RSV-associated Hospitalizations in Adults Aged >=18 Years and the Impact of the COVID-19 Pandemic in the United States, October 2018 - February 2022

Background. Respiratory syncytial virus (RSV) is a significant cause of hospitalizations in older adults and typically circulates during the fall and winter in the United States. The COVID-19 pandemic and implementation of nonpharmaceutical interventions (NPIs) including masking, improved handwashing, and social distancing likely impacted RSV circulation. To explore the pandemic's impact on RSV seasonality and hospitalizations in adults aged >=18 years, we analyzed laboratory-confirmed RSV-associated hospitalizations through the RSV Hospitalization Surveillance Network (RSV-NET) across four seasons. Methods. RSV-NET is a population-based surveillance system that collects data on RSV-associated hospitalizations across 75 counties in 12 states. An RSV-NET case is a resident of a defined catchment area who tests positive for RSV through a clinician-ordered test within 14 days prior to or during hospitalization. Surveillance was conducted October-April for the 2018-19 and 2019-20 pre-pandemic seasons and October 2020-September 2021 (2020-21 season). Available data October 2021-February 2022 (ongoing 2021-22 season) are presented. Results. 2,536, 3,195, 618, and 1,758 laboratory-confirmed hospitalizations were identified in adults >=18 years in 2018-19, 2019-20, 2020-21, and 2021-22, respectively;case counts were 4.1 and 5.2 times higher in 2018-19 and 2019-20, respectively, than in 2020-2021. Hospitalizations peaked in January for pre-pandemic and 2021-22 seasons and in September for 2020-21 (Figure). For all years combined, 16.2%, 23.4%, 33.3%, and 27.1% of all RSV-associated hospitalizations were among those aged 18-49, 50-64, 65-79 and >=80 years, respectively. Laboratory-confirmed RSV-associated hospitalizations in adults >=18 years, October 2018 - February 2022 Conclusion. Laboratory-confirmed RSV-associated hospitalizations in adults were lower during the 2020-21 and 2021-22 seasons compared with pre-pandemic seasons, with a marked change in seasonal patterns in 2020-21, likely because of NPIs implemented during the pandemic. Continued monitoring of RSV-associated hospitalizations will be critical to understand ongoing changes in RSV circulation that resulted from the COVID-19 pandemic and associated NPIs. (Figure Presented).

COVID-19-Associated Hospitalizations among Long-Term Care Facility Residents Ages >=65 Years - COVID-NET, 14 U.S. States, March 2020-January 2022

Background. Adults aged >=65 years and those with underlying medical conditions, including residents of long-term care facilities (LTCF), are at increased risk for COVID-19-associated hospitalizations and other severe outcomes. Methods. Hospitalizations among LTCF residents aged >= 65 years from March 2020-January 2022 were described using data on a representative sample of hospitalizations from the CDC's COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), a population-based surveillance network of > 250 acute care hospitals in 99 counties across 14 states. A Poisson regression model adjusting for age, race/ethnicity, underlying medical conditions, vaccination status, month of admission, and do-not-resuscitate/intubate-or-provide comfort-measures-only (DNR/DNI/CMO) code status examined the relationship of LTCF residency to death during COVID-19-associated hospitalization. Results. Of 11,901 hospitalizations among adults aged >= 65 years reported during the study period, 2,965 (24.9%) were LTCF residents;most resided in nursing homes (53.8%) or assisted living facilities (26.8%). LTCF residents hospitalized with COVID-19 were older and more likely to have cardiovascular disease, congestive heart failure, a neurologic condition, dementia, or >= 3 underlying medical conditions than non-residents (Figure). The proportion of LTCF residents vs non-residents who required intensive care unit admission or invasive mechanical ventilation were not statistically different (23.2% vs 23.5% and 10.7 vs 13.5%, respectively). The proportion of in-hospital death was higher among LTCF residents than non-residents (22.8% vs 14.4%, p < 0.01). More LTCF residents have a DNR/DNI/CMO code status (48%) compared to non-residents (19%). The fully adjusted regression model found the risk ratio for death was 1.03 (95% CI, 1.01-1.05) among LTCF residents compared to non-residents. Conclusion. Compared to non-residents, LTCF residents were older, had more underly ingconditions, and had a higher risk of in-hospital death. After adjusting formultiple potential confounders, results suggest that LTCF residency is a weak but significant independent risk factor for death during COVID-19-associated hospitalization.

Viral and bacterial infections among adults hospitalized with COVID-19, Coronavirus Disease 2019-Associated Hospitalization Surveillance Network, 14 states, March 2020-February 2022

Background. Coinfections, both bacterial and viral, occur with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but prevalence, risk factors, and associated clinical outcomes are not fully understood. Methods. We used the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET), a population-based surveillance platform to investigate the occurrence of viral and bacterial coinfections among hospitalized adults with laboratory-confirmed SARS-CoV-2 infection during March 2020 and February 2022. Patients receiving additional standard of care (SOC) molecular testing for viral pathogens (14 days prior to admission or 7 days after), including respiratory syncytial virus, rhinovirus/enterovirus (RV/EV), influenza, adenovirus, human metapneumovirus, parainfluenza viruses, and endemic coronaviruses, were included. SOC testing for clinically relevant bacterial pathogens (7 days before admission or 7 days after) from sputum, deep respiratory, and sterile sites were included. The demographic and clinical features of those with and without bacterial infections were compared. Results. Among 2,654 adults hospitalized with COVID-19 and tested for all 7 virus groups, another virus was identified in 3.1% of patients. RV/EV (1.2%) and influenza (0.4%) were the most commonly detected viruses. Half (17,842/35,528, 50.2%) of hospitalized adults with COVID-19 had bacterial cultures taken within 7 days of admission, and 1,092 (6.1%) of these had a clinically relevant bacterial pathogen. A higher percentage of those with a positive culture died compared to those with negative cultures (32.3% vs 13.3%, p< 0.001). Staphylococcus aureus was the most common isolate overall;Pseudomonas aeruginosa was the second most common respiratory isolate This figure includes 1,408 bacterial cultures from 1,066 individuals. Deep respiratory sites include endotracheal aspirate, bronchoalveolar lavage fluid, bronchial washings, pleural fluid, and lung tissue. Commensal organisms were excluded. Conclusion. Consistent with previous studies, a relatively low proportion of adults hospitalized with COVID-19 had concomitantly identified viral or bacterial infections. Identification of a bacterial infection within 7 days of admission is associated with increasedmortality among adults hospitalized with COVID-19. Conclusions about the clinical relevance of bacterial infections is limited by the retrospective nature of this study.

Morbidity and mortality of pregnant women due to COVID-19 and racial biases: an intersectional analysis

Objective: to analyze racial biases in the context of morbidity and mortality due to COVID-19 of Brazilian pregnant women from an intersectional perspective. Method: an ecological, documental study using epidemiological bulletins intended to monitor the novel coronavirus in Brazil. Data were collected in March and April 2021 and analyzed using descriptive statistics mediated by the intersectional theory-based methodology. Results: Afro-descendant pregnant women presented an average prevalence rate of 65.18% hospitalizations and 70.85% deaths due to COVID-19 in 2020. On the other hand, the average prevalence rate of hospitalizations and deaths among Caucasian pregnant women was 32.32% and 27.23%, respectively. Conclusion: A greater difficulty to access prenatal care, a high prevalence rate of comorbidities, poor working conditions and impossibility to leave work during the pandemic, institutional racism, and necropolitics adopted by the Brazilian government are potential explanations for the vulnerable context faced by this population © All Rights Reserved.

Brazilian nurses' practices in monitoring child health at the beginning of the COVID-19 pandemic

Introduction: COVID-19 has affected the routine of health services, and there are few studies that address the practices of nurses in monitoring child health during the pandemi c period. Objective: To describe the practices of Brazilian nurses in monitoring child health at the beginning of the COVID-19 pandemic. Methods: Cross-sectional study carried out with 115 Brazilian nurses from Primary Health Care. The questionnaire sent by email and WhatsApp, included questions about activities for monitoring child health, aspects addressed in nursing care and the implementation of innovative strategies. Descriptive statistics were used for data analysis through Stata 15.1 software. Results: The majority of participants belonged to the family health strategy (75.65%) and were from the southeastern region of Brazil (40.87%). Child health monitoring activities were suspended or reduced in most Brazilian regions. Promotion of physical activity, guidance on playing, evaluation of food consumption and guidance on sleep quality were the least addressed aspects. Regarding the use of innovative strategies, phone calls and messages through WhatsApp were the most used. Conclusions: At the beginning of the pandemic, the nurses adapted their practices to innovative strategies to keep monitoring the child population, however, important health promotion actions for this pandemic period were little addressed. © 2022, Editorial Ciencias Medicas. All rights reserved.

Cardiovascular disease, hypertension, diabetes and cystatin c jointly predict covid-19 mortality alongside age, male sex and black ethnicity

Introduction: Studies of risk factors for severe/fatal COVID-19 to date may not have identified the optimal set of informative predictors. Hypothesis: Use of penalized regression with stability analysis may identify new, sparse sets of risk factors jointly associated with COVID-19 mortality. Methods: We investigated demographic, social, lifestyle, biological (lipids, cystatin C, vitamin D), medical (comorbidities, medications) and air pollution data from UK Biobank (N=473,574) in relation to linked COVID-19 mortality, and compared with non-COVID-19 mortality. We used penalized regression models (LASSO) with stability analysis (80% selection threshold from 1,000 models with 80% subsampling) to identify a sparse set of variables associated with COVID-19 mortality. Results: Among 43 variables considered by LASSO stability selection, cardiovascular disease, hypertension, diabetes, cystatin C, age, male sex and Black ethnicity were jointly predictive of COVID-19 mortality risk at 80% selection threshold (Figure). Of these, Black ethnicity and hypertension contributed to COVID-19 but not non-COVID-19 mortality. Conclusions: Use of LASSO stability selection identified a sparse set of predictors for COVID-19mortality including cardiovascular disease, hypertension, diabetes and cystatin C, a marker of renalfunction that has also been implicated in atherogenesis and inflammation. These results indicate theimportance of cardiometabolic comorbidities as predisposing factors for COVID-19 mortality.Hypertension was differentially highly selected for risk of COVID-19 mortality, suggesting the need for continued vigilance with good blood pressure control during the pandemic.

Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 — COVID-NET, 14 States, March 1–30, 2020

The Coronavirus Disease 2019–Associated Hospitalization Surveillance Network (COVID-NET) was implemented to produce robust, weekly, age-stratified COVID-19–associated hospitalization rates.