Research priorities to reduce the impact of COVID-19 in low- and middle-income countries

Background The COVID-19 pandemic has caused disruptions to the functioning of societies and their health systems. Prior to the pandemic, health systems in low- and middle-income countries (LMIC) were particularly stretched and vulnerable. The International Society of Global Health (ISoGH) sought to systematically identify priorities for health research that would have the potential to reduce the impact of the COVID-19 pandemic in LMICs. Methods The Child Health and Nutrition Research Initiative (CHNRI) method was used to identify COVID-19-related research priorities. All ISoGH members were invited to participate. Seventy-nine experts in clinical, translational, and population research contributed 192 research questions for consideration. Fifty-two experts then scored those questions based on five pre-defined criteria that were selected for this exercise: 1) feasibility and answerability;2) potential for burden reduction;3) potential for a paradigm shift;4) potential for translation and implementation;and 5) impact on equity. Results Among the top 10 research priorities, research questions related to vaccination were prominent: health care system access barriers to equitable uptake of COVID-19 vaccination (ranked 1st), determinants of vaccine hesitancy (4th), development and evaluation of effective interventions to decrease vaccine hesitancy (5th), and vaccination impacts on vulnerable population/s (6th). Health care delivery questions also ranked highly, including: effective strategies to manage COVID-19 globally and in LMICs (2nd) and integrating health care for COVID-19 with other essential health services in LMICs (3rd). Additionally, the assessment of COVID-19 patients’ needs in rural areas of LMICs was ranked 7th, and studying the leading socioeconomic determinants and consequences of the COVID-19 pandemic in LMICs using multi-faceted approaches was ranked 8th. The remaining questions in the top 10 were: clarifying paediatric case-fatality rates (CFR) in LMICs and identifying effective strategies for community engagement against COVID-19 in different LMIC contexts. Interpretation Health policy and systems research to inform COVID-19 vaccine uptake and equitable access to care are urgently needed, especially for rural, vulnerable, and/or marginalised populations. This research should occur in parallel with studies that will identify approaches to minimise vaccine hesitancy and effectively integrate care for COVID-19 with other essential health services in LMICs. ISoGH calls on the funders of health research in LMICs to consider the urgency and priority of this research during the COVID-19 pandemic and support studies that could make a positive difference for the populations of LMICs.

Analysis of myocardial enzyme spectrum in 230 COVID-19 patients of Chongqing, China. (preprint)

Background A novel coronavirus disease COVID-19 outbreak caused pandemic in China and worldwide. In addition to pneumonia, Cardiac failure is also a clinical outcome of coronavirus (COVID-19) patients and one of the leading causes for the death of COVID-19 patients. This study focused on a spectrum of cardiac enzymes to provide biomarkers for the severity of cardiomyopathy, and provide guidance of clinical treatment.Methods 230 coronavirus patients (182 mild and 48 severe cases) enrolled in Three Gorges Hospital of Chongqing University from January to March 2020 were analyzed for a spectrum of cardiac injury enzymes including α-hydroxybutyric dehydrogenase (αHBDH), lactic acid dehydrogenase (LDH), creatine kinase (CK), and creatine kinase isoenzyme (CK-MB).Results The severe cases had significantly higher myocardial enzyme levels than mild cases, regardless of male and females. Males appeared to be more susceptible than females to COVID-19 induced heart injury, having higher CK and CK-MB in mild cases, and higher αHBDH and LDH levels in severe cases. Age is also a susceptible factor to COVID-19, but affected males were younger than females.Conclusions This study reveals that the heart is also a major target of COVID-19 infection, and myocardial enzyme spectrum assays could help the diagnosis, prognosis and guide the treatments to prevent heart failure in COVID-19 patients.