Forecasting COVID-19 infection trends and new hospital admissions in England due to SARS-CoV-2 Variant of Concern Omicron (preprint)

ObjectivesOn November 26, 2021, WHO designated the variant B.1.1.529 as a new SARS-CoV-2 variant of concern (VoC), named Omicron, originally identified in South Africa. Several mutations in Omicron indicate that it may have an impact on how it spreads, resistance to vaccination, or the severity of illness it causes. We used our previous modelling algorithms to forecast the spread of Omicron in England. DesignWe followed EQUATORs TRIPOD guidance for multivariable prediction models. SettingEngland. ParticipantsNot applicable. InterventionsNon-interventional, observational study with a predicted forecast of outcomes. Main outcome measuresTrends in daily COVID-19 cases with a 7-day moving average and of new hospital admissions. MethodsModelling included a third-degree polynomial curve in existing epidemiological trends on the spread of Omicron and a new Gaussian curve to estimate a downward trend after a peak in England. ResultsUp to February 15, 2022, we estimated a projection of 250,000 COVID-19 daily cases of Omicron spread in the worse scenario, and 170,000 in the "best" scenario. Omicron might represent a relative increase from the background daily rates of COVID-19 infection in England of mid December 2021 of 1.9 to 2.8-fold. With a 5-day lag-time, daily new hospital admissions would peak at around 5,063 on January 23, 2022 in the worse scenario. ConclusionThis warning of pandemic surge of COVID-19 due to Omicron is calling for further reinforcing in England and elsewhere of universal hygiene interventions (indoor ventilation, social distance, and face masks), and anticipating the need of new total or partial lockdowns in England.

Forecasting COVID-19 infection trends in the EU-27 countries, the UK and Switzerland due to SARS-CoV-2 Variant of Concern Omicron (preprint)

Background: On November 26, 2021, WHO designated the variant B.1.1.529 as a new SARS-CoV-2 variant of concern (VoC), named Omicron, originally identified in South Africa. Several mutations in Omicron indicate that it may have an impact on how it spreads, resistance to vaccination, or the severity of illness it causes. Methods: We used our previous modelling algorithms to forecast the spread of Omicron aggregated in the EU-27 countries, the United Kingdom and Switzerland, and report trends in daily cases with a 7-day moving average. We followed EQUATOR TRIPOD guidance for multivariable prediction models. Modelling included a third-degree polynomial curve in existing epidemiological trends on the spread of Omicron in South Africa, a five-parameter logistic (5PL) asymmetrical sigmoidal curve following a parametric growth in Europe, and a new Gaussian curve to estimate a downward trend after a peak. Results: Up to January 15, 2022, we estimated a background rate projection in EU-27 countries, the UK and Switzerland of about 145,000 COVID-19 daily cases without Omicron, which increases up to 440,000 COVID-19 daily cases in the worst scenario of Omicron spread, and 375,000 in the best scenario. Therefore, Omicron might represent a relative increase from the background daily rates of COVID-19 infection in Europe of 1.03-fold or 2.03-fold, that is up to a 200% increase. Conclusion: This warning pandemic surge due to Omicron is calling for further reinforcing of COVID-19 universal hygiene interventions (indoor ventilation, social distance, and face masks), and anticipating the need of new lockdowns in Europe.

Patients with COVID-19 Interstitial Pneumonia Exhibit Pancreatic Hyperenzymemia and Not Acute Pancreatitis (preprint)

Background and aims: Gastrointestinal manifestations of COVID-19 have been well established, but pancreatic involvement is under debate. The aim of the study is to evaluate the presence of acute pancreatitis in COVID-19 patients and to assess the frequency of pancreatic hyperenzymemia. Methods: From April 1st 2020 to April 30th 2020, 110 consecutive patients (69 males, 41 females; mean age 63.0 years, range 24-93 years) met these criteria and were enrolled in the study.. The clinical data and serum activity of pancreatic amylase and lipase were assayed in all patients using commercially available kits. Results: None of the patients studied developed clinical signs or morphological alterations compatible with acute pancreatitis. However, it was found that 24.5% of the patients had amylase values above 53 IU/L and 16.4% had lipase values above 300 IU/. Only one patient (0.9%) had both amylase and lipase values in excess of three-fold the upper normal limit without clinical signs of pancreatitis. Conclusions: The presence of pancreatic hyperenzymemia in a patient with COVID-19 requires the management of these patients be guided by clinical evaluation and not merely by evaluation of the biochemical results.

Prolonged low-dose methylprednisolone in patients with severe COVID-19 pneumonia (preprint)

BackgroundIn hospitalized patients with COVID-19 pneumonia, progression to acute respiratory failure requiring invasive mechanical ventilation (MV) is associated with significant morbidity and mortality. Severe dysregulated systemic inflammation is the putative mechanism. We hypothesize that early prolonged methylprednisolone (MP) treatment could accelerate disease resolution, decreasing the need for ICU and mortality. MethodsWe conducted a multicenter, observational study to explore the association between exposure to prolonged, low-dose, MP treatment and need for ICU referral, intubation or death within 28 days (composite primary endpoint) in patients with severe COVID-19 pneumonia admitted to Italian respiratory high-dependency units. Secondary outcomes were invasive MV-free days and changes in C-reactive protein (CRP) levels. ResultsFindings are reported as MP (n=83) vs. control (n=90). The composite primary endpoint was met by 19 vs. 40 [adjusted hazard ratio (HR) 0.41; 95% confidence interval (CI): 0.24-0.72]. Transfer to ICU and need for invasive MV was necessary in 15 vs. 27 (p=0.07) and 14 vs. 26 (p=0.10), respectively. By day 28, the MP group had fewer deaths (6 vs. 21, adjusted HR=0.29; 95% CI: 0.12-0.73) and more days off invasive MV (24.0 {+/-} 9.0 vs. 17.5 {+/-} 12.8; p=0.001). Study treatment was associated with rapid improvement in PaO2:FiO2 and CRP levels. The complication rate was similar for the two groups (p=0.84). ConclusionIn patients with severe COVID-19 pneumonia, early administration of prolonged MP treatment was associated with a significantly lower hazard of death (71%) and decreased ventilator dependence. Randomized controlled studies are needed to confirm these findings. RegistrationClinicalTrials.gov. Identifier: NCT04323592