ABSTRACT
Political affiliation has been reported as a determinant of COVID-19 vaccine acceptance in some countries, although few studies have examined the Asian context. This study aimed to fill this gap by employing an ecological study design using Indonesian regions as data points. Political affiliation was represented by incumbent President Joko "Jokowi" Widodo's vote share in the 2019 presidential election. Potential confounders included population density, human development index, availability of hospitals and primary health care, 2019-2020 economic growth, COVID-19 mortality rate, and proportion of Muslims in the population. The final analysis included 201 out of 501 districts and cities in Indonesia. Controlling for confounders, multivariate regression found that Jokowi's vote share was an independent predictor of vaccination rate, with standardized beta and R2 values of 0.350 and 0.734 for the first dose vaccination rates and 0.251 and 0.782 for the second dose, respectively. This association may be underpinned by differences in religiosity, public trust, and vulnerability to misinformation between Jokowi's supporters and the opposition. Improving public trust in a politically polarizing society is crucial to improving future coverage of COVID-19 and other vaccines.
ABSTRACT
BACKGROUND AND AIM: The COVID-19 pandemic impacted high (HICs) and low to high- middle income countries (LHMICs) disproportionately. We sought to investigate factors contributing to disparate pediatric COVID-19 mortality. METHOD(S): We used the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) COVID-19 database, and stratified country group defined by World Bank criteria. All hospitalized patients aged less than 19 years with suspected or confirmed COVID-19 diagnosis from January 2020 through April 2021 were included. RESULT(S): A total of 12,860 patients with 3,819 cases from HICs and 9,041 cases from LHMICs were included in this study. Of these, 8,961 (73.8%) patiens were confirmed cases and 2444 (20.1%) were suspected COVID19. Overall in-hospital mortality was 425 (3.3%) patients, with 4.0% mortality in LHMICs (361/9041), which was higher than 1.7% mortality in HICs (64/3819);adjusted HR (aHR) 4.74, 95%CI 3.16-7.10, p<0.001. There were significant differences between country income groups in the use of interventions, with higher use of antibiotics, corticosteroid, prone position, high flow nasal cannula, and invasive mechanical ventilation in HICs, and higher use of anticoagulants and non-invasive ventilation in LHMICs. Infectious comorbidities such as tuberculosis and HIV/AIDS were shown to be more prevalent in LHMICs [2 (0.0%) vs 171 (1.9 %), 1 (0.0%) vs. 149 (1.6%) patients, respectively]. Mortality rates in children who received mechanical ventilation in LHMICs were higher compared with children in HICs [89 (43.6%) vs. 17 (7.2%) patients, aHR 12.0, CI95% 7.2-19.9, p<0.001]. CONCLUSION(S): Various contributing factors to COVID-19 mortality identified in this study may reflect management differences in HICs and LHMICs. (Figure Presented).
ABSTRACT
One of the most challenging issues in facing the Coronavirus Disease (COVID-19) pandemic relies on the considerable uncertainty of the extent of its involvement. The wide spectrum of manifestations, ranging from generally milder manifestations to Multisystem Inflammatory Syndrome, and the concurrence with other disease entities substantially obscure clinical diagnosis. Diagnostic pitfalls persisted despite advancement in diagnostic criteria and modalities. We present a case series of confirmed COVID-19 cases in a tertiary hospital in Bali, Indonesia, with fever as the sole presenting feature and diagnostic hint.