COVID-19-related stigma and its relationship with mental wellbeing: A cross-sectional analysis of a cohort study in Japan

Objective Social stigma related to coronavirus disease (COVID-19), i. e., COVID-19 stigma, forms a burden on people socially, economically, and mentally. This study assessed COVID-19 stigma using a scale to identify a population likely to exhibit higher prejudice against COVID-19 itself as well as those infected with COVID-19. Methods We adapted and modified the Cancer Stigma Scale to assess COVID-19 stigma and used it as the baseline survey of a cohort study in Japan. The questionnaire was disseminated to 1,573 participants (51.7% men) between December 2020 and March 2021. The questionnaire items included the infection status of individuals close to the respondent and their preventive behaviors related to COVID-19, quality of life (QOL;using the EuroQoL 5-Dimension 5-Level [EQ-5D-5L]), and psychological distress (using the 6-item Kessler Psychological Distress Scale [K6]). Exploratory and confirmatory factor analyses were performed to validate the COVID-19 stigma scale, and we further used the structural equation modeling (SEM) to assess the relationship with QOL and psychological distress. Results COVID-19 stigma was calculated for the 257 (16.3%) participants who responded to the questionnaire. The mean age (standard deviation) was 54.5 (14.4) years, and 50.2% were men. Factor analysis revealed a five-factor model: Awkwardness (feeling uncomfortable being with a person infected before), Severity (fear of not being able to return to normal after infection), Avoidance (attitude of avoiding infected persons), Policy Opposition (expecting more public funding investment), and Personal Responsibility (believing that infected persons themselves are responsible for their infection). Participants > 70 years had the highest scores among other age groups considering all factors except for Policy Opposition. Standardized coefficients in SEM for COVID-19 stigma (latent variable) was highest for Severity (beta = 0.86). Regression coefficients of COVID-19 stigma on K6 and QOL were 0.21 (95% confidence interval [CI] 0.074–0.342) and −0.159 (95% CI −0.295–0.022), respectively. Conclusion People aged ≥ 70 years are more likely to exhibit COVID-19 stigma. Additionally, the results indicate that COVID-19 stigma impacts QOL and psychological distress.

Effectiveness of Corticosteroid Therapy for Non-Severe COVID-19 in Patients Not Requiring Supplemental Oxygen Who Have Risk Factors for Severe Disease.

BACKGROUND: Because they suppress cytokine production, corticosteroids are a candidate therapy for coronavirus disease 2019 (COVID-19). However, the effectiveness of corticosteroids is unclear for non-severe COVID-19 that does not require supplemental oxygen. This study investigated the effectiveness of corticosteroid therapy for patients with non-severe COVID-19. METHODS: This retrospective observational study analyzed data from 10 patients with non-severe COVID-19 who received corticosteroid therapy at our center between July 1, 2020 and January 31, 2021. RESULTS: The median age of the 10 patients was 60 years, and nine were male. Nine of the 10 patients had multiple comorbid conditions (e.g., hypertension, diabetes, and obesity). Although blood oxygen saturation was maintained above 95%, all patients had persistent fever and deterioration in chest imaging findings, which led to initiation of corticosteroid treatment. The median duration symptom onset to initiation of corticosteroid therapy was 8 days. All patients received dexamethasone 6 mg/day as corticosteroid therapy, and the median period was 7.5 days. After the start of corticosteroid therapy, clinical improvement was rapid in all patients, and no patient developed severe disease. CONCLUSION: The latest World Health Organization guidance recommends against corticosteroid treatment for patients with non-severe COVID-19. In this report, early administration of corticosteroids during the non-critical phase, when oxygen supplementation was not required, was associated with early improvement and prevention of severe disease in patients with risk factors for severe COVID-19 and worsening clinical symptoms.

Kikuchi-Fujimoto disease can present as delayed lymphadenopathy after COVID-19 vaccination.

Following COVID-19 vaccination, ipsilateral axillary and cervical lymphadenopathy may occur, called vaccine-related hypermetabolic lymphadenopathy, which is considered reactive lymphadenopathy. We report here a case of Kikuchi-Fujimoto disease, which occurred three months after vaccination with COVID-19 vaccine. The patient had cervical and axillary lymph node enlargement and a short-term fever that resolved spontaneously after the first and second vaccines. On the 90th day after the first vaccination, the patient developed a high fever and pathologically diagnosed necrotizing lymphadenitis in the axilla, which was diagnosed as Kikuchi-Fujimoto disease. Gallium scintigraphy showed localized swelling and strong uptake in the ipsilateral axilla. It implies the possibility of Kikuchi-Fujimoto Disease in axillary drainage lymph nodes in association with COVID-19 vaccine. Although only a few cases have been reported so far, this case is novel because of its later onset and diagnosis based on pathological and gallium scintigraphy imaging findings.