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Understanding the prevalence and severity of post-COVID-19 conditions among hospitalized patients is crucial for developing effective strategies for managing the long-term consequences of the disease. This study aimed to estimate the prevalence and severity of post-COVID-19 conditions in previously hospitalized COVID-19 patients. The study involved two phases: first, participants were contacted via phone call by trained personnel from the healthcare company and surveyed. In the second phase, two months after the telephone survey, a medical visit was conducted in the group of individuals who reported persistent symptoms in the previous call. Summary statistics such as mean, standard deviation (SD), interquartile range (IQR), 95%CI as well as absolute and relative frequencies of patients' baseline characteristics were reported. Changes were assessed through statistical tests for differences in means and proportions. Multivariate analyses were also conducted. The prevalence of at least one post-hospitalization condition after three months of COVID-19 hospitalization was 78.7 per 100 people. The most common symptoms included fatigue (55.4%), joint pain (46.0%), dyspnea (44.6%), sleep disorders (36.1%), anorexia (33.7%), and chest pain (31.7%). These conditions were frequent and disabling, experiencing at least one condition after three months. Within this group, more than 70% showed a deterioration in their health status (EQ5D-5L Scale) or experienced new or worsened disability in at least one domain of the Washington Group. Our study demonstrates that post-COVID-19 conditions in previously hospitalized patients are highly prevalent, which can adversely affect patients' quality of life and lead to increased demand for healthcare services.
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Dyspnea , Chest Pain , Arthralgia , COVID-19 , Sleep Wake Disorders , Fatigue , AnorexiaABSTRACT
OBJECTIVES: This study aimed to estimate the burden of acute COVID-19 in Córdoba, one of the most affected departments (states) in Colombia, through the estimation of disability-adjusted life-years (DALYs). METHODS: DALYs were estimated based on the number of cases of severe acute respiratory syndrome coronavirus 2 infection cases reported by official Colombian sources. A transition probability matrix among severity states was calculated using data obtained from a retrospective cohort that included 1736 COVID-19 confirmed subjects living in Córdoba. RESULTS: Córdoba had 120.23 deaths per 100 000 habitants during the study period (March 2020 to April 2021). Estimated total DALYs were 49 243 (2692 DALYs per 100 000 inhabitants), mostly attributed to fatal cases (99.7%). On average, 25 years of life were lost because of death by this infection. A relevant proportion of years of life lost because of COVID-19 (46.6%) was attributable to people < 60 years old and was greater in men. People ≥ 60 years old showed greater risk of progression to critical state than people between the age of 35 and 60 years (hazard ratio 2.5; 95% confidence interval 2.5-12.5) and younger than 35 years (9.1; 95% confidence interval 4.0-20.6). CONCLUSION: In Córdoba, premature mortality because of COVID-19 was substantially represented by people < 60 years old and was greater in males. Our data may be representative of Latin American populations with great infection spread during the first year of the pandemic and contribute to novel methodological aspects and parameter estimations that may be useful to measure COVID-19 burden in other countries of the region.
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Macroeconomics in Context lays out the principles of macroeconomics in a manner that is thorough, up to date, and relevant to students. Like its counterpart, Microeconomics in Context, the book is uniquely attuned to economic, social, and environmental realities. The "In Context” books offer engaging coverage of current topics including policy responses to recession and inflation, inequality, deficits and government debt, economic impacts of the COVID-19 pandemic, and the economics of environmental sustainability. This fourth edition includes: Improved and concise discussions of introductory topics, especially on key economic activities, macroeconomic goals, and economic models Further emphasis on inequality, environmental sustainability, financialization, the changing nature of work, and international developments such as the role of transnational corporations and supply chain issues Discussion of the impacts of the COVID-19 pandemic on macroeconomic factors like well-being, inequality, and labor markets Presentation of policy issues in historical, environmental, institutional, social, political, and ethical contexts, including an updated discussion of fiscal policy in relation to the Biden administration's infrastructure and social investment spending Clear explanations of basic economic concepts alongside more in-depth analysis of macroeconomics models and economic activity This book combines real-world relevance with a thorough grounding in multiple economic paradigms. It is the ideal textbook for modern introductory courses in macroeconomics. The book's companion website is available at: https://www.bu.edu/eci/macro. © 2023 Neva Goodwin, Jonathan M. Harris, Julie A. Nelson, Pratistha Joshi Rajkarnikar, Brian Roach, and Mariano Torras.
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COVID-19 has changed the landscape within which we travel. Working from Home (WFH) in many countries has increased significantly, and while it was often forced on a society it has delivered some unintended positive consequences associated in particular with the levels of congestion on the roads and crowding on public transport. With a likelihood of some amount of WFH continuing as we move out of the active COVID-19 period, the question being asked is whether the post-COVID-19 period will return the pre-COVID-19 levels of traffic congestion and crowding. In many jurisdictions, there is a desire to avoid this circumstance and to use WFH as a policy lever that has appeal to employees, employers and government planning agencies in order to find ways of better managing future levels of congestion and crowding. This chapter uses the ongoing research and surveys we have been undertaking in Australia since March 2020 to track behavioural responses that impact on commuting and non-commuting travel, and to examine what the evidence tells us about opportunities into the future in many geographical settings to better manage congestion and crowding. This is linked to a desire by employers to maintain WFH where it makes sense as a way of not only supporting sustainability charters but also the growing interest in a commitment to a broader social licence. We discuss ways in which WFH can contribute to flattening peaks in travel;but also the plans that some public transport authorities are putting in place to ensure that crowding on public transport is mitigated as people increasingly return to using public transport. Whereas we might have thought that we now have plenty of public transport capacity, this may not be the case if we want to control crowding, and more capacity may be needed which could be a challenge for trains more than buses given track capacity limits. We conclude the chapter by summarising some of the positive benefits associated with WFH, and the implications not just for transport but for society more widely. © 2022 by Emerald Publishing Limited.
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This chapter focusses primarily on the short-term measures and policy reactions of transport operators and regulators to the COVID-19 pandemic throughout 2020/2021 (such as the introduction of physical distancing and mask wearing) but also considers those policies which directly influence public transport (such as parking management and working from home). Emphasis is placed on the experience in a number of jurisdictions to identify the influence of varying governmental level responses to the pandemic. The approaches of different jurisdictions are compared using a narrative approach to help identify policy narrative elements by policy actors as the pandemic unfolded. Such an approach enables us to focus on how decision-makers can learn from the COVID-19 experience to better react to future unexpected incidents. In identifying the future policy implications and challenges, the chapter suggests that strategic planning will need to respond to both the ‘current normal’ and the ‘next normal’, and will require flexibility and tight integration between urban planning and public transport planning, as well as private transport and long-distance transport. The chapter also highlights the importance of learning from the experience of other jurisdictions and disciplines (such as disaster manage-ment) and offers suggestions for further research. © 2022 by Emerald Publishing Limited.
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Purpose: To evaluate the efficacy and safety of a protocol increasing the net state of immunosuppression for adult kidney transplant recipients (KTR) with delayed graft function (DGF). Method(s): Single-center retrospective cohort of adult KTR with DGF transplanted from January 2017 to March 2021. Pre- vs post-DGF protocol implementation outcomes were evaluated. Protocol included cumulative 6 mg/kg rabbit antithymocyte globulin (rATG) induction, non-weight-based mycophenolate mofetil dosing (1000 mg bid), and higher goal tacrolimus trough (9-12 ng/mL). Pre-protocol patients received cumulative 4.5 mg/kg rATG. Efficacy outcomes were biopsy proven acute rejection (BPAR) and graft loss at 6 months. Safety outcomes were incidence of cytopenia, infection, and all-cause readmission at 6 months. Result(s): Eighty-nine DGF patients met inclusion criteria. Baseline characteristics were similar between groups, with median age (57+/-19) years and majority Hispanic (42.7%) males (61.8%) with a negative crossmatch (100%). Most post-protocol patients received 6 mg/kg cumulative rATG induction (71.4%) and mycophenolate mofetil 1,000 mg bid (80.3%) with therapeutic tacrolimus troughs by discharge (64.3%). Significantly less BPAR was observed post-protocol (7/56, 12.5% vs 10/33, 30.3%;p = 0.04). Of those with BPAR, significantly less post-protocol patients experienced T-cell mediated rejection (TCMR) than pre-protocol (2/7, 28.6% vs 9/10, 90.0%;p = 0.03). However, antibody-mediated (4/7, 57.1% vs 1/10, 10%) and mixed (1/7, 14.3% vs 0%) rejection were more frequent post-protocol (p = 0.10 and 0.41, respectively). Graft loss was similar post- vs pre-protocol (5/56, 8.9% vs 0;p = 0.16). All post-protocol graft losses were due to death (4 from COVID-19 and 1 unknown). Safety outcomes were similar between groups (Table 1). Conclusion(s): An increased net state of immunosuppression in DGF KTR significantly lowered the 6-month incidence of BPAR without significantly affecting safety. TCMR incidence was significantly decreased, but displaced by antibody-mediated and mixed rejection, implying need to conduct further prospective studies of larger sample sizes. Given majority of graft losses were due to COVID-19 pneumonia, studies are needed to evaluate the risk of COVID-19 infections in DGF KTR, especially with the availability of vaccines. (Table Presented).
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Purpose: Describe outcomes of patients (pt) with pre-tx COVID-19. Method(s): Multicenter study of SOT/HCT candidates who had a positive (pos) SARS-CoV-2 PCR pre-tx. Result(s): Pre-tx: Of 208 pt, median age was 56 (range 3-76). 87.8% were SOT candidates (40.5% kidney, 40.5% liver, 9.8% lung, 6.9% heart, 2.3% pancreas) and 13.9% were HCT candidates (54.2% allo, 45.8% auto). Pt underwent a median of 2 tests (range 1 - 14). In 41% of pt, > 1 neg PCR was required by the tx center before reactivation. Neg PCR was documented in 67.4% of pt at a median of 41 days (18-68) after pos PCR. Waitlist mortality was 11.0%;deaths were due to COVID-19 in 60% (12/20). Post-tx (all pt): 78 pt underwent tx at a median of 65.5 days (range 17-324) from COVID-19;71/78 have completed 4-weeks of follow-up. 24/78 (30.7%) pt were still PCR pos at time of tx (details below). 54/78 (69.2%) pt underwent routine PCR testing post-tx;62% were tested regularly for 8 weeks. Only 1 pt, who remained asymptomatic, developed recurrent pos PCR on surveillance testing 18 days post-tx. 1 pt had graft loss. There were no deaths at 4 weeks post-tx. Pt transplanted without a negative PCR: 24 pt with COVID-19 did not have neg PCR at time of tx: 9 (37.5%) kidney, 9 (37.5%) liver, 2 (8.3%) SLK, 1 (4.2%) lung, 1 heart (4.2%), 2 auto-HSCT (8.3%), 2 allo-HSCT (8.3%). Of 24 pt who were reactivated at a median of 21 days (range 8 - 38) from COVID-19 diagnosis, 7 underwent tx emergently (5 liver, 1 lung, 1 heart). 20/24 completed 4-weeks of follow-up;all were alive. PCR Cycle thresholds (Ct) increased over time, suggesting a reduction in SARS-CoV-2 viral loads with time elapsed since COVID-19 diagnosis. Conclusion(s): Short-term outcomes of transplantation in SOT/HCT candidates with prior COVID-19 were promising in this small cohort, even with a positive PCR going into transplant. Whether documentation of a negative PCR should be required for all tx candidates with a history of COVID-19 prior to transplantation should be investigated further, particularly among lung tx candidates. For certain tx candidates with COVID-19, relying time-based strategy instead of a test-based strategy may be safe.
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Obsessive-compulsive disorder (OCD), which is characterized by distressing intrusive thoughts and repetitive, time-consuming, task-oriented actions intended to counter these thoughts and reduce anxiety, represents a serious psychiatric condition and cause of disability worldwide. This book consists of five chapters that provide details on the effects of OCD and strategies for reducing its negative impact. Chapter One provides a general overview of OCD, including its neurochemical basis and treatment approaches. Chapter Two explores some of the nuisances present in working with individuals with OCD within the context of obsessive and compulsive content that may require additive elements to be considered in treatment. Chapter Three discusses the diagnostic criteria, clinical aspects, and current treatment approaches of pediatric acute-onset neuropsychiatric syndrome and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. Chapter Four describes the effects of the COVID-19 pandemic on children and adolescents with OCD. Lastly, Chapter Five explains the role that religion takes in certain presentations of OCD and informs clinicians how to differentiate between standard religious practices and compulsive behaviors. © 2021 by Nova Science Publishers, Inc.
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Background: In February 2021, Colombia began mass vaccination against COVID-19 using mainly BNT162b2 and CoronaVac vaccines. We aimed to estimate vaccine effectiveness (VE) to prevent COVID-19 symptomatic cases, hospitalization, critical care admission, and deaths in a cohort of 796,072 insured subjects older than 40 years in northern Colombia, a setting with a high SARS-CoV-2 transmission. Methods: We identified individuals vaccinated between March 1st of 2021 and August 15th of 2021. We included symptomatic cases, hospitalizations, critical care admissions, and deaths in patients with confirmed COVID-19 as main outcomes. We calculated VE for each outcome from the hazard ratio in Cox proportionally hazards regressions (adjusted by age, sex, place of residence, diabetes, human immunodeficiency virus, cancer, hypertension, tuberculosis, neurological diseases, and chronic renal disease), with 95% confidence intervals (CI). Findings: A total of 719,735 insured participants of 40 and more years were followed. We found 21,545 laboratory-confirmed symptomatic COVID-19 among unvaccinated population, along with 2874 hospitalizations, 1061 critical care admissions, and 1329 deaths, for a rate of 207.2 per million person-days, 27.1 per million person-days, 10.0 per million person-days, and 12.5 per million person-days, respectively. We found CoronaVac was not effective for any outcome in subjects above 80 years old; but for people 40-79 years of age, we found two doses of CoronaVac reduced hospitalization (33.1%; 95% CI, 14.5-47.7), critical care admission (47.2%; 95% CI, 18.5-65.8), and death (55.7%; 95% CI, 32.5-70.0). We found BNT162b2 was effective for all outcomes in the entire population of subjects above 40 years of age, significantly declining for subjects ≥80 years. Interpretation: Two doses of either CoronaVac in population between 40 and 79 years of age, or BNT162b2 among vaccinated above 40 years old significantly reduced deaths of confirmed COVID-19 in a cohort of individuals from Colombia. Vaccine effectiveness for CoronaVac and BNT162b2 declined with increasing age. Funding: UK National Institute for Health Research, the European Union's Horizon 2020 research and innovation programme, and the Bill & Melinda Gates Foundation.
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OBJECTIVES: This study aimed to estimate the direct medical costs due to hospitalizations by COVID-19 in Colombia and to identify their cost drivers in Colombia. METHODS: This is a retrospective cost-of-illness study of COVID-19 in Colombia. We estimated direct medical costs using data from patients insured to a Benefit Plan Administrator Company, between March 15, 2020 and May 29, 2020. Absolute and relative frequencies, averages, medians, and interquartile ranges (IQRs) were used to characterize the population and estimate the costs of hospitalized patients with COVID-19. We stratified the cost analysis by sex, age groups, comorbidities, and type of hospitalization (general ward and intensive care unit [ICU]). Cost drivers were calculated from a generalized linear model. RESULTS: We studied 113 confirmed patients, 51.3% men. On average, the hospital length of stay was 7.3 (± 6.2) days. A person hospitalized with COVID-19 reported median costs of $1688 (IQR 788-2523). In women, this cost was $1328 (IQR 463-2098); in men, this was 1.4 times greater. The median cost for ICU was $4118 (IQR 2069-5455), 3 times higher than those hospitalized only in the general ward. Admission to the ICU, having 1 comorbidity, length of stay, high blood pressure, having 5 comorbidities, and being treated in the city of Cartagena were statistically significant with direct medical costs. CONCLUSIONS: Our study provides an idea of the magnitude of costs needed to hospitalize a COVID-19 case in Colombia. Other studies in Colombia have assessed the costs of hospitalization for infectious diseases such as influenza, costs significantly lower than those described here.
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COVID-19 , COVID-19/epidemiology , Colombia/epidemiology , Female , Hospitalization , Humans , Intensive Care Units , Male , Retrospective StudiesABSTRACT
Severe acute respiratory syndrome - coronavirus 2 (SARS-CoV-2) continues to effect communities across the world. One way to combat these effects is to enhance our collective ability to remotely monitor community spread. Monitoring SARS-CoV-2 in wastewater is one approach that enables researchers to estimate the total number of infected people in a region; however, estimates are often made at the sewershed level which may mask the geographic nuance required for targeted interdiction efforts. In this work, we utilize an apportioning method to compare the spatial and temporal trends of daily case count with the temporal pattern of viral load in the wastewater at smaller units of analysis within Austin, TX. We find different lag-times between wastewater loading and case reports. Daily case reports for some locations follow the temporal trend of viral load more closely than others. These findings are then compared to socio-demographic characteristics across the study area.
Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/epidemiology , Humans , Spatio-Temporal Analysis , WastewaterABSTRACT
The current COVID-19 pandemic has aggravated pre-existing oxygen supply gaps all over the world. In fact, oxygen shortages occurred in affluent areas with highly developed healthcare systems. The state-of-affairs created much suffering and resulted in potentially preventable deaths. Meanwhile, several international activities have been initiated to improve oxygen availability in the long-term by creating new networks of oxygen plants and supply channels. However, disasters such as the current pandemic may require rapid, autarkic oxygen production. Therefore, we determined whether oxygen resilience could conceivably be improved through self-made oxygen generators using material that is easily available even in remote areas. The team comprised engineers and physicians with hands-on experience in low- and middle-income countries. We constructed and tested self-made setups for water hydrolysis and membrane-based oxygen purification. We must conclude, however, that the massive amounts of oxygen patients with COVID-19 require cannot be reasonably met with such simple measures, which would require high efforts and hold potential risks.
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Due to the impact of unexpected circumstances such as COVID-19, several adaptations have been made to the current working environment which makes it more conducive for less travel. For example, because of the pandemic more individuals are working from home and do not need to travel daily to and from a workplace. In addition, some workplace practices such as the ‘10-day fortnight’ have been introduced. Furthermore, due to virtual meetings and conferences there is less demand for international and domestic business flights. Although this potentially means less daily travel, this also has negative implications as individuals are more likely to choose a method of transport that's convenient and cost effective. This often means using a personal vehicle. Public transport has been negatively impacted because of the pandemic and will require a significant behavioural change to recover and consolidate its position as a viable alternative to the personal vehicles. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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This book provides multiple insights and support to the policy area of transport and land use. It provides a focus on the ability of transport policy and land use policy to deliver not only the preferred urban form but also to do so with a level of accessibility for citizens to access the destinations of choice. Although not constrained by sections, the book starts from the more general and works toward the specific. Following scene setting to establish the links between urban form and accessibility and to explore the implications for sustainable planning in urban areas, chapters are grouped by topic. The next group of chapters discusses the impact of governance and this is followed by a number of chapters broadly investigating urban form and accessibility in the context of travel behavior. The following three groups of chapters discuss more specific areas: health, equity, and public transport network planning. The concluding chapter is an in-depth consideration of the role of logistics in the determination of sustainable urban form. In addition to summarizing the book’s chapters, this introduction provides a brief commentary on the influence of COVID-19 and identifies the areas for future research. © 2021 Elsevier Inc. All rights reserved.
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Study Objectives: At the peak of the initial COVID-19 outbreak in Italy, providers were required to make decisions related to resource rationing due to a shortage of medical equipment. Identifying COVID-19 positive patients who were high-risk for severe illness early in their course could have assisted in determining the most appropriate medical management in many cases. Currently, few models exist to predict the outcome of COVID-19 positive patients. Among those that do, none to our knowledge utilize Bayesian logistic regression. The goal of this study was to generate a model that would dynamically estimate the probability of severe disease in patients who test positive for COVID-19 during their initial emergency department (ED) visit. Methods: This model initially utilized a Bayesian approach with prior data based on the literature at the time, and after one week employed logistical regression using retrospective data from our own patient set. In total, data from 428 RT-PCR-confirmed COVID-19 patients who presented between March 4th and May 7th of 2020 was incorporated. Priors included: female sex, O2 Saturation, lymphocytes, LDH, and CRP. Data acquired during the patients’ encounter included co-morbidities, temperature, MAP, HR, ferritin, d-dimer, hs-troponin, platelets, total bilirubin, hgb, lactate, albumin, and SOFA score. Single imputation was utilized to address patients with missing data points. Our primary outcomes were vasopressor requirement, intubation, and death. Results: Utilizing these data points, a risk calculator for vasopressor requirement, intubation, and/or death was developed with a C-statistic of 0.85. See the supplementary materials for a comprehensive list of the regression coefficients, their betas, and standardized betas (Table 1) and a graph of our predicted primary outcomes compared to actual primary outcomes (Figure 1). Conclusion: A model predictive of vasopressor use, intubation, and death in COVID-19 positive patients was derived. By initially incorporating Bayesian logistic regression and prior data, this model could have theoretically been utilized in medical decision-making early in US outbreak the event that resource rationing had to be pursued at our institution. [Formula presented] [Formula presented]
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Purpose: The optimal testing strategy for solid organ transplantation (SOT) donor and recipient evaluation, as well as treatment for COVID-19 is unknown. We assessed the management strategy of COVID-19 within the West Coast Transplant Infectious Disease group. Methods: A survey assessing strategies for COVID-19 management was sent to 11 Transplant Infectious Diseases providers from 8 centers. Results: For both living and deceased donor clearance, 81.8% (n=9) providers utilize one negative PCR within 72 hours of transplantation. However, when a living donor tests positive for SARS-COV-2, 36.4% (n=4) will require two negative PCR tests >24 hours apart for donor clearance, with 90.9% (n=10) requiring at least a 28-day wait period prior to retesting. Amongst providers caring for lung transplant recipients, 77.7% (7/9) utilized negative PCR from donor BAL as part of pre-transplant evaluation. For transplant candidates, all providers required both the absence of COVID-19 symptoms with only one negative PCR test. In candidates that tested positive for SARS-COV-2, 54.5% (n=6) required at least two negative PCRs prior to transplantation. For positive candidates, 63.6% (n=7) considered re-testing for PCR negativity at 20 days. When a transplant recipient tested positive for SARSCoV-2, all providers would reduce antimetabolites and utilized dexamethasone for patients requiring oxygen therapy. Remdesivir was prescribed by all providers with variability in the timing of administration. Conclusions: Management and treatment of COVID-19 for SOT donors, candidates, and recipients was heterogeneous. While all providers require at least one negative COVID-19 test as both donor and recipient evaluation prior to transplantation, the number of negative tests sent varied amongst providers, geographical region, and clinical scenario. The significant diversity of COVID-19 management strategies for immunocompromised adults seen in this study highlights the further need for studies defining the optimal management of COVID-19.