One-year mortality in COVID-19 is associated with patients' comorbidities rather than pneumonia severity

Background: In patients with pneumonia or ARDS who survived hospitalization, one-year mortality can affect up to one third of discharged patients. Therefore, significant long-term mortality after COVID-19 respiratory failure could be expected. The primary outcome of the present study was one-year all-cause mortality in hospitalized COVID-19 patients. Method(s): Observational study of COVID-19 patients hospitalized at Papa Giovanni XXIII Hospital (Bergamo, Italy), during the first pandemic wave. Result(s): A total of 1326 COVID-19 patients were hospitalized. Overall one-year mortality was 33.6% (N 446/1326), with the majority of deaths occurring during hospitalization (N=412, 92.4%). Thirty-four patients amongst the 914 discharged (3.7%) subsequentely died within one year. A third of these patients died for advanced cancer, while death without a cause other than COVID-19 was uncommon (8.8% of the overall post-discharge mortality). Inhospital late mortality (i.e. after 28 days of admission) interested a population with a lower age, and fewer comorbidities, more frequentely admitted in ICU. Independent predictors of post-discharge mortality were age over 65 years (HR 3.19;95% CI 1.28-7.96, p-value=0.013), presence of chronic obstructive pulmonary disease (COPD) (HR 2.52;95% CI 1.09-5.83, p-value=0.031) or proxy of cardiovascular disease (HR 4.93;95% CI 1.45-16.75, pvalue=0.010), and presence of active cancer (HR 3.64;95% CI 1.50-8.84, p-value=0.004), but not pneumonia severity. Conclusion(s): One-year post-discharge mortality depends on underlying patients' comorbidities rather than COVID19 pneumonia severity per se. Awareness among physicians of predictors of post-discharge mortality might be helpful in structuring a follow-up program for discharged patients.

Outreach activities of the Extreme Energy Events Project

The Extreme Energy Events Project (EEE) represents a breakthrough in outreach activities in Cosmic Ray Physics: high school students are protagonists of an experiment to measure Extensive Air Showers at ground. They start their experience at CERN with the construction of the three high performing Multigap Resistive Plate Chambers constituting the telescope that is then installed inside their school;then they take care of the telescope operation and data analysis. Presently 60 telescopes are installed in Italy and, since 2014, coordinated data taking have been performed during each school year providing a huge amount of candidate muon tracks. Every year hundreds of students and teachers are involved in the activities directly correlated to EEE. The COVID-19 pandemic has strongly affected the experimental activities of the EEE Project. However in the last two years the online activities were strengthened, with an intense programme of collaboration meetings, masterclasses, and hugely successful topical seminars. Starting from the fall of 2021, the improvement of epidemiological situation made it possible to start some of the EEE activities in presence. © Copyright owned by the author(s) under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0)

Outreach and educational activities within the EEE cosmic ray network

The Extreme Energy Events (EEE) network consists in a sparse array of telescopes based on Multigap Resistive Plate Chambers, installed in high school buildings all over the Italian territory and at CERN. Besides the many research activities concerned with extensive air shower detection, long distance correlation studies and additional physics results obtained during the last decade, the EEE project is extensively employed for educational and outreach activities, constituting a unique opportunity to promote a fruitful and close collaboration between students, high-school teachers and researchers. The involvement is at all levels, from the construction of the chambers during short stages at CERN over the past 15 years, with the participation of several hundred high-school students and teachers, to the installation, monitoring and data taking with the telescopes by high-school teams, to masterclasses, physics lectures, data analysis sessions and joint discussions on the results and their interpretation. Recent developments of the EEE network led to the installation and use of additional detectors in the Arctic region and on board of sailing ships, to measure the cosmic ray flux over large latitude intervals. Periodical remote and in presence (pre-Covid era) meetings allowed in these years a large participation (several thousand people) from the high-school community to the EEE activities. National and local outreach initiatives in cosmic ray physics are also carried out around Italy by the EEE network, as a contribution to the dissemination of science among young people. © Copyright owned by the author(s) under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0)

The Extreme-Energy Events Project: a bridge between school and professional research

The Extreme-Energy Events (EEE) Experiment is a cosmic ray observatory based on a network of detecting stations distributed over the Italian territory and at CERN. A station of the network, called “telescope”, consists of three superimposed Multi-gap Resistive Plate Chambers (MRPCs), each one covering a surface of about 1.5 m2, used with the same technology as the time-of-flight detector of the ALICE experiment at CERN-LHC. Data are collected and sent in real time to the INFN-CNAF computer center for reconstruction and analysis. The large area covered by the network, ranging from Southern Italy up to the CERN laboratories, was achieved with the decision to install the detectors inside high schools, involving students and teachers in a modern experiment within a unique program. This very coexistence of scientific activity and outreach represents the uniqueness of the EEE Project. The outreach programme is articulated in several initiatives, each encoding the different aspects of the research activity normally expected in a high-energy physics experiment. Students are involved in detector construction at CERN, installation in school, and in the commissioning of the station when data taking starts. Once the detector reaches a steady working regime, students are requested to monitor on a daily basis the performance of the telescope and report any failure. In parallel to the hardware-related operations, students learn how to perform the analysis of EEE data under the supervision of their teachers and of the EEE researchers, supporting the scientific output of the experiment. Every month students report progress and issues in a dedicated online meeting open to all schools and to the EEE researchers. Beside this monthly appointment, in the pre-COVID era an in-person meeting was taking place twice per year, hosted by the Ettore Majorana Foundation and Centre for Scientific Culture in Erice or by a school or institution involved in the project. During a three-day, students attend masterclasses and take part in measurement campaigns, disseminating their results by submitting contributions to important outreach-oriented journals (such as the Italian Giornale di Fisica). © Copyright owned by the author(s)

Role of endothelium activation biomarkers in prediction COVID-19 related intra-Hospital Mortality

Background : Endothelial damage and hypercoagulability are major players behind the hemostatic derangement in SARS-CoV-2 infection. Aims : In this prospective cohort study of COVID-19 patients, we aimed to assess the role of circulating endothelial activation/damage biomarkers in predicting in-hospital mortality. Methods : Clinical data of COVID-19 patients hospitalized in intensive care (ICU) and non-ICU units at 2 Bergamo (Italy) hospitals from March 23 to May 30, 2020, were analyzed. Markers of endothelium activation including von-Willebrand factor (vWF), soluble thrombomodulin (sTM), and fibrinolytic proteins (t-PA and PAI-1) were measured. Additionally, D-dimer, Fibrinogen, FVIII, nucleosomes, CRP and procalcitonin were assessed. Results : Sixty-three (45 ICU, and 18 non-ICU) patients, with a median age of 62 years were analyzed. Increased plasma levels of Ddimer, FVIII, fibrinogen, nucleosomes, CRP, and procalcitonin were observed in the whole cohort. Extremely elevated vWF levels characterized all patients (highest values in ICU-subjects). Patients with a moderate and severe ARDS (i.e. PaO2/FiO2 ≤200%) have considerably higher vWF and sTM levels, and lower t-PA/PAI-1 values compared to patients in the mild ARDS group (i.e. PaO2/FiO2 >200%). After a median time of 30 days, death occurred in 13 (21%) patients. By multivariable analysis, vWF-activity, neutrophil-count and PaO2/ FiO2 were significantly associated with death. Using these variables, we generated a linear score with 3-risk groups (AUC 0.903) that provided a cumulative incidence of death of 0 % in the low-, 32% in the intermediate-, and 78% in the high-risk group ( P < 0.001). Conclusions : In conclusion, our study provides an extensive overview of the endothelial damage induced by SARSCoV-2 infection in hospitalized patients with virus-induced pneumonia and different degrees of disease severity. In addition, despite the small sample size and the need for the external validation, we could generate an accurate score based on circulating vWF to predicting mortality in severe COVID-19 patients.

Antibody rapid test positive health care workers at a german university hospital: First wave characteristics

Background: Freiburg was among the most heavily affected German cities during the first wave of Sars-Cov-2 infections in spring 2020. Consequently, the University Medical Center Freiburg was one of the first hospitals in Germany to treat Covid19 patients. Objectives: To assess the proportion and characteristics of health care workers (HCW) that have been infected during that first wave SARS-CoV-2 serum IgG and IgM antibodies were measured. Methods: HCW (n=902, mean age: 40.7 years) participated in this study, and filled out an epidemiological questionnaire. Serum samples were analysed for SARS-Cov-2 IgG/IgM antibodies via rapid diagnostic test (RT) and via ELISA. Statistical analyses were performed using STATA 14.2. An exposure prevention score was developed to quantify the adherence to preventive measures in everyday life. Results: 902 HCW were tested by RT, and 499 by ELISA. In total, 11.5% of recruited HCW were antibody-positive in the RT, 12.2% in the ELISA. 87.5% of RT positives, 98% of ELISA-positives reported symptoms, compared to 74.6% and 78% of negatives, respectively. Symptoms such as cough (57%/46%), loss of smell and taste (34%/5.2%), fatigue (68%/45%), fever (48%/24%), body aches (45%/22%), and headaches (58%/46%) were reported by significantly more RT positives compared to negatives. The respective differences were even more pronounced (p<0.001) among ELISA-positives compared to negatives with >50% of those positive reported impaired smell or taste compared to less than 7% among the group of ELISA-negatives (p<0.00001). In logistic regression models, shift work and belonging to the lowest quartile of the exposure prevention score were significantly associated with seropositivity in both tests. Exposure towards children was inversely associated with seropositivity, however, in the finally adjusted model only significant for those that were RT-positive, but not ELISA-positive, reflecting the lower specificity of the former. Conclusion: The endemic infection rate in HCW was high. HCW adhering to preventive measures in everyday life had lower infection rates. Disclosure of Interests: Manuel Beck: None declared, Alexandra Nieters: None declared, Marta Rizzi: None declared, Ulrich Salzer: None declared, Jens Thiel Speakers bureau: BMS, Nils Venhoff Speakers bureau: Novartis, Nicole Peter: None declared, Hermann Eibel: None declared, Reinhard Voll Speakers bureau: Novartis, Grant/research support from: BMS, Pfizer, Novartis, Stephanie Finzel Speakers bureau: Novartis.

Rethinking Vaccine Development as an Integral Part of Preparedness in the European Health Union

This opinion piece puts forward a critique of the policy and regulatory frameworks governing vaccines, understood as tools to confront pandemic and epidemic diseases (PEDs). Vaccines being the universally recognised prime method of prevention, immunisation campaigns and vaccine research and development (R&D) could reasonably be expected to feature prominently in any policy and/or strategic document addressing emerging health threats. Yet, vaccination occupies a relatively subsidiary role, with a prevalent focus on risk management mechanisms. This piece outlines the main characteristics of preparedness frameworks and looks at vaccine development in the course of PED outbreaks in the recent past, concluding that the COVID-19 pandemic calls for a paradigm shift in vaccine R&D, which should become integral to public health preparedness. © The Author(s), 2020. Published by Cambridge University Press.

Severe respiratory failure in COVID19 patients was associated with higher transaminases values during the disease outbreak

Background: Sars-Cov-2 pneumonia is a pandemic disease with high morbidity and mortality In literature transaminases were frequently found abnormal but their role has not been clarified, particularly in patients with liver disease (LD). Aim of this retrospective study is to explore the role of transaminases on short-term prognosis of hospitalized COVID-19 patients Methods: patients admitted in hospital for respiratory failure due to Sars-Cov-2 were consecutively recruited Primary endpoint: evaluate role of transaminases on disease progression (DP). Secondary endpoints: find possible risk factors for (1) mortality and (2) composite outcome consisting of DP or death Results: 135 patients included Median age was 68 years (IQR 58-74), 33 3% (n=45) were female AST/ ALT at admission and after 7 days were abnormal in about two/thirds of cases CPAP patients had transaminases more frequently abnormal (p=0 01) Transaminases alterations were predictive of DP at univariate analysis In multivariate analysis CRP at day 7 was predictor of DP (OR 3 08 and 1 08) while cardiopathy and ventilation type at admission were significantly associated with death (OR 9.95 and 11.5). Conclusion: This study individuates possible prognostic factors in Sars-Cov-2 pneumonia Transaminases values do not predict DP or death, even if more severe patients have a higher prevalence of transaminases elevation CRP at day 7 is a predictor of DP, while cardiopathy and type of ventilation at admission are predictive factors of short-term mortality.

Impact of the COVID-19 pandemic on hospital emergency departments: results of a survey of departments in 2020 - the Spanish ENCOVUR study

OBJECTIVES: To estimate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the organization of Spanish hospital emergency departments (EDs). To explore differences between Spanish autonomous communities or according to hospital size and disease incidence in the area. MATERIAL AND METHODS: Survey of the heads of 283 EDs in hospitals belonging to or affiliated with Spain's public health service. Respondents evaluated the pandemic's impact on organization, resources, and staff absence from work in March and April 2020. Assessments were for 15-day periods. Results were analyzed overall and by autonomous community, hospital size, and local population incidence rates. RESULTS: A total of 246 (87%) responses were received. The majority of the EDs organized a triage system, first aid, and observation wards;areas specifically for patients suspected of having COVID-19 were newly set apart. The nursing staff was increased in 83% of the EDs (with no subgroup differences), and 59% increased the number of physicians (especially in large hospitals and locations where the COVID-19 incidence was high). Diagnostic tests for the severe acute respiratory syndrome coronavirus 2 were the resource the EDs missed most: 55% reported that tests were scarce often or very often. Other resources reported to be scarce were FPP2 and FPP3 masks (38% of the EDs), waterproof protective gowns (34%), and space (32%). More than 5% of the physicians, nurses, or other emergency staff were on sick leave 20%, 19%, and 16% of the time. These deficiencies were greatest during the last half of March, except for tests, which were most scarce in the first 15 days. Large hospital EDs less often reported that diagnostic tests were unavailable. In areas where the COVID-19 incidence was higher, the EDs reported higher rates of staff on sick leave. Resource scarcity differed markedly by autonomous community and was not always associated with the incidence of COVID-19 in the population. CONCLUSION: The COVID-19 pandemic led to organizational changes in EDs. Certain resources became scarce, and marked differences between autonomous communities were detected.