Hospital at home: A systematic review of how medication management is conceptualised, described and implemented in practice-A study protocol.

INTRODUCTION: Hospital at Home (H@H) is a method of healthcare delivery, where hospital level interventions are conducted in the patient's usual place of residence, offering an alternative to hospital admission. This often includes the ability to perform point of care diagnostics and treat conditions using a range of treatments traditionally associated with hospital admission, including intravenous medicines and oxygen. H@H services have been established worldwide but there is a wide variation in definition and delivery models and currently no documented evidence supporting the delivery of medicines and medicines management within the H@H model. Therefore, this study aims to 1) describe how medication management in H@H is conceptulised, 2) describe and identify key components of medication management in H@H and 3) describe and identify variability in the implementation of medication management services within H@H models. METHODS AND ANALYSIS: We will search a range of databases (PubMed, Medline, Embase, CINAHL), publicly accessible documents and expert recommendations. Studies, reports and policy documents published between 1st January 2000 and 31st January 2022 will be included. Two independent reviewers will 1) screen and select studies based on a priori inclusion/exclusion, 2) conduct quality assessment using the Mixed Methods Appraisal Tool on included studies and 3) extract data. Inductive thematic analysis (objectives 1 and 2), the SEIPS 2.0 model (objective 2) and the Consolidated Framework for Implementation Research (objective 3) will be used to synthesise data. ETHICS AND DISSEMINATION: This systematic review will use secondary data sources from published documents, and as such research ethical approval was not required. We will disseminate the findings of this study in a peer-reviewed journal and national/international conference(s). TRIAL REGISTRATION: PROSPERO registration number: CRD42022300691. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022300691.

Detection of SARS-CoV-2 by RT-LAMP assay in Human COVID-19 patients

Background: The novel COVID-19 outbreak has infected human population all around the world. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) diagnosis in a rapid manner remains challenging for health care professionals. Currently, RT-qPCR technique is extensively practiced in SARS-CoV-2 diagnosis and is considered as gold standard. The constraints of RT-qPCR, high cost and need for trained technician, longer detection time, highlighted the need for alternate healthcare diagnostic approaches. They follow the WHO assured standard and offer the health-care sector optimism. One of them is the Loop Mediated isothermal amplification system (LAMP). There is no need for costly equipment like thermal cycler since LAMP assay is performed at a fixed temperature. It can also be implemented as a point of care testing device. RT-LAMP is one of the extensively used isothermal amplification system in pathogen diagnostics.Aims: The current study aims to validate and standardize RT-LAMP assay for rapid diagnosis of SARS-CoV-2 in both lab and field conditions. The reactions can be carried out using a heating vessel including the use of a water bath and end-point detection by colorimetry. A rising middle ground of tiny, more portable technology, that provides most of the capability at less cost and time.Methods and Results: 20 Samples were taken from COVID-19 positive patients. RNA extraction from COVID-19 samples was followed up by one-step reverse transcription and loop-mediated isothermal amplification (LAMP). LAMP primers were designed to amplify the conserved regions of SARS-COV-2 specific genes. The target regions for primer design were selected after genome-wide sequence alignment of SARS-CoV-2 strains isolated in various regions of the world i.e., Europe, Africa, Asia, and North America. RT-LAMP assays were performed at the specific incubation temperature (60°C) for 50 minutes. Assay was optimized as per consumable compatibility, COVID template integrity, primer concentration, template concentration, primer ratio, testing time etc. Sensitivity and specificity of the assay was elucidated. Finally, different end-point analysis i.e., Agarose Gel Electrophoresis and Colorimetry have been used to interpret the results.Conclusion: RT-LAMP assay has shown to be a quick and accurate diagnostic method that can be put to use for SARS-CoV-2 detection in laboratories and Point-of- Care settings. © 2022 IEEE.

Global Coinfections with Bacteria, Fungi, and Respiratory Viruses in Children with SARS-CoV-2: A Systematic Review and Meta-Analysis.

BACKGROUND: Coinfection with bacteria, fungi, and respiratory viruses has been described as a factor associated with more severe clinical outcomes in children with COVID-19. Such coinfections in children with COVID-19 have been reported to increase morbidity and mortality. OBJECTIVES: To identify the type and proportion of coinfections with SARS-CoV-2 and bacteria, fungi, and/or respiratory viruses, and investigate the severity of COVID-19 in children. METHODS: For this systematic review and meta-analysis, we searched ProQuest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus, and Nature through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for studies on the incidence of COVID-19 in children with bacterial, fungal, and/or respiratory coinfections, published from 1 December 2019 to 1 October 2022, with English language restriction. RESULTS: Of the 169 papers that were identified, 130 articles were included in the systematic review (57 cohort, 52 case report, and 21 case series studies) and 34 articles (23 cohort, eight case series, and three case report studies) were included in the meta-analysis. Of the 17,588 COVID-19 children who were tested for co-pathogens, bacterial, fungal, and/or respiratory viral coinfections were reported (n = 1633, 9.3%). The median patient age ranged from 1.4 months to 144 months across studies. There was an increased male predominance in pediatric COVID-19 patients diagnosed with bacterial, fungal, and/or viral coinfections in most of the studies (male gender: n = 204, 59.1% compared to female gender: n = 141, 40.9%). The majority of the cases belonged to White (Caucasian) (n = 441, 53.3%), Asian (n = 205, 24.8%), Indian (n = 71, 8.6%), and Black (n = 51, 6.2%) ethnicities. The overall pooled proportions of children with laboratory-confirmed COVID-19 who had bacterial, fungal, and respiratory viral coinfections were 4.73% (95% CI 3.86 to 5.60, n = 445, 34 studies, I2 85%, p < 0.01), 0.98% (95% CI 0.13 to 1.83, n = 17, six studies, I2 49%, p < 0.08), and 5.41% (95% CI 4.48 to 6.34, n = 441, 32 studies, I2 87%, p < 0.01), respectively. Children with COVID-19 in the ICU had higher coinfections compared to ICU and non-ICU patients, as follows: respiratory viral (6.61%, 95% CI 5.06-8.17, I2 = 0% versus 5.31%, 95% CI 4.31-6.30, I2 = 88%) and fungal (1.72%, 95% CI 0.45-2.99, I2 = 0% versus 0.62%, 95% CI 0.00-1.55, I2 = 54%); however, COVID-19 children admitted to the ICU had a lower bacterial coinfection compared to the COVID-19 children in the ICU and non-ICU group (3.02%, 95% CI 1.70-4.34, I2 = 0% versus 4.91%, 95% CI 3.97-5.84, I2 = 87%). The most common identified virus and bacterium in children with COVID-19 were RSV (n = 342, 31.4%) and Mycoplasma pneumonia (n = 120, 23.1%). CONCLUSION: Children with COVID-19 seem to have distinctly lower rates of bacterial, fungal, and/or respiratory viral coinfections than adults. RSV and Mycoplasma pneumonia were the most common identified virus and bacterium in children infected with SARS-CoV-2. Knowledge of bacterial, fungal, and/or respiratory viral confections has potential diagnostic and treatment implications in COVID-19 children.

Data Science-Based Statistical Modeling in Revealing Community Intentions and Behaviors for the Covid-19 Vaccine

This study wants to examine the effect of the Benefits of Vaccines and the Ease of Getting Vaccines on the Intention to get vaccinated against Covid-19 and Covid-19 Vaccinated Behavior, while originality in terms of application lies in the analysis of Intention and Covid-19 Vaccinated Behavior. The approach used in this research is descriptive, exploratory, and explanatory using a mixed-method. This study uses several analytical methods, DNA is used to compose the questionnaire, cluster analysis is used to group several data sets that have been obtained, and path analysis is used to model Intention and Covid-19 Vaccinated Behavior. The variables in this study are the Benefits of Vaccines, Ease of Getting Vaccines, Intention to get vaccinated against Covid-19, and Covid-19 Vaccinated Behavior. The source of data used in this research is DNA by crawling data from various information in cyberspace, either in the form of articles, online news, journals, or content on social media. The location of this research will be carried out in the area of Malang City, Indonesia. The research will be carried out from July to September 2021 by taking primary data, in the form of assessments or perceptions from respondents, so that a survey is carried out with enumerators submitting questionnaires directly to the community as respondents. The population used in this study is the community throughout the city of Malang with a total of 635575 residents. The sampling technique used is simple random sampling. © 2022 by authors.

Systematic literature review on physical distancing policy for mass gathering events

The explosive spread of Corona Virus Disease-19 (COVID-19) in late December 2019, requires the health authorities worldwide to enforced stricter standard operating procedures (SOP) for mass gathering events, which eventually caused postponement and cancellation. This has led to a great loss and bankruptcy for most event organizers. As an effort to offer solution to this matter, a professional touch producing "soft landing"such as "Mathematical Modelling of Physical Distancing Policy for Mass Gathering Event Organizer"was proposed. Therefore, a holistic understanding about the issues related to physical distancing in mass gathering event is required. This systematic review paper summarizes current practice of physical distancing among mass gathering event organizers. This study reviewed thirteen articles using two leading databases namely Scopus and Google Scholar. Based on thematic analysis, this review finalized four themes: 1) physical distancing method;2) the importance of physical distancing;3) challenges in physical distancing enforcement and 4) approach to monitor the compliance of physical distancing. © 2022 Author(s).

Physical distancing evaluation for classroom layout management during COVID-19 pandemic era

Mass gathering has been identified as one of the causes of fast-spreading of COVID-19. Physical distancing practices and large gathering control in Malaysia and all over the world are likely to be continued until the end of the year, even after Movement Control Order (MCO) has been lifted. This has imposed event organizers to redesign their events into virtual events where attendees are to stay at their houses and meet with the host and other attendees virtually. However, certain types of educational events or activities such as practical and hands-on classes are not to be virtually conducted as it by nature carries a competency for the students. This paper evaluates the standard classroom layout by comparing with optimal layout based on circle packing problem (CPP) solution. CPP solution is used to optimize the physical distancing-constrained for the student seat layout as in it happens in real life. The findings can provide an effective exit strategy for Malaysia to deal with this COVID-19 pandemic or other pandemics in the future. © 2022 Author(s).

Optimization and simulation methods in addressing COVID-19 physical distancing policy: A bibliometric analysis

COVID-19 has received tremendous attention from scholars worldwide and even being labelled as a black swan event that has disrupted every aspect of human life. Within a short time span of the pandemic, a large volume of research pertaining to COVID-19 has been published in diverse research fields. This paper adopts a bibliometric analysis to systematically evaluate the research development in the application of optimization and simulation methods to address COVID-19 physical distancing policy (OSPhyD) using Bibliometrix R package. A textual query on Scopus database using the combination of four classes of keywords;covid-19, optimization, simulation, and physical distance has returned a total of 299 original research articles and reviews published in English. Appropriate visualizations were generated to describe the collaborations between different authors, countries, and institutions, whilst co-word analysis that uses text mining technique has produced a conceptual cluster via co-occurrence network map to underscore the emerging themes in the current research interest. The main findings pinpoint that: 1) OSPhyD as a scientific research field is an emerging multidisciplinary research topic that is growing progressively and steadily in the fields of medicine, engineering, social sciences, mathematics and decision science, 2) The field has attracted the attention of scholars from all over the world particularly from United States of America, United Kingdom, European countries including authors from Asia, and 3) Three dominant themes or research front emerged from the publications including COVID-19 mainstream, medical education and undergraduate. © 2022 Author(s).

COVID-19 vaccine hesitancy in Africa: a scoping review.

BACKGROUND: Vaccination against the novel coronavirus is one of the most effective strategies for combating the global Coronavirus disease (COVID-19) pandemic. However, vaccine hesitancy has emerged as a major obstacle in several regions of the world, including Africa. The objective of this rapid review was to summarize the literature on COVID-19 vaccine hesitancy in Africa. METHODS: We searched Scopus, Web of Science, African Index Medicus, and OVID Medline for studies published from January 1, 2020, to March 8, 2022, examining acceptance or hesitancy towards the COVID-19 vaccine in Africa. Study characteristics and reasons for COVID-19 vaccine acceptance were extracted from the included articles. RESULTS: A total of 71 articles met the eligibility criteria and were included in the review. Majority (n = 25, 35%) of the studies were conducted in Ethiopia. Studies conducted in Botswana, Cameroun, Cote D'Ivoire, DR Congo, Ghana, Kenya, Morocco, Mozambique, Nigeria, Somalia, South Africa, Sudan, Togo, Uganda, Zambia, Zimbabwe were also included in the review. The vaccine acceptance rate ranged from 6.9 to 97.9%. The major reasons for vaccine hesitancy were concerns with vaccine safety and side effects, lack of trust for pharmaceutical industries and misinformation or conflicting information from the media. Factors associated with positive attitudes towards the vaccine included being male, having a higher level of education, and fear of contracting the virus. CONCLUSIONS: Our review demonstrated the contextualized and multifaceted reasons inhibiting or encouraging vaccine uptake in African countries. This evidence is key to operationalizing interventions based on facts as opposed to assumptions. Our paper provided important considerations for addressing the challenge of COVID-19 vaccine hesitancy and blunting the impact of the pandemic in Africa.

Perceptions of distance learning among Al-Qunfudhah medical students during the COVID-19 pandemic.

Objectives: This study aimed to assess perceptions among undergraduate medical students toward distance learning and its effects on their academic performance during the COVID-19 pandemic at Al-Qunfudhah College of Medicine, Umm Al-Qura University, KSA. Material and Methods: A cross-sectional study was conducted among medical students at Al-Qunfudhah College of Medicine, Umm Al-Qura University, KSA, during the 2020-2021 academic year. Data were collected through a predesigned, well-structured online survey from (1st March to 31th May 2021). Results: A sample of 223 undergraduates responded to an online survey, with a response rate of 74.3%; female students represented 54.3%. Blended education was preferred by most students (73.1%). Moreover, 72.2% of students perceived that distance learning saved their time, and approximately two-thirds (61.4%) were stimulated by the availability of lecture recordings. Approximately 59% and 54% reported that distance learning was more comfortable and improved their technology skills, respectively. Poor communication (66%) and network problems (61.4%) were the most common challenges in distance learning. Nonetheless, a substantial increase (P = 0.001) in students' grade point averages was observed with distance learning. Conclusion: Most medical students preferred blended education combining the advantages of both traditional and distance learning strategies. The availability of educational materials, improvements in students' technological skills and time saving were the most perceived benefits of distance learning among students. However, the main obstacles were internet problems, poor communication and deprivation from real clinical practice. Despite the improvement in students' grade point averages during distance learning compared with traditional learning, blended education was recommended by the majority or participants.

What are the Governmental Response Policies on COVID-19? A Meta-Thematic Analysis of Government Response Policy in the World

This paper aims to review numerous scientific papers on watershed governance published in globally recognized journals. Moreover, the overview article in this report is intended to conceptualize a study on COVID-19 government policy, which is explained by the following questions: (1) What are government policy answers on the relation and clustering of issues? (2) In the current government policy on COVID-19, what is the dominant issue? The results of the analysis of research papers show that the handling of COVID-19 around the world takes on “measures” or tactical policies with nine (9) dominant forms. The willingness of bureaucratized departments of public health to adapt to an outbreak helps state-of-the-art biomedical research and epidemiology to form policies. Each policy action entails insecurity and typically a great deal. © 2021.

Stigma toward healthcare providers from patients during COVID-19 era in Jordan.

AIM: This study aimed to explore healthcare providers' (HCP) stigmatization from patients during the COVID-19 outbreak in Jordan. METHOD: A cross-sectional design was used. Data collection was conducted between May and July 2021. The research questionnaire included demographic information about participants and multiple statements that reflect stigma of participants toward HCPs. Regression analysis was conducted to assess the association between stigma and explanatory variables. RESULTS: A total of 777 surveys were included in the study. Many people show high stigma toward HCPs during COVID-19 pandemic. Various factors including hearing news all time (p<.001), having children (p<.024), and smoking (p<.001) were significant in prediction stigma toward HCPs. CONCLUSION: This one of few studies conducted in Jordan regarding the stigma toward HCP from other people with chronic diseases. Our study found that many people showed some stigma toward HCP during COVID-19. Stigmatization of HCP related to a pandemic is a lesson most people have not learned. It is not enough to cheer HCPs. A clear, sensible public education campaign about the public's risks by interacting with HCP is necessary.

Bacteremia in Patients Hospitalized with Covid-19 Disease, Risk Factors, Impact of immunomodulator Therapy, Role of Inflammatory Markers, Antibiotic Use, and Outcomes: A Single Center Retrospective Study

Background. Novel coronavirus 2019 (Covid19) caused by SARS-CoV2 can lead to significant morbidity and mortality. There is unclear association between Covid19 and bacteremia. Patient characteristics and outcomes are not well defined. This retrospective cohort study assessed this in patients with Covid19 and bacteremia. Methods. Patients with Covid-19 admitted to a tertiary care suburban academic medical center (UH) were assessed retrospectively by EMR chart review for co-morbidities, pre and in hospital factors, and outcomes as defined below. Bacteremias grouped into gram-negative or gram-positive with collation of each unique bacterial species (Table 1). Results. Total 1398 patients with Covid19 hospitalized at UH during local peak of pandemic of whom 238 (17.02%) developed 264 bacteremias with gram-positive (244, 92.4%) and gram-negative organisms (20, 7.57%). Relevant characteristics (Table 2) 53% with immunomodulator therapy (steroids/Tocilizumab), mean length of stay 21.04 days (SEM ± 1.67) with day SARS-CoV2 PCR positivity -1.15 days from hospitalization (SEM ± 0.49) and day initial bacteremia 6.38 (SEM ± 0.77), 55.4% required ICU admission, with 89% ICU admissions requiring mechanical ventilation. Most common co-morbidity (Figure 1 full list) Hypertension 56.3% followed by Obesity (BMI >30) 45.8% and CAD/CHF 40.3%. Laboratory parameters (Table 3) significant for average difference (date bacteremia- date admission) for Procalcitonin 4.15 ng/mL (SEM ± 0.97, p-value 0.02), CRP -0.934 mg/dL (SEM ± 0.95, p-value 0.32), WBC 7.027 K/uL (SEM ± 0.65, p-value < 0.005). These analyses excluded difference of 0 from hospital day 1 bacteremia. Average antibiotic number (1+ dose per antibiotic) 3.24 (SEM ± 0.16) and total C difficile cases 3 (1.26%). Mortality rate 34.45%. Conclusion. Patients with Covid19 and bacteremia had high mortality (Figure 2), 53% received immunomodulator therapy, possibly contributing to bacteremia development. With bacteremia increase in WBC and Procalcitonin, not CRP, noted. Most organisms CoNS, likely contaminants, gram positive bacteremias likely from indwelling lines. Only 3 C difficile infections identified. Trends noted in Procalcitonin rise, immunomodulator therapy, and low C difficile infection rates warrant further studies.

Characteristics and Outcomes in Hospitalized Patients with Covid-19 Complicated by Fungemia: A Single Center Retrospective Study

Background. Covid19 caused by SARS-CoV2 can lead to significant morbidity and mortality. Fungemia is a rare hospital-associated infection and there are limited data regarding its association with Covid19. We reviewed all cases of fungemia in our Covid19 cohort at Stony Brook University Hospital (SBUH). Methods. We conducted a retrospective medical record review of patients admitted with Covid19 in a 3-month interval. We reviewed positive blood cultures for fungi and recorded co-morbidities, co-infections, length of stay, treatments, and outcomes (survival vs death). There were 60 positive blood cultures for fungi in 25 unique patients (Table 1);in prior years < 30 per year reported at SBUH. Collation of each unique identified fungal species from fungal blood cultures in patients hospitalized with Covid-19 Results. During a 3 month interval at the local peak of the pandemic 1398 patients hospitalized with Covid19 at SBUH, 25 cases of fungemia were detected;C. albicans (CA) n=8,32%, non C albicans species (nCA) n=16,64%, and C. neoformans n=1,4%, 17/25 (68%) also with bacteremia during same hospitalization. In same 3 months there were 264 cases of bacteremia and Covid19 co-infection. Demographics and medical co-morbidities of fungemic patients are in Table 2. Majority were men (76%). No difference between fungaemic (FC) and total cohort (TC) in median age (62 vs 62), DM p=0.31, HTN p=1.0, COPD p=0.12. Within FC, DM was higher in nCA group (58.8%) vs CA group (37%). Mortality was 40% in FC vs 15% in TC, p< 0.001. Within FC mortality was 56% in nCA and 25% in CA group. C. parapsilosis was the most common nCA species isolated with 43% mortality. FC more likely to require ICU and mechanical ventilation (88% vs 15%, p< 0.0001) and had longer median length of stay 42 days vs 22 days. The median time from admission to fungaemia was 21d, from central line placement 19d, Table 3. Of FC 21 (84%) were treated with steroids/Tocilizumab concurrently. Of note, no mortality was recorded in the 4 patients that did not receive steroids/Tocilizumab. PCT and WBC were significantly higher at time of fungemia as compared to admission, Table 3. Relevant patient characteristics and laboratory parameters in patients hospitalized with Covid19 and fungemia Conclusion. Fungemia in hospitalized patients with COVID-19 is associated with higher mortality. We observed higher fatality in non C. albicans infections. Prolonged use of central line catheters and concurrent treatment with steroids/tociluzimab are likely high-risk factors for development of fungemia.

A Social Media Analytics on How People Feel about Their Cancelled Homecoming during Covid-19 Pandemic

The existence of coronavirus disease 19 (COVID-19) has prompted the Indonesian government to issue some policies to prevent the spread of the virus. One of them is by prohibiting homecoming (mudik) during the Eid al-Fitr holiday on 12-14 May 2021. Homecoming has become an Indonesian tradition since a long time ago. The policy raised different kinds of opinions and responses on social media. In this paper, we would like to see how people really feel about this policy. We are conducting a social media analysis focusing on the sentiment and emotion analysis about the homecoming from Twitter (as one social media platform). We used Bidirectional Long Short-Term Memory (BiLSTM) architecture as the base in modeling the classifier for both sentiment and emotion analysis. The results show an accuracy of 0.84 for the sentiment analysis model and an accuracy of 0.91 for emotion analysis. The number of positive sentiments is higher than negative sentiment and this means that there are more people who support the government policy to ban homecoming than those who oppose it. While the emotion that appears higher than the other is 'tender' and this means that Indonesians really care and love their family. © 2021 IEEE.

Factors associated with mortality in hospitalized cardiovascular disease patients infected with COVID-19.

INTRODUCTION: To reduce mortality in hospitalized patients with COVID-19 and cardiovascular disease (CVD), it is necessary to understand the relationship between patient's symptoms, risk factors, and comorbidities with their mortality rate. To the best of our knowledge, this paper is the first which take into account the determinants like risk factors, symptoms, and comorbidities leading to mortality in CVD patients who are hospitalized with COVID-19. METHODS: This study was conducted on 660 hospitalized patients with CVD and COVID-19 recruited between January 2020 and January 2021 in Iran. All patients were diagnosed with the previous history of CVD like angina, myocardial infarction, heart failure, cardiomyopathy, abnormal heart rhythms, and congenital heart disease before they were hospitalized for COVID-19. We collected data on patient's signs and symptoms, clinical and paraclinical examinations, and any underlying comorbidities. t test was used to determine the significant difference between the two deceased and alive groups. In addition, the relation between pairs of symptoms and pairs of comorbidities has been determined via correlation computation. RESULTS: Our findings suggest that signs and symptoms such as fever, cough, myalgia, chest pain, chills, abdominal pain, nausea, vomiting, diarrhea, and anorexia had no impact on patients' mortality. There was a significant correlation between COVID-19 cardiovascular patients' mortality rate and symptoms such as headache, loss of consciousness (LOC), oxygen saturation less than 93%, and need for mechanical ventilation. CONCLUSIONS: Our results might help physicians identify early symptoms, comorbidities, and risk factors related to mortality in CVD patients hospitalized for COVID-19.

Immunosuppression and COVID-19 infection in British Columbia: Protocol for a linkage study of population-based administrative and self-reported survey data.

INTRODUCTION: Cases of the novel coronavirus disease (COVID-19) continue to spread around the world even one year after the declaration of a global pandemic. Those with weakened immune systems, due to immunosuppressive medications or disease, may be at higher risk of COVID-19. This includes individuals with autoimmune diseases, cancer, transplants, and dialysis patients. Assessing the risk and outcomes of COVID-19 in this population has been challenging. While administrative databases provide data with minimal selection and recall bias, clinical and behavioral data is lacking. To address this, we are collecting self-reported survey data from a randomly selected subsample with and without COVID-19, which will be linked to administrative health data, to better quantify the risk of COVID-19 infection associated with immunosuppression. METHODS AND ANALYSIS: Using administrative and laboratory data from British Columbia (BC), Canada, we established a population-based case-control study of all individuals who tested positive for SARS-CoV-2. Each case was matched to 40 randomly selected individuals from two control groups: individuals who tested negative for SARS-CoV-2 (i.e., negative controls) and untested individuals from the general population (i.e., untested controls). We will contact 1000 individuals from each group to complete a survey co-designed with patient partners. A conditional logistic regression model will adjust for potential confounders and effect modifiers. We will examine the odds of COVID-19 infection according to immunosuppressive medication or disease type. To adjust for relevant confounders and effect modifiers not available in administrative data, the survey will include questions on behavioural variables that influence probability of being tested, acquiring COVID-19, and experiencing severe outcomes. ETHICS AND DISSEMINATION: This study has received approval from the University of British Columbia Clinical Research Ethics Board [H20-01914]. Findings will be disseminated through scientific conferences, open access peer-reviewed journals, COVID-19 research repositories and dissemination channels used by our patient partners.

SARS-CoV-2 shedding dynamics across the respiratory tract, sex, and disease severity for adult and pediatric COVID-19.

Background: Previously, we conducted a systematic review and analyzed the respiratory kinetics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Chen et al., 2021). How age, sex, and coronavirus disease 2019 (COVID-19) severity interplay to influence the shedding dynamics of SARS-CoV-2, however, remains poorly understood. Methods: We updated our systematic dataset, collected individual case characteristics, and conducted stratified analyses of SARS-CoV-2 shedding dynamics in the upper (URT) and lower respiratory tract (LRT) across COVID-19 severity, sex, and age groups (aged 0-17 years, 18-59 years, and 60 years or older). Results: The systematic dataset included 1266 adults and 136 children with COVID-19. Our analyses indicated that high, persistent LRT shedding of SARS-CoV-2 characterized severe COVID-19 in adults. Severe cases tended to show slightly higher URT shedding post-symptom onset, but similar rates of viral clearance, when compared to nonsevere infections. After stratifying for disease severity, sex and age (including child vs. adult) were not predictive of respiratory shedding. The estimated accuracy for using LRT shedding as a prognostic indicator for COVID-19 severity was up to 81%, whereas it was up to 65% for URT shedding. Conclusions: Virological factors, especially in the LRT, facilitate the pathogenesis of severe COVID-19. Disease severity, rather than sex or age, predicts SARS-CoV-2 kinetics. LRT viral load may prognosticate COVID-19 severity in patients before the timing of deterioration and should do so more accurately than URT viral load. Funding: Natural Sciences and Engineering Research Council of Canada (NSERC) Discovery Grant, NSERC Senior Industrial Research Chair, and the Toronto COVID-19 Action Fund.