included. The prevalence of GI symptoms was 21.0% (537/2,552). Diarrhea (8.9%, 226/2,552) was the most common GI symptom. Patients with GI symptoms had significantly higher proportions of severe COVID-19 and worse outcomes than those without. Univariate logistic regression analyses demonstrated that GI symptoms were significantly associated with the composite endpoint (OR = 2.426, 95% CI = 1.608-3.661; P < 0.001) and death (OR = 2.137, 95% CI = 1.209-3.778; P = 0.009). After adjusting for age, sex, and severe/critical COVID-19, GI symptoms were still independently associated with the composite endpoint (OR = 2.029, 95% CI = 1.294-3.182; P = 0.002), but not death (OR = 1.726, 95% CI = 0.946-3.150; P = 0.075). According to the type of GI symptoms, GI bleeding was an independent predictor of the composite endpoint (OR = 8.416, 95% CI = 3.465-20.438, P < 0.001) and death (OR = 6.640, 95% CI = 2.567-17.179, P < 0.001), but not other GI symptoms (i.e., diarrhea, abdominal discomfort, nausea and/or vomiting, constipation, acid reflux and/or heartburn, or abdominal pain). Conclusion: GI symptoms are common in COVID-19 patients and may be associated with their worse outcomes. Notably, such a negative impact of GI symptoms on the outcomes should be attributed to GI bleeding.

Comparison of liver biochemical abnormality between COVID-19 patients with liver cirrhosis versus COVID-19 alone and liver cirrhosis alone: A STROBE observational study.

ABSTRACT: Coronavirus disease (COVID-19) patients frequently develop liver biochemical abnormality. However, liver biochemical abnormality in COVID-19 patients with liver cirrhosis is under-recognized.Patients hospitalized during COVID-19 pandemic in China (ie, from February to April 2020) were screened. All of 17 COVID-19 patients with liver cirrhosis consecutively admitted to the Wuhan Huoshenshan Hospital were identified. Meanwhile, 17 age-, sex-, and severity-matched COVID-19 patients without liver cirrhosis admitted to this hospital were selected as a control group; all of 14 cirrhotic patients without COVID-19 consecutively admitted to the Department of Gastroenterology of the General Hospital of Northern Theater Command were selected as another control group. Incidence of liver biochemical abnormality and decompensated events were primarily compared.Among the COVID-19 patients with liver cirrhosis, the incidence of liver biochemical abnormality at admission and during hospitalization were 76.50% and 84.60%, respectively; 7 (41.20%) had decompensated events at admission; 1 was transferred to intensive care unit due to gastrointestinal bleeding. Among the COVID-19 patients without liver cirrhosis, the incidence of liver biochemical abnormality at admission and during hospitalization were 58.80% (P = .271) and 60.00% (P = .150), respectively. Among the cirrhotic patients without COVID-19, the incidence of liver biochemical abnormality at admission and during hospitalization were 69.20% (P = .657) and 81.80% (P = .855), respectively; 11 (78.60%) had decompensated events at admission (P = .036). None died during hospitalization among the three groups.Liver biochemical abnormality is common in COVID-19 patients with liver cirrhosis. Management of decompensated events in cirrhotic patients without COVID-19 should not be neglected during COVID-19 pandemic.

Symptom and Age Homophilies in SARS-CoV-2 Transmission Networks during the Early Phase of the Pandemic in Japan.

Kanagawa and Hokkaido were affected by COVID-19 in the early stage of the pandemic. Japan's initial response included contact tracing and PCR analysis on anyone who was suspected of having been exposed to SARS-CoV-2. In this retrospective study, we analyzed publicly available COVID-19 registry data from Kanagawa and Hokkaido (n = 4392). Exponential random graph model (ERGM) network analysis was performed to examine demographic and symptomological homophilies. Age, symptomatic, and asymptomatic status homophilies were seen in both prefectures. Symptom homophilies suggest that nuanced genetic differences in the virus may affect its epithelial cell type range and can result in the diversity of symptoms seen in individuals infected by SARS-CoV-2. Environmental variables such as temperature and humidity may also play a role in the overall pathogenesis of the virus. A higher level of asymptomatic transmission was observed in Kanagawa. Moreover, patients who contracted the virus through secondary or tertiary contacts were shown to be asymptomatic more frequently than those who contracted it from primary cases. Additionally, most of the transmissions stopped at the primary and secondary levels. As expected, significant viral transmission was seen in healthcare settings.

Symptom and Age Homophilies in SARS-CoV-2 Transmission Networks during the First and Second Waves of the Pandemic in Japan (preprint)

Background Hokkaido is the northernmost, least populous, and coldest of the Japanese islands. It was the first prefecture to be affected by COVID-19, while Kanagawa is home to one of the most populous areas of Japan, namely the Tokyo metro area. The Japanese government responded early during the pandemic by identifying infected patients, contact tracing, and performing PCR analysis on anyone who was suspected of having been exposed to SARS-CoV-2. The government has also been publishing information about each individual who tested positive for the virus. Both Hokkaido and Kanagawa started recording COVID-19 cases in the winter of 2020 and have detailed records of thousands of patients, thus providing an invaluable resource for the transmission and behavior of the virus. Methods The current study analyzed the COVID-19 registry data from the Hokkaido and Kanagawa prefectures. The Hokkaido registry contained 1,269 cases (674 (53%) females and 595 (47%) males) recorded between February 14 and July 22, 2020. The Kanagawa registry had 3,123 cases (1,346 (43%) females and 1,777 (57%) males. The final data contained a total of 4,392 cases (2,020 (46%) females and 2,372 (54%) males). By leveraging the information on viral transmission paths available in the registry data, we performed exponential random graph model (ERGM) network analysis to examine demographic and symptomological homophilies of the SARS-CoV-2 viral transmission networks. Results We observed age, symptomatic, and asymptomatic homophilies in both prefectures. Furthermore, those patients who contracted the virus through secondary or tertiary contacts were more likely to be asymptomatic than those who contracted it from primary infection cases. The transmission networks showed that transmission occurred significantly in healthcare settings, as well as in families, although the size of the networks was small in the latter. Most of the transmissions stopped at the primary and secondary levels and no transmission beyond quaternary was observed. We also observed a higher level of asymptomatic transmission in Kanagawa than in Hokkaido. Conclusions Symptom homophilies are an important component of COVID-19 and suggest that nuanced genetic differences in the virus may affect its epithelial cell type range and can thus result in the diversity of symptoms seen in individuals infected by SARS-CoV-2. Moreover, environmental variables such as temperature and humidity may also be playing an important role in the overall pathogenesis of the virus.

A Note on COVID-19 Diagnosis Number Prediction Model in China (preprint)

Objective: In December 2019, pneumonia infected with the novel coronavirus burst in Wuhan, China. We aimed to use a mathematical model to predict number of diagnosed patients in future to ease anxiety on the emergent situation. Methods: According to all diagnosis number from WHO website and combining with the transmission mode of infectious diseases, the mathematical model was fitted to predict future trend of outbreak. Our model was based on the epidemic situation in China, which could provide referential significance for disease prediction in other countries, and provide clues for prevention and intervention of relevant health authorities. In this retrospective, all diagnosis number from Jan 21 to Feb 10, 2020 reported from China was included and downloaded from WHO website. We develop a simple but accurate formula to predict the next day diagnosis number: ，where N i is the total diagnosed patient till the i th day, and was estimated as 0.904 at Feb 10. Results: Based on this model, it is predicted that the rate of disease infection will decrease exponentially. The total number of infected people is limited; thus, the disease will have limited impact. However, new diagnosis will last to end of March. Conclusions: Through the establishment of our model, we can better predict the trend of the epidemic in China.

A Note on COVID-19 Diagnosis Number Prediction Model in China (preprint)

In December 2019, pneumonia infected with the novel coronavirus burst in Wuhan, China. We aimed to use a mathematical model to predict number of diagnosed patients in future to ease anxiety on the emergent situation. Our model was based on the epidemic situation in China, which could provide referential significance for disease prediction in other countries, and provide clues for prevention and intervention of relevant health authorities. In this retrospective, all diagnosis number from Jan 21 to Feb 10, 2020 reported from China was included and downloaded from WHO website. We develop a simple but accurate formula to predict the next day diagnosis number: N_i/N_(i-1) =〖(N_(i-1)/N_(i-2) )〗^α，where Ni is the total diagnosed patient till the ith day, and α was estimated as 0.904 at Feb 10. Based on this model, it is predicted that the rate of disease infection will decrease exponentially. The total number of infected people is limited; thus, the disease will have limited impact. However, new diagnosis will last to end of March. Through the establishment of our model, we can better predict the trend of the epidemic in China.

The Impact of Differing COVID-19 Mitigation Policies: Three Natural Experiments (preprint)

This paper presents a comparison of the COVID-19 infections between a select pair of neighboring states and their border county regions where the policies of the Non-Pharmaceutical Interventions (NPI) such as Lockdown/Stay-at-Home differ. These analyses use a Difference-in-Differences (Diff-in Diff) model to test the effectiveness of NPI in mitigating COVID-19 infections at the state and border county regions between these states. The counties are in the states on the Iowa and Illinois border, the Dakotas (North and South) and Minnesota border and the Arkansas and Mississippi border. In each case the policies on each side of the border differ and the border is clearly designated by a river separation. Based on the Diff-in-Diff model output, state policies appear to make a significant difference in some of these specific border regions, at least early in the pandemic (April-June 2020). State level results are mixed reflecting spatial heterogeneity across the inter-state system.

Determinants of Voluntary Compliance: COVID-19 Mitigation (preprint)

During the pre-vaccine period, the success of containing the spread of COVID-19 depends upon how communities respond to non-pharmaceutical mitigation policies such as social distancing, wearing of masks, retail and dining constraints, crowd limitation, and shelter-in-place orders. Of these policies, shelter-in-place and social distancing are of central importance. By using county-level mobility data as a measure of a community’s voluntary compliance with social distancing policies, this study found that counties who received strong state social distancing policy directives and who had a high pro-social character showed lower mobility (better social distancing) after states reopened from shelter-in-place orders. Counties that experienced a longer duration of shelter-in-place orders showed higher mobility (less social distancing), implying that the duration of the shelter-in-place order deteriorated social distancing response after reopening. This may be because reopening sent a “safe” signal to these counties or resulted in a response to the pent-up demand inducing higher mobility. The results indicate that implementing shelter-in-place and social distancing policies to slow down the transmission of COVID-19 were not necessarily effective in motivating a county to reduce mobility voluntarily. A county’s pro-social character and the duration of shelter-in-place order should be considered when designing COVID-19 mitigation policies.

Regional Poverty Worsens Infectious Diseases: Evidence from COVID-19 Pandemic (preprint)

This paper examines the role of regional poverty on the COVID-19 pandemic in the U.S.A. It also verifies if the effects differ with the concentration of ethnic minorities. We find that poverty is a significant and consistent determinant of higher COVID-19 infections and fatalities. The prevalent poverty areas experienced higher infections due to its economic structures that require hypermobility - more physical human-to-human contacts and experienced higher deaths due to limited access to health services. These are also regions where minority groups are concentrated, and thus, the disproportionate infections and fatalities occurred within the black, Hispanic, and Asian population. Our evidence is robust to state fixed effects that capture local COVID-19 mitigation policies, multi-level hierarchical modeling, and large sets of county-level health, social, and economic factors. This paper contributes to the literature on health and economic disparities and their resulting consequences for infectious diseases.