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1.
Gastroenterology ; 162(7):S-837, 2022.
Article in English | EMBASE | ID: covidwho-1967373

ABSTRACT

Background and Aims: Long COVID is a syndrome affecting patients infected with SARSCoV- 2 who show a broad spectrum of symptoms, such as fatigue and dyspnoea, persisting for several months after the initial infection. Patients with type 2 diabetes (T2D) have frequent co-morbidities affecting multiple organs. Both long COVID and T2D are multi-system conditions associated with abnormalities in organ structure and function. Therefore, multi-organ assessment is critical for monitoring organ health and early detection of co-morbidities in both conditions. This study aimed to define the prevalence of multi-organ abnormalities in patients with long COVID and patients with T2D with a rapid, non-contrast, magnetic resonance imaging (MRI) scan. Methods: Overall, 135 long COVID patients without diabetes were recruited in the COVERSCAN study (NCT04369807) at a median of 183 days since first COVID-19 symptoms. 135 patients with established T2D were recruited in the MODIFY study (NCT04114682). MRI data were acquired to derive abdominal organ-specific measures of size, fat deposition and fibroinflammation (CoverScan®, Perspectum Ltd.). Reference values of MRI metrics were based on 92 healthy volunteers and published literature. The prevalence of abnormalities for each measure was assessed using Fisher's exact tests in the whole cohort and in a subset of patients with obesity (BMI≥30 kg/m2). Results: The demographics of the three cohorts were as follows: long COVID: median age 54 yrs [interquartile interval 46–60], 56% male, BMI 27 kg/m2 [26–31];T2D: 62 yrs [54–70], 59% male, BMI 32 kg/m2 [28–35], median T2D duration 11 yrs;healthy volunteers: 44 yrs [32–53], 66% male, BMI 23 kg/m2 [21–25]). There was a high prevalence of abdominal organ abnormality in both long COVID and T2D patient groups (Figure, left), including increased fat deposition (steatosis) in the liver, pancreas, and kidney (Figure, right). 35% of patients with T2D had clustering of abnormalities involving at least 2 organs, compared to 23% in long COVID. Abnormalities affecting the liver (steatosis, fibroinflammation and hepatomegaly) and renomegaly were more common in T2D than in long COVID (p<0.001). Considering only patients with obesity, liver fibroinflammation, hepatomegaly, and renomegaly remained significantly more prevalent in T2D than in long COVID (p<0.05). Conclusion: Long COVID and established T2D have distinct profiles of multi-organ impairment, more prevalent with obesity but not fully explained by it. Multi-organ MRI assessment can enrich the current blunt assessment of multi-system/multi-organ abnormalities in diverse disease states to inform earlier intervention and treatments. (Figure Presented) Left: Prevalence (%) of organ abnormalities in long COVID patients (black numbers) and T2D patients (grey numbers) (liver, pink;pancreas, yellow;kidney, green;spleen, blue). Right: Prevalence of organ steatosis, fibroinflammation and increased organ size by patient group. Colour per organ as in left figure.

2.
Medical Journal of Dr. D.Y. Patil Vidyapeeth ; 15(4):453-454, 2022.
Article in English | Scopus | ID: covidwho-1954411
3.
JOURNAL OF INDIAN ACADEMY OF ORAL MEDICINE AND RADIOLOGY ; 34(2):237-240, 2022.
Article in English | Web of Science | ID: covidwho-1939216

ABSTRACT

Mucormycosis is an opportunistic fulminant fungal infection that can cause significant morbidity and frequent mortality in susceptible patients. Common predisposing factors include diabetes mellitus and immunosuppression. Even though this fungus is ubiquitous, the immune system usually prevents the disease, and it is rare. But in the present pandemic era, Mucormycosis has become a prevalent disease among immunocompromised patients and individuals with systemic pathosis. The infection begins in the nose and paranasal sinuses due to inhalation of fungal spores. The fungus invades the arteries leading to thrombosis that subsequently causes tissue necrosis. The infection can spread to orbital and intracranial structures by direct invasion of blood vessels. Here, we describe an interesting and rare case of sino-nasal mucormycosis in a seropositive, uncontrolled diabetic and suspected Covid positive individual to emphasize early diagnosis and treatment of this fatal fungal infection.

4.
Harm Reduct J ; 19(1): 49, 2022 05 20.
Article in English | MEDLINE | ID: covidwho-1910326

ABSTRACT

BACKGROUND: The increasing prevalence of highly potent, illicitly manufactured fentanyl and its analogues (IMF) in the USA is exacerbating the opioid epidemic which has worsened during the COVID-19 pandemic. Narcan® (naloxone HCl) Nasal Spray has been approved by the US Food and Drug Administration as a treatment for opioid-related overdoses. Due to the high potency of IMF, multiple naloxone administrations (MNA) may be needed per overdose event. It is essential to determine the patterns of naloxone use, including MNA, and preferences among bystanders who have used naloxone for opioid overdose reversal. METHODS: A cross-sectional web-based survey was administered to 125 adult US residents who administered 4 mg Narcan® Nasal Spray during an opioid overdose in the past year. The survey asked about the most recent overdose event, the use of Narcan® during the event and the associated withdrawal symptoms, and participant preferences regarding dosages of naloxone nasal spray. An open-ended voice survey was completed by 35 participants. RESULTS: Participants were mostly female (70%) and white (78%), while reported overdose events most frequently occurred in people who were males (54%) and white (86%). Most events (95%) were successfully reversed, with 78% using ≥ 2 doses and 30% using ≥ 3 doses of Narcan® Nasal Spray. Over 90% were worried that 1 Narcan® box may not be enough for a successful future reversal. Reported withdrawal symptoms were similar in overdose events where 1 versus ≥ 2 sprays were given. Eighty-six percent of participants reported more confidence in an 8 mg versus a 4 mg naloxone nasal spray and 77% reported a stronger preference for 8 mg over 4 mg. CONCLUSIONS: MNA occurred in most overdose events, often involving more sprays than are provided in one Narcan® nasal spray box, and participants predominantly expressed having a stronger preference for and confidence in an 8 mg compared to a 4 mg nasal spray. This suggests the need and desire for a higher dose naloxone nasal spray formulation option. Given that bystanders may be the first to administer naloxone to someone experiencing an opioid overdose, ensuring access to an adequate naloxone supply is critical in addressing the opioid overdose epidemic.


Subject(s)
COVID-19 , Drug Overdose , Opiate Overdose , Substance Withdrawal Syndrome , Adult , Analgesics, Opioid/therapeutic use , Cross-Sectional Studies , Drug Overdose/drug therapy , Drug Overdose/epidemiology , Female , Humans , Male , Naloxone/therapeutic use , Narcotic Antagonists/therapeutic use , Nasal Sprays , Pandemics , Substance Withdrawal Syndrome/drug therapy
5.
Data Science for COVID-19: Volume 2: Societal and Medical Perspectives ; : 705-728, 2021.
Article in English | Scopus | ID: covidwho-1872875

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has witnessed a total of 2, 631, 338 infected cases as on April 22, 2020. The first case being recorded in January 2020, followed by more than 20, 000 case in a matter of 3 months creating a tremor among the population of India. The United States tops the total number of infected cases in the world with 8, 45, 822 cases, followed by Spain summing up to 2, 08, 389 cases. India having 21, 370 total infected cases, along with 4370 recoveries and a total death toll of 681, ranks 17th among the other countries. In this study, a detailed summary has been conducted on how India is working together to fight this pandemic. The countrymen, along with following the strict instructions provided by the WHO, have set up new rules to fight this disease. This study includes the various medical procedures adopted by the government of India along with the economic guidelines for its fellow citizens during these hard times;a geospatial approach has also been used to identify the infected regions of the country and their pandemic control methods in the 1-month period (22 March-22 April). To date, being the second most populated developing country in the world, India has managed to control the spread of the virus to a large extent. The WHO has praised India’s efforts in monitoring the spread of the virus and has alerted India that a simple lockdown would not stop the spread of the virus. They have recommended India to increase the number of tests to segregate the people showing early/mild symptoms. The outcomes of the precautions taken are also discussed in this study. © 2022 Elsevier Inc.

6.
Physics of Fluids ; 34(5), 2022.
Article in English | Scopus | ID: covidwho-1860502

ABSTRACT

The current COVID-19 pandemic has increased the use of facial masks globally, which of late have registered their presence as a part of our civilization. The N95 mask is one of the most popular choices under the current situation. However, the available masks cannot provide breathing comfort for an extended period, which results in rebreathing of exhaled air that is CO2 rich, and which remains in the breathing space of the respirator. Furthermore, problems like moisture settlement on the covered area of the face due to the multiple layers of fabric-like material causes significant discomfort. Hence, the need for a mask with an air-purification activity is the need of the hour. The present innovation relates to the invention of a mask that is battery-powered or solar-operated and addresses the aforementioned problems. This mask not only regulates the airflow, which is beneficial to our body in every way, but also lowers the discomfort of sweating and heating. The effect of the addition of the self-developed active respirator to the commercially available masks on the inspired CO2 level, thermal comfort, and speech clarity has been demonstrated in this study. We have exhibited through in vitro experiments that the filtration capability of the active-respirator improvised mask, we call the Bose shield, does not deter from that of the standard N95 mask. To our understanding, the use of this novel mask can reduce the occurrence of CO2 rebreathing in respiratory protective devices and its impact on workers who inevitably wear them for a prolonged period of time. © 2022 Author(s).

7.
Economic and Political Weekly ; 57(17):20-25, 2022.
Article in English | Scopus | ID: covidwho-1856962

ABSTRACT

This article tries to analyse the non-tariff measures enacted by countries during the COVID-19 pandemic from the lens of trade protectionism. It further suggests ways for reforming the World Trade Organization rules and highlights the importance of eliminating trade barriers for effectively combating the pandemic. © 2022 Economic and Political Weekly. All rights reserved.

8.
Journal of the American College of Cardiology ; 79(9):1312-1312, 2022.
Article in English | Web of Science | ID: covidwho-1849195
9.
Medical Journal of Dr. D.Y. Patil Vidyapeeth ; 15(3):293-298, 2022.
Article in English | Scopus | ID: covidwho-1835272
10.
Journal of Clinical and Diagnostic Research ; 16(SUPPL 2):88, 2022.
Article in English | EMBASE | ID: covidwho-1798740

ABSTRACT

Introduction: Scoliosis refers to the lateral curvature of the spine, which is progressive leading to morphological changes affecting quality of life, postural disability, even causing respiratory distress. Hence, screening the prevalence of scoliosis is much needed at a very early stage among school going children, thereby preventing permanent damage and spinal disorders that worsens. Aim: This study was undertaken to identify the prevalence of scoliosis among school going children in Puducherry thereby adequate adequate knowledge shall be provided to them to make them aware of the clinical condition,change their perception about the disease and motivate them to take necessary steps to overcome scoliosis at an earlier phase. Materials and Methods: A total of 1164 children (724 boys, 440 girls) aged from 6-17 years, were recruited for the study (since COVID-19 phase, most of the educational institutions were conducting only online sessions). The screening procedure included Adam's test(forward bending test) and scoliometer measurements, if >70 referred for poster anterior radiograph of the trunk, where Cobb angle is measured ,and if found to be >200 were identified to have scoliosis. The objectives were fully informed to the parents and the students and respondents were allowed to participate voluntarily. The data obtained were analyzed statistically. Results: A total of 60 students were found positive on forward bending test and scoliometer measurements >7°, among which 22 were confirmed with scoliosis on standing radiographs., 16 (73%) girls and 6 (27%) boys. Thirty-eight of which 23 (60%) girls and 15 (40%) boys had normal spine curvatures on X- ray examination (false positive). Conclusion: A total of 60 students were suffering from scoliosis, who needs further attention and the same have been informed to the concerned parents.

11.
Journal of the American College of Cardiology ; 79(15):S334-S335, 2022.
Article in English | EMBASE | ID: covidwho-1796602

ABSTRACT

Clinical Information Patient Initials or Identifier Number: SP Relevant Clinical History and Physical Exam: A 30-year-old female was referred to our centre with chief complaint of orthopnea. The patient had received medical attention elsewhere and was treated empirically for asthma, COVID pneumonia and antitubercular treatment. On examination the patient had a bounding pulse on right upper limb and an impalpable pulse on left upper limb, weak pulses in bilateral carotid and lower limbs. Further examination revealed a right upper limb blood pressure of 230/120 mm of Hg. [Formula presented] [Formula presented] Relevant Test Results Prior to Catheterization: The chest roentgenogram of the patient revealed bat-wing pulmonary edema with cardiomegaly. ECG revealed left ventricular hypertrophy with strain pattern and echocardiography revealed left ventricular dysfunction with ejection fraction of 35%. CT aortogram revealed wall thickening with fusiform dilatation of distal thoracic, proximal abdominal aorta, and stenosis of left subclavian, celiac artery at ostium and bilateral renal arteries at ostium. The patient also had a raised ESR (40 mm/hr). Interventional Management Procedural Step: The procedure was done under local anesthetic from a right femoral artery access with 7 French sheath. A coronary angiogram was done first which revealed normal epicardial coronaries. Pull back gradient was then taken across thoracic and abdominal aorta which revealed a gradient of 20 mmHg. Next, renal angiogram was taken in individual renal arteries which revealed significant ostial stenosis of bilateral renal arteries. The lesions were serially dilated with 1.5 mm, 2.5 mm and 4 mm diameter coronary balloons. After dilatation Invatec Hippocampus 5x15 mm stent was placed in right renal artery and a 6x14 mm Boston scientific vascular SD stent placed in left renal artery. Post stenting angiography showed a good flow with relief of stenosis. [Formula presented] [Formula presented] [Formula presented] Conclusions: Although, there is controversy regarding role of angioplasty in treatment of hypertension in atheromatous renal artery stenosis, no consensus exists in Takayasu arteritis with renal artery stenosis due to a lack of randomised controlled trials. Our case represents an interesting case where the patient had a dramatic relief of hypertension and heart failure after bilateral renal angioplasty in Takayasu arteritis.

12.
Journal of Cardiovascular Disease Research ; 13(1):1693-1701, 2022.
Article in English | EMBASE | ID: covidwho-1791330

ABSTRACT

Objective- The aim of this study was to assess whether major blood inflammatory parameters like neutrophil/lymphocyte ratio (NLR), interleukin-6 (IL-6) and high sensitivity C-reactive protein (hs-CRP) levels are associated with left ventricular remodeling parameters, New York heart association (NYHA) functional classes and pro-B- type natriuretic peptide (pro-BNP) levels in patients with idiopathic DCM. Methodology-59 patients with DCM were initially screened and categorized as idiopathic DCM and 22 were included for further analyses due to COVID-19 restrictions and positive cases were eliminated from the study. Biochemical assessment and echocardiographic investigations were done to assess cardiac structure and function. Results- There was a statistically significant correlation found between NLR and NYHA functional class (r=0.48, p<0.001), pro-BNP level (r=0.61, P<0.001) and left ventricular (LV) systolic parameters. Similar correlation was observed for IL-6 (with NYHA, r=0.40, P=0.011 and with pro-BNP, r=0.55, P=0.002). hs-CRP showed low to moderate correlation with the cardiac markers. NLR was also significantly higher in NYHA functional class III-IV patients (n=11) compared to NYHA class I-II (n=11), (3.1±0.5 vs 3.8±0.8, P=0.045). IL-6 showed similar significant difference between NYHA class I-II and III-IV (10.0±2.6 vs 20.0±11.2, P=0.045). NLR and IL-6 also found to be independent positive predictors of heart failure progression in NYHA class III-IV (P=0.019 and 0.015 respectively). Conclusion- Our findings clearly exhibit the efficacy of NLR and IL-6 in predicting severity of chronic heart failure in IDCM patients.

13.
Embase; 2022.
Preprint in English | EMBASE | ID: ppcovidwho-332715

ABSTRACT

Objective To assess the risk of death involving COVID-19 following infection from Omicron (B.1.1.539/BA.1) relative to Delta (B.1.617.2). Design Retrospective cohort study. Setting England, UK, 1 December 2021 to 25 January 2022. Participants 1,035,163 people aged 18-100 years who tested positive for SARS-CoV-2 in the national surveillance programme, and had an infection identified as either Omicron- or Delta compatible. Main outcome measures Death involving COVID-19 as identified from death certification records. The exposure of interest was the SARS-CoV-2 variant identified from NHS Test and Trace PCR positive tests taken in the community (pillar 2) and analysed by Lighthouse laboratories. Cause-specific Cox proportional hazard regression models were adjusted for sex, age, vaccination status, previous infection, calendar time, ethnicity, Index of Multiple Deprivation rank, household deprivation, university degree, keyworker status, country of birth, main language, region, disability, and comorbidities. Additionally, we tested for interactions between variant and sex, age, vaccination status and comorbidities. Results The risk of death involving COVID-19 was 67% lower for Omicron compared to Delta and the reduction in the risk of death involving COVID-19 for Omicron compared to Delta was more pronounced in males than in females and in people under 70 years old than in people aged 70 years or over. Regardless of age, reduction of the risk of death from Omicron relative to Delta more was more pronounced in people who had received a booster than in those having received only two doses. Conclusions Our results support early work showing the relative reduction in severity of Omicron compared to Delta in terms of hospitalisation and extends this research to assess COVID-19 mortality. Our work also highlights the importance of the vaccination booster campaign, where the reduction in risk of death involving COVID-19 is most pronounced in individuals who had received a booster.

14.
Journal of Association of Physicians of India ; 70(3):25-26, 2022.
Article in English | Scopus | ID: covidwho-1772365

ABSTRACT

COVID-19 is the disease caused by SARS-CoV-2. The present hospital based study was performed to find out prevalence of Urinary Tract Infection among COVID 19 patients. The cross sectional study was performed with seven hundred fifty three laboratory confirmed COVID 19 cases over six months (from 1st July to 31st December, 2020). Urine samples collected from laboratory confirmed COVID-19 cases in appropriate sterile manner and were screened for pus cells and bacteria. This was followed by plating on Mac-conkey's agar media and 5% Sheep Blood agar media. Inoculated plates were incubated overnight in aerobic condition at 37°C. Discrete colonies were further studied by Gram staining, tests for motility, battery of biochemical tests. Antibiogram was performed by disk diffusion method as per CLSI guidelines. Species confirmation and MIC (Minimum Inhibitory Concentration) values of the tested antibiotics were detected by automation. Results were analyzed according to standard statistical methods. Ninety urine samples were culture positive (11.95%). Escherichia coli was found to be the commonest pathogen, isolated in forty three cases (47.78%) followed by Enterococcus faecalis in twenty nine (32.22%) and Klebsiella pneumoniae subspp. pneumonia in eighteen occasions (20%). Enterococcus faecalis isolates were sensitive to Vancomycin, Linezolid and Nitrofurantoin and nineteen isolates were resistant to fluroquinolones (65.51%). Majority of the Gram Negative isolates were susceptible to nitrofurantoin (80.32%) where as fifteen carbapenemase producers, thirteen AmpC Betalactamase producers and twenty one Extended Spectrum Beta Lactamase (ESBL) producers have been recorded. Constant awareness regarding the antibiotic guidelines for COVID-19 cases is the need of the hour. © 2022 Journal of Association of Physicians of India. All rights reserved.

15.
Working Paper Series - National Bureau of Economic Research (Massachusetts)|2021. (w29021):unpaginated. 15 ref. ; 2021.
Article in English | CAB Abstracts | ID: covidwho-1760220

ABSTRACT

During the COVID-19 epidemic, many health professionals started using mass communication on social media to relay critical information and persuade individuals to adopt preventative health behaviors. Our group of clinicians and nurses developed and recorded short video messages to encourage viewers to stay home for the Thanksgiving and Christmas Holidays. The researchers then conducted a two-stage clustered randomized controlled trial in 820 counties (covering 13 States) in the United States of a large-scale Facebook ad campaign disseminating these messages. In the first level of randomization, the researchers randomly divided the counties into two groups: high intensity and low intensity. In the second level, the researchers randomly assigned zip codes to either treatment or control such that 75% of zip codes in high intensity counties received the treatment, while 25% of zip codes in low intensity counties received the treatment. In each treated zip code, the researchers sent the ad to as many Facebook subscribers as possible (11,954,109 users received at least one ad at Thanksgiving and 23,302,290 users received at least one ad at Christmas). The first primary outcome was aggregate holiday travel, measured using mobile phone location data, available at the county level: the researchers find that average distance travelled in high-intensity counties changed by -0.993 percentage points (95% CI -1.616, -0.371, p-value 0.002) the three days before each holiday. The second primary outcome was COVID-19 infection at the zip-code level: COVID-19 infections recorded in the two-week period starting five days post-holiday declined by 3.5 percent (adjusted 95% CI [-6.2 percent, -0.7 percent], p-value 0.013) in intervention zip codes compared to control zip codes.

16.
Medical Journal of Dr. D.Y. Patil Vidyapeeth ; 15(2):143-145, 2022.
Article in English | Scopus | ID: covidwho-1753800
17.
Operations Research Forum ; 2(3), 2021.
Article in English | Scopus | ID: covidwho-1750909

ABSTRACT

This paper addressed a scheduling problem which handles urgent tasks along with existing schedules. The uncertainties in this problem come from random process of existing schedules and unknown upcoming urgent tasks. To deal with the uncertainties, this paper proposes a stochastic integer programming (SIP) based aggregated online scheduling method. The method is illustrated through a study case from the outpatient clinic block-wise scheduling system which is under a hybrid scheduling policy combining regular far-in-advance policy and the open-access policy. The COVID-19 pandemic brings more challenges for the healthcare system including the fluctuations of service time and increasing urgent requests which this paper is designed for. The schedule framework designed in the method is comprehensive to accommodate various uncertainties in the healthcare service system, such as: no-shows, cancellations and punctuality of patients as well as preference of patients over time slots and physicians. © 2021, The Author(s), under exclusive licence to Springer Nature Switzerland AG.

18.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-329180

ABSTRACT

During the COVID-19 epidemic, many health professionals started using mass communication on social media to relay critical information and persuade individuals to adopt preventative health behaviors. Our group of clinicians and nurses developed and recorded short video messages to encourage viewers to stay home for the Thanksgiving and Christmas Holidays. We then conducted a two-stage clustered randomized controlled trial in 820 counties (covering 13 States) in the United States of a large-scale Facebook ad campaign disseminating these messages. In the first level of randomization, we randomly divided the counties into two groups: high intensity and low intensity. In the second level, we randomly assigned zip codes to either treatment or control such that 75% of zip codes in high intensity counties received the treatment, while 25% of zip codes in low intensity counties received the treatment. In each treated zip code, we sent the ad to as many Facebook subscribers as possible (11,954,109 users received at least one ad at Thanksgiving and 23,302,290 users received at least one ad at Christmas). The first primary outcome was aggregate holiday travel, measured using mobile phone location data, available at the county level: we find that average distance travelled in high-intensity counties decreased by -0.993 percentage points (95% CI -1.616, -0.371, p-value 0.002) the three days before each holiday. The second primary outcome was COVID-19 infection at the zip-code level: COVID-19 infections recorded in the two-week period starting five days post-holiday declined by 3.5 percent (adjusted 95% CI [-6.2 percent, -0.7 percent], p-value 0.013) in intervention zip codes compared to control zip codes.

19.
Kidney International Reports ; 7(2):S387-S388, 2022.
Article in English | EMBASE | ID: covidwho-1707477

ABSTRACT

Introduction: Chronic Kidney Disease (CKD) is a global burden on public health, both as a risk factor for mortality, and as the end syndrome of underlying diseases. CKD is a common comorbidity associated with increased risk of severe coronavirus infection and poor clinical outcomes. The pandemic has had both direct (through infection) and indirect impact. The direct impact on individuals with CKD and other underlying conditions is related to baseline risk, influenced by age, multimorbidity and other socio-demographic factors. However, previous studies of COVID-19 in CKD have been small scale (12-1099 cases), mostly focused on end-stage CKD, and ignored major comorbidities. Thus, using large-scale, population-based electronic health records, in people with incident CKD we aimed to (a) identify the most common comorbidities;(b) estimate 1-year (pre-pandemic) risk of mortality and (c) predict excess deaths related to COVID-19 over 1-year of pandemic based on pre-pandemic risk of mortality at different population infection rates and relative risks. Methods: We used linked primary and secondary care records (Clinical Practice Research Datalink GOLD data) from England;of 3,862,012 individuals aged ≥ 30 registered with a GP practice between 1997 and 2017. Incident CKD was identified based on diagnosis codes and eGFR levels;classified mutually exclusively into five CKD Stages. The underlying conditions were obtained using validated phenotyping algorithms in CALIBER and the most prevalent ones were identified. The 1-year mortality were estimated using Kaplan–Meier survival analysis;stratified by key demographic factors and number of comorbidities. Using these pre-pandemic risk estimates and our recently published Lancet model, we calculated excess COVID-19 related deaths at different population infection rates and relative risks. For validation, we identified the number of people who died with both CKD and positive COVID-19 test result during 1-year of pandemic using the contemporary NHSD TRE data of England (NHS Digital Trusted Research Environment, n=54 million). Results: We identified 294,381 individuals with incident CKD (mean age 72.5 years;female: 59%). Multimorbidity was common among CKD patients especially the presence of hypertension (61.4%) and CVD complications (35.6%) (Fig 1 ). The proportion of CKD patients having at least one underlying condition increases significantly either by age or CKD stage whilst age was the main confounder within each CKD stage. Age, Stage of CKD and underlying conditions combined to influence pre-pandemic risk (Fig 2 ). At an IR of 10%, we predicted 31003 and 46505 excess deaths at RR of 2 and 3 respectively (Table 1 ) which is close to actual observed mortality (47214) from the NHSD TREin England. [Formula presented] [Formula presented] [Formula presented] Conclusions: Individuals with CKD have high risk of pre-pandemic mortality particularly those with comorbidities. The data on multimorbidity, CKD stage and age together could help prioritise patients for vaccination, post-COVID policy, and designing stratified pathways for CKD patients. We illustrate that the direct burden of pandemic could be predicted using pre-pandemic large scale EHR data. Conflict of interest Potential conflict of interest: This study was funded by AstraZeneca and Health Data Research UK. AB has received research grants from AstraZeneca. JBM and TM are employed full-time by AstraZeneca UK Ltd, a biopharmaceutical company who develops, manufactures and markets medicines in the cardiovascular, renal and metabolic disease area.

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