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1.
JAMA Health Forum ; 3(10): e223764, 2022 Oct 07.
Article in English | MEDLINE | ID: covidwho-2084932

ABSTRACT

This survey study uses 2020 American Hospital Association data to assess strategies of US hospitals serving vulnerable populations in addressing social needs during the COVID-19 pandemic.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Pandemics , Hospitals , Needs Assessment
2.
J Atmos Chem ; : 1-18, 2022 Oct 07.
Article in English | MEDLINE | ID: covidwho-2059949

ABSTRACT

The countrywide lockdown in China during the COVID-19 pandemic provided a natural experiment to study the characteristics of surface ozone (O3). Based on statistical analysis of air quality across China before and during the lockdown, the tempo-spatial variations and site-specific formation regimes of wintertime O3 were analyzed. The results showed that the O3 pollution with concentrations higher than air quality standards could occur widely in winter, which had been aggravated by the emission reduction during the lockdown. On the national scale of China, with the significant decrease (54.03%) in NO2 level from pre-lockdown to COVID-19 lockdown, the maximum daily 8-h average concentration of O3 (MDA8h O3) increased by 39.43% from 49.05 to 64.22 µg/m3. This increase was comprehensively contributed by attenuated NOx suppression and favorable meteorological changes on O3 formation during the lockdown. As to the pollution states of different monitoring stations, surface O3 responded oppositely to the consistent decreased NO2 across China. The O3 levels were found to increase in the northern and central regions, but decrease in the southern region, where the changes in both meteorology (e.g. temperature drops) and precursors (reduced emissions) during the lockdown had diminished local O3 production. The spatial differences in NOx levels generally dictate the site-specific O3 formation regimes in winter, with NOx-titration/VOCs-sensitive regimes being dominant in northern and central China, while VOCs-sensitive/transition regimes being dominant in southern China. These findings highlight the influence of NOx saturation levels on winter O3 formation and the necessity of VOCs emission reductions on O3 pollution controls.

3.
JAMA ; 328(10): 941-950, 2022 09 13.
Article in English | MEDLINE | ID: covidwho-2047346

ABSTRACT

Importance: During the COVID-19 pandemic, the US federal government required that skilled nursing facilities (SNFs) close to visitors and eliminate communal activities. Although these policies were intended to protect residents, they may have had unintended negative effects. Objective: To assess health outcomes among SNFs with and without known COVID-19 cases. Design, Setting, and Participants: This retrospective observational study used US Medicare claims and Minimum Data Set 3.0 for January through November in each year beginning in 2018 and ending in 2020 including 15 477 US SNFs with 2 985 864 resident-years. Exposures: January through November of calendar years 2018, 2019, and 2020. COVID-19 diagnoses were used to assign SNFs into 2 mutually exclusive groups with varying membership by month in 2020: active COVID-19 (≥1 COVID-19 diagnosis in the current or past month) or no-known COVID-19 (no observed diagnosis by that month). Main Outcomes and Measures: Monthly rates of mortality, hospitalization, emergency department (ED) visits, and monthly changes in activities of daily living (ADLs), body weight, and depressive symptoms. Each SNF in 2018 and 2019 served as its own control for 2020. Results: In 2018-2019, mean monthly mortality was 2.2%, hospitalization 3.0%, and ED visit rate 2.9% overall. In 2020, among active COVID-19 SNFs compared with their own 2018-2019 baseline, mortality increased by 1.60% (95% CI, 1.58% to 1.62%), hospitalizations decreased by 0.10% (95% CI, -0.12% to -0.09%), and ED visit rates decreased by 0.57% (95% CI, -0.59% to -0.55%). Among no-known COVID-19 SNFs, mortality decreased by 0.15% (95% CI, -0.16% to -0.13%), hospitalizations by 0.83% (95% CI, -0.85% to -0.81%), and ED visits by 0.79% (95% CI, -0.81% to -0.77%). All changes were statistically significant. In 2018-2019, across all SNFs, residents required assistance with an additional 0.89 ADLs between January and November, and lost 1.9 lb; 27.1% had worsened depressive symptoms. In 2020, residents in active COVID-19 SNFs required assistance with an additional 0.36 ADLs (95% CI, 0.34 to 0.38), lost 3.1 lb (95% CI, -3.2 to -3.0 lb) more weight, and were 4.4% (95% CI, 4.1% to 4.7%) more likely to have worsened depressive symptoms, all statistically significant changes. In 2020, residents in no-known COVID-19 SNFs had no significant change in ADLs (-0.06 [95% CI, -0.12 to 0.01]), but lost 1.8 lb (95% CI, -2.1 to -1.5 lb) more weight and were 3.2% more likely (95% CI, 2.3% to 4.1%) to have worsened depressive symptoms, both statistically significant changes. Conclusions and Relevance: Among skilled nursing facilities in the US during the first year of the COVID-19 pandemic and prior to the availability of COVID-19 vaccination, mortality and functional decline significantly increased at facilities with active COVID-19 cases compared with the prepandemic period, while a modest statistically significant decrease in mortality was observed at facilities that had never had a known COVID-19 case. Weight loss and depressive symptoms significantly increased in skilled nursing facilities in the first year of the pandemic, regardless of COVID-19 status.


Subject(s)
COVID-19 , Health Status , Skilled Nursing Facilities , Activities of Daily Living , Aged , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Testing , COVID-19 Vaccines , Environmental Exposure/statistics & numerical data , Health Policy , Humans , Medicare/statistics & numerical data , Pandemics/statistics & numerical data , Quality of Life , Retrospective Studies , Skilled Nursing Facilities/statistics & numerical data , United States/epidemiology
4.
Int J Environ Res Public Health ; 19(19)2022 Sep 22.
Article in English | MEDLINE | ID: covidwho-2043719

ABSTRACT

Restaurant online review websites have made changes to adapt to customers' shifting needs during the COVID-19 crisis. Based on information behavior theory and social penetration theory, the present study investigated the changes in customers' emotions and how the volume of online reviews as an indication of sales is impacted by the instructional (i.e., with quantitative variables) and emotional (i.e., with qualitative variables) information on review websites. By comparing the same month (January-April) during 2017-2020, positive sentiment experienced a plunge, while negative sentiment showed an upsurge in April 2020. The volume of reviews was impacted by five quantitative variables (i.e., confirmed COVID-19 case number, food delivery option, takeout option, delivery fee, and delivery time) and seven qualitative variables (i.e., anticipation, fear, trust, anger, disgust, joy, and sadness). This study provides new insight into understanding information content on review websites during the crisis (e.g., pandemic) from the perspective of health risk communication.


Subject(s)
COVID-19 , Social Media , Anger , COVID-19/epidemiology , Emotions , Humans , Pandemics , Restaurants
5.
Microb Genom ; 8(6)2022 06.
Article in English | MEDLINE | ID: covidwho-2042679

ABSTRACT

Emerging evidence has identified viral circular RNAs (circRNAs) in human cells infected by viruses, interfering with the immune system and inducing diseases including human cancer. However, the biogenesis and regulatory mechanisms of virus-encoded circRNAs in host cells remain unknown. In this study, we used the circRNA detection tool CIRI2 to systematically determine the virus-encoded circRNAs in virus-infected cancer cell lines and cancer patients, by analysing RNA-Seq datasets derived from RNase R-treated samples. Based on the thousands of viral circRNAs we identified, the biological characteristics and potential roles of viral circRNAs in regulating host cell function were determined. In addition, we developed a Viral-circRNA Database (http://www.hywanglab.cn/vcRNAdb/), which is open to all users to search, browse and download information on circRNAs encoded by viruses upon infection.


Subject(s)
RNA, Circular , Viruses , Cell Line , Humans , RNA/genetics , RNA/metabolism , RNA, Circular/genetics , Viruses/genetics
6.
J Biol Chem ; 298(8): 102250, 2022 08.
Article in English | MEDLINE | ID: covidwho-1991134

ABSTRACT

Rubella, a viral disease characterized by a red skin rash, is well controlled because of an effective vaccine, but outbreaks are still occurring in the absence of available antiviral treatments. The Rubella virus (RUBV) papain-like protease (RubPro) is crucial for RUBV replication, cleaving the nonstructural polyprotein p200 into two multifunctional proteins, p150 and p90. This protease could represent a potential drug target, but structural and mechanistic details important for the inhibition of this enzyme are unclear. Here, we report a novel crystal structure of RubPro at a resolution of 1.64 Å. The RubPro adopts a unique papain-like protease fold, with a similar catalytic core to that of proteases from Severe acute respiratory syndrome coronavirus 2 and foot-and-mouth disease virus while having a distinctive N-terminal fingers domain. RubPro has well-conserved sequence motifs that are also found in its newly discovered Rubivirus relatives. In addition, we show that the RubPro construct has protease activity in trans against a construct of RUBV protease-helicase and fluorogenic peptides. A protease-helicase construct, exogenously expressed in Escherichia coli, was also cleaved at the p150-p90 cleavage junction, demonstrating protease activity of the protease-helicase protein. We also demonstrate that RubPro possesses deubiquitylation activity, suggesting a potential role of RubPro in modulating the host's innate immune responses. We anticipate that these structural and functional insights of RubPro will advance our current understanding of its function and help facilitate more structure-based research into the RUBV replication machinery, in hopes of developing antiviral therapeutics against RUBV.


Subject(s)
Peptide Hydrolases , Rubella virus , Amino Acid Motifs , Papain/chemistry , Peptide Hydrolases/chemistry , Peptide Hydrolases/metabolism , Protein Folding , Protein Structure, Tertiary , Rubella virus/chemistry , Rubella virus/enzymology
7.
BMJ Open ; 12(7): e058770, 2022 07 04.
Article in English | MEDLINE | ID: covidwho-1916393

ABSTRACT

OBJECTIVE: To explore the impact of the COVID-19 on the distribution, type and patterns of diseases in hospitalised children under local antiepidemic measures. DESIGN: Retrospective chart review. SETTING: Electronic medical records of patients hospitalised in the paediatric department of a tertiary hospital in South China from 21 January 2019 to 20 January 2021. PARTICIPANTS: Records of 2139 patients. OUTCOME MEASURES: Data were analysed before and during the COVID-19 pandemic. Disease characteristics were analysed based on the 10th revision of the International Statistical Classification of Diseases and Related Health Problems. Features of the length of hospital stay were investigated. Categorical variables involving more than three groups were analysed using an overall χ2 test, followed by pairwise comparisons. RESULTS: During the COVID-19 outbreak period, paediatric hospitalisation was reduced by 29.6%, from 1255 to 884. The proportions of infection-related diseases (36.3% (455 cases) vs 20.8% (184 cases)), respiratory system-related diseases (22.5% (283 cases) vs 9.4% (83 cases)); and endocrine, nutritional and metabolic diseases (17.1% (214 cases) vs 9.2% (81 cases)) decreased significantly, whereas that of musculoskeletal and connective tissue diseases increased from 11.0% (138 cases) to 20.1% (178 cases), thereby becoming the most common reason for hospitalisation. The proportions of diseases of the nervous system (12.4% (156 cases) to 18.8% (166 cases)) and mental and behavioural disorders (0.2% (3 cases) to 2.1% (19 cases)) increased significantly. The average length of hospital stay increased after the outbreak (7.57±6.53 vs 8.36±6.87). CONCLUSION: The number of hospitalisation cases decreased during the COVID-19 period. The prominent decreases in hospitalisation associated with infections and respiratory system diseases were likely attributed to the improved epidemic prevention work, enhancement of people's health awareness and fear of possible exposure to COVID-19. Describing the impact of COVID-19 on disease patterns may provide a reference for resource planning during the pandemic.


Subject(s)
COVID-19 , Communicable Diseases , Respiration Disorders , COVID-19/epidemiology , Child , Hospitalization , Humans , Pandemics , Retrospective Studies , Tertiary Care Centers
8.
EBioMedicine ; 81: 104112, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1906948

ABSTRACT

BACKGROUND: Recent omic studies prioritised several drug targets associated with coronavirus disease 2019 (COVID-19) severity. However, little evidence was provided to systematically estimate the effect of drug targets on COVID-19 severity in multiple ancestries. METHODS: In this study, we applied Mendelian randomization (MR) and colocalization approaches to understand the putative causal effects of 16,059 transcripts and 1608 proteins on COVID-19 severity in European and effects of 610 proteins on COVID-19 severity in African ancestry. We further integrated genetics, clinical and literature evidence to prioritise drug targets. Additional sensitivity analyses including multi-trait colocalization and phenome-wide MR were conducted to test for MR assumptions. FINDINGS: MR and colocalization prioritized four protein targets, FCRL3, ICAM5, ENTPD5 and OAS1 that showed effect on COVID-19 severity in European ancestry. One protein target, SERPINA1 showed a stronger effect in African ancestry but much weaker effect in European ancestry (odds ratio [OR] in Africans=0.369, 95%CI=0.203 to 0.668, P = 9.96 × 10-4; OR in Europeans=1.021, 95%CI=0.901 to 1.157, P = 0.745), which suggested that increased level of SERPINA1 will reduce COVID-19 risk in African ancestry. One protein, ICAM1 showed suggestive effect on COVID-19 severity in both ancestries (OR in Europeans=1.152, 95%CI=1.063 to 1.249, P = 5.94 × 10-4; OR in Africans=1.481, 95%CI=1.008 to 2.176; P = 0.045). The OAS1, SERPINA1 and ICAM1 effects were replicated using updated COVID-19 severity data in the two ancestries respectively, where alternative splicing events in OAS1 and ICAM1 also showed marginal effects on COVID-19 severity in Europeans. The phenome-wide MR of the prioritised targets on 622 complex traits provided information on potential beneficial effects on other diseases and suggested little evidence of adverse effects on major complications. INTERPRETATION: Our study identified six proteins as showing putative causal effects on COVID-19 severity. OAS1 and SERPINA1 were targets of existing drugs in trials as potential COVID-19 treatments. ICAM1, ICAM5 and FCRL3 are related to the immune system. Across the six targets, OAS1 has no reliable instrument in African ancestry; SERPINA1, FCRL3, ICAM5 and ENTPD5 showed a different level of putative causal evidence in European and African ancestries, which highlights the importance of more powerful ancestry-specific GWAS and value of multi-ancestry MR in informing the effects of drug targets on COVID-19 across different populations. This study provides a first step towards clinical investigation of beneficial and adverse effects of COVID-19 drug targets. FUNDING: No.


Subject(s)
COVID-19 , Mendelian Randomization Analysis , COVID-19/drug therapy , COVID-19/genetics , Genome-Wide Association Study , Humans , Odds Ratio , Phenotype , Polymorphism, Single Nucleotide
9.
ANZ J Surg ; 92(7-8): 1614-1625, 2022 07.
Article in English | MEDLINE | ID: covidwho-1874380

ABSTRACT

BACKGROUND: Tracheostomy is a commonly performed procedure in patients with coronavirus disease 2019 (COVID-19) receiving mechanical ventilation (MV). This review aims to investigate the occurrence of SARS-CoV-2 transmission from patients to healthcare workers (HCWs) when tracheostomies are performed. METHODS: This systematic review used the preferred reporting items for systematic reviews and meta-analysis framework. Studies reporting SARS-CoV-2 infection in HCWs involved in tracheostomy procedures were included. RESULTS: Sixty-nine studies (between 01/11/2019 and 16/01/2022) reporting 3117 tracheostomy events were included, 45.9% (1430/3117) were performed surgically. The mean time from MV initiation to tracheostomy was 16.7 ± 7.9 days. Location of tracheostomy, personal protective equipment used, and anaesthesia technique varied between studies. The mean procedure duration was 14.1 ± 7.5 minutes; was statistically longer for percutaneous tracheostomies compared with surgical tracheostomies (mean duration 17.5 ± 7.0 versus 15.5 ± 5.6 minutes, p = 0.02). Across 5 out of 69 studies that reported 311 tracheostomies, 34 HCWs tested positive for SARS-CoV-2 and 23/34 (67.6%) were associated with percutaneous tracheostomies. CONCLUSIONS: In this systematic review we found that SARS-CoV-2 transmission to HCWs performing or assisting with a tracheostomy procedure appeared to be low, with all reported transmissions occurring in 2020, prior to vaccinations and more recent strains of SARS-CoV-2. Transmissions may be higher with percutaneous tracheostomies. However, an accurate estimation of infection risk was not possible in the absence of the actual number of HCWs exposed to the risk during the procedure and the inability to control for multiple confounders related to variable timing, technique, and infection control practices.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/epidemiology , Health Personnel , Humans , Personal Protective Equipment , Tracheostomy/adverse effects
10.
Global Health ; 18(1): 51, 2022 05 15.
Article in English | MEDLINE | ID: covidwho-1846851

ABSTRACT

BACKGROUND: Practical links between health systems and health security are historically prevalent, but the conceptual links between these fields remain under explored, with little on health system strengthening. The need to address this gap gains relevance in light of the COVID-19 pandemic as it demonstrated a crucial relationship between health system capacities and effective health security response. Acknowledging the importance of developing stronger and more resilient health systems globally for health emergency preparedness, the WHO developed a Health Systems for Health Security framework that aims to promote a common understanding of what health systems for health security entails whilst identifying key capacities required. METHODS/ RESULTS: To further explore and analyse the conceptual and practical links between health systems and health security within the peer reviewed literature, a rapid scoping review was carried out to provide an overview of the type, extent and quantity of research available. Studies were included if they had been peer-reviewed and were published in English (seven databases 2000 to 2020). 343 articles were identified, of those 204 discussed health systems and health security (high and medium relevance), 101 discussed just health systems and 47 discussed only health security (low relevance). Within the high and medium relevance articles, several concepts emerged, including the prioritization of health security over health systems, the tendency to treat health security as exceptionalism focusing on acute health emergencies, and a conceptualisation of security as 'state security' not 'human security' or population health. CONCLUSION: Examples of literature exploring links between health systems and health security are provided. We also present recommendations for further research, offering several investments and/or programmes that could reliably lead to maximal gains from both a health system and a health security perspective, and why these should be explored further. This paper could help researchers and funders when deciding upon the scope, nature and design of future research in this area. Additionally, the paper legitimises the necessity of the Health Systems for Health Security framework, with the findings of this paper providing useful insights and evidentiary examples for effective implementation of the framework.


Subject(s)
COVID-19 , COVID-19/epidemiology , Government Programs , Humans , Medical Assistance , Pandemics/prevention & control
11.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-325148

ABSTRACT

Background: Lymphopenia is associated with COVID-19 severity. Herein we describe the dynamic changes in lymphocyte count during hospitalization and explore a possible association with the severity of COVID-19.Methods In this retrospective study, 13 non-severe COVID-19 patients diagnosed at admission were enrolled. One patient progressed to severe disease. Dynamic changes in lymphocyte count and CT score of all patients were analyzed.Results Lymphocyte count changed significantly in the non-severe patients over time (admission vs day 5, P=0.685;day 5 vs day 15, P<0.001). Lymphocyte count of the severe patient fluctuated, and even decreased within the first 12 days post-admission, before increasing gradually. Chest CT scores of nine (75%) non-severe patients on the 5th day of hospitalization were higher than at admission, but decreased gradually thereafter (admission vs day 5, P<0.001, day 5 vs day 15, P=0.004). In the severe patient, CT score continued to increase for 2 weeks after admission, before decreasing gradually.Conclusions Non-severe COVID-19 patients had significantly increased lymphocyte count and decreased CT score 1 week after illness onset. Dynamic change in lymphocyte count in the early stages of COVID-19 may be helpful to identify the patients who are more likely to develop severe or critical illness.

12.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-324151

ABSTRACT

Contact tracing APPs have been recently advocated by many countries (e.g., the United Kingdom, Australia, etc.) as part of control measures on COVID-19. Controversies have been raised about their effectiveness in practice as it still remains unclear how they can be fully utilized to fuel the fight against COVID-19. In this article, we show that an abundance of information can be extracted from contact tracing for COVID-19 prevention and control, providing the first data-driven evidence that supports the wide implementation of such APPs. Specifically, we construct a temporal contact graph that quantifies the daily contacts between infectious and susceptible individuals by exploiting a large volume of location related data contributed by 10,527,737 smartphone users in Wuhan, China. Five time-varying indicators we introduce can accurately capture actual contact trends at individual and population levels, demonstrating that travel restriction in Wuhan played an important role in containing COVID-19. We reveal a strong correlation (Pearson coefficient 0.929) between daily confirmed cases and daily total contacts, which can be utilized as a new and efficient way to evaluate and predict the evolving epidemic situation of COVID-19. Further, we find that there is a prominent distinction of contact behaviors between the infected and uninfected contacted individuals, and design an infection risk evaluation framework to identify infected ones. This can help narrow down the search of high risk contacted individuals for quarantine. Our results indicate that user involvement has an explicit impact on individual-level contact trend estimation while minor impact on situation evaluation, offering guidelines for governments to implement contact tracing APPs.

13.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-321367

ABSTRACT

Objectives: A pneumonia associated with 2019 novel coronavirus (2019-nCoV, subsequently named SARS-CoV2) emerged worldwide since December, 2019. We aimed to describe the epidemiological characteristics of 2019 coronavirus disease (COVID-19) in Shaanxi province of China. Results: : 1. Among the 245 patients, 132 (53.9%) were males and 113 (46.1%) were females. The average age was 46.15±16.43 years, ranging from 3 to 89 years. 2. For the clinical type, 1.63% (4/245) patients were mild type , 84.90% (208/245) were moderate type, 7.76% (19/245) were severe type, 5.31% (13/245) were critical type and only 0.41% (1/245) was asymptomatic. 3. Of the 245 patients, 116 (47.35%) were input case, 114 (46.53%) were non-input case , and 15 (6.12%) were unknown exposure. 4. 48.57% (119/245) cases were family cluster , involving 42 families. The most common pattern of COVID-19 family cluster was between husband and wife or between parents and children.

14.
JAMA health forum ; 2(12), 2021.
Article in English | EuropePMC | ID: covidwho-1679215

ABSTRACT

Key Points Question To what extent did the COVID-19 pandemic reduce access to surgical care, and were racial and ethnic minority groups more likely to have reduced access to surgical care? Findings In this cohort study of more than 13 million inpatient and outpatient surgical encounters in 767 US hospitals in a hospital administrative database, surgical use was 13% lower in 2020 compared with 2019, with the greatest decrease concentrated in elective surgical procedures. While Black and Hispanic patients experienced a reduction in surgical encounters, White patients experienced the greatest reduction in surgical encounters. Meaning Despite severe and persistent disruptions to health systems during the COVID-19 pandemic, racial and ethnic minority groups did not experience a disproportionate decrease in access to surgical care. Importance The extent of the disruption to surgical care during the COVID-19 pandemic has not been empirically characterized on a national level. Objective To characterize the use of surgical care across cohorts of surgical urgency during the COVID-19 pandemic, and to assess for racial and ethnic disparities. Design, Setting, and Participants This was a retrospective observational study using the geographically diverse, all payer data from 767 hospitals in the Premier Healthcare Database. Procedures were categorized into 4 cohorts of surgical urgency (elective, nonelective, emergency, and trauma). A generalized linear regression model with hospital-fixed effects assessed the relative monthly within-hospital reduction in surgical encounters in 2020 compared with 2019. Main Outcomes and Measures Outcomes were the monthly relative reduction in overall surgical encounters and across surgical urgency cohorts and race and ethnicity. Results The sample included 13 175 087 inpatient and outpatient surgical encounters. There was a 12.6% relative reduction in surgical use in 2020 compared to 2019. Across all surgical cohorts, the most prominent decreases in encounters occurred during Spring 2020 . For example, elective encounters began falling in March, reached a trough in April, and subsequently recovered but never to prepandemic levels (March: −26.8%;95% CI, −29.6% to −23.9%;April: −74.6%;95% CI, −75.5% to −73.5%;December: −13.3%;95% CI, −16.6%, −9.8%). Across all operative surgical urgency cohorts, White patients had the largest relative reduction in encounters. Conclusions and Relevance As shown by this cohort study, the COVID-19 pandemic resulted in large disruptions to surgical care across all categories of operative urgency, especially elective procedures. Racial and ethnic minority groups experienced less of a disruption to surgical care than White patients. Further research is needed to explore whether the decreased surgical use among White patients was owing to patient discretion and to document whether demand for surgical care will rebound to baseline levels. This cohort study examines the use of surgical care across cohorts of surgical urgency during the COVID-19 pandemic and assesses whether there are racial or ethnic disparities in care.

15.
Science ; 375(6584): 1048-1053, 2022 03 04.
Article in English | MEDLINE | ID: covidwho-1673339

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant has become the dominant infective strain. We report the structures of the Omicron spike trimer on its own and in complex with angiotensin-converting enzyme 2 (ACE2) or an anti-Omicron antibody. Most Omicron mutations are located on the surface of the spike protein and change binding epitopes to many current antibodies. In the ACE2-binding site, compensating mutations strengthen receptor binding domain (RBD) binding to ACE2. Both the RBD and the apo form of the Omicron spike trimer are thermodynamically unstable. An unusual RBD-RBD interaction in the ACE2-spike complex supports the open conformation and further reinforces ACE2 binding to the spike trimer. A broad-spectrum therapeutic antibody, JMB2002, which has completed a phase 1 clinical trial, maintains neutralizing activity against Omicron. JMB2002 binds to RBD differently from other characterized antibodies and inhibits ACE2 binding.


Subject(s)
Angiotensin-Converting Enzyme 2/chemistry , Antibodies, Neutralizing/chemistry , Antibodies, Viral/chemistry , SARS-CoV-2/chemistry , SARS-CoV-2/immunology , Spike Glycoprotein, Coronavirus/chemistry , Angiotensin-Converting Enzyme 2/metabolism , Antibodies, Neutralizing/immunology , Antibodies, Neutralizing/metabolism , Antibodies, Neutralizing/therapeutic use , Antibodies, Viral/immunology , Antibodies, Viral/metabolism , Binding Sites , Cryoelectron Microscopy , Epitopes , Humans , Immunoglobulin Fab Fragments/chemistry , Immunoglobulin Fab Fragments/immunology , Immunoglobulin Fab Fragments/metabolism , Models, Molecular , Mutation , Protein Binding , Protein Conformation , Protein Domains , Protein Interaction Domains and Motifs , Protein Multimerization , Protein Subunits/chemistry , SARS-CoV-2/genetics , SARS-CoV-2/metabolism , Spike Glycoprotein, Coronavirus/genetics , Spike Glycoprotein, Coronavirus/immunology , Spike Glycoprotein, Coronavirus/metabolism , Thermodynamics
16.
Intern Med J ; 52(5): 724-739, 2022 05.
Article in English | MEDLINE | ID: covidwho-1642672

ABSTRACT

BACKGROUND: Observational data during the pandemic have demonstrated mixed associations between frailty and mortality. AIM: To examine associations between frailty and short-term mortality in patients hospitalised with coronavirus disease 2019 (COVID-19). METHODS: In this systematic review and meta-analysis, we searched PubMed, Embase and the COVID-19 living systematic review from 1 December 2019 to 15 July 2021. Studies reporting mortality and frailty scores in hospitalised patients with COVID-19 (age ≥18 years) were included. Data on patient demographics, short-term mortality (in hospital or within 30 days), intensive care unit (ICU) admission and need for invasive mechanical ventilation (IMV) were extracted. The quality of studies was assessed using the Newcastle-Ottawa Scale. RESULTS: Twenty-five studies reporting 34 628 patients were included. Overall, 26.2% (n = 9061) died. Patients who died were older (76.7 ± 9.6 vs 69.2 ± 13.4), more likely male (risk ratio (RR) = 1.08; 95% confidence interval (CI): 1.06-1.11) and had more comorbidities. Fifty-eight percent of patients were frail. Adjusting for age, there was no difference in short-term mortality between frail and non-frail patients (RR = 1.04; 95% CI: 0.84-1.28). The non-frail patients were commonly admitted to ICU (27.2% (4256/15639) vs 29.1% (3567/12274); P = 0.011) and had a higher mortality risk (RR = 1.63; 95% CI: 1.30-2.03) than frail patients. Among patients receiving IMV, there was no difference in mortality between frail and non-frail (RR = 1.62; 95% CI 0.93-2.77). CONCLUSION: This systematic review did not demonstrate an independent association between frailty status and short-term mortality in patients with COVID-19. Patients with frailty were less commonly admitted to ICU and non-frail patients were more likely to receive IMV and had higher mortality risk. This finding may be related to allocation decisions for patients with frailty amidst the pandemic.


Subject(s)
COVID-19 , Frailty , Adolescent , Aged , Frail Elderly , Frailty/diagnosis , Frailty/epidemiology , Hospital Mortality , Humans , Intensive Care Units , Length of Stay , Male , Pandemics
17.
JAMA Health Forum ; 2(12): e214214, 2021 12.
Article in English | MEDLINE | ID: covidwho-1598802

ABSTRACT

Importance: The extent of the disruption to surgical care during the COVID-19 pandemic has not been empirically characterized on a national level. Objective: To characterize the use of surgical care across cohorts of surgical urgency during the COVID-19 pandemic, and to assess for racial and ethnic disparities. Design Setting and Participants: This was a retrospective observational study using the geographically diverse, all payer data from 767 hospitals in the Premier Healthcare Database. Procedures were categorized into 4 cohorts of surgical urgency (elective, nonelective, emergency, and trauma). A generalized linear regression model with hospital-fixed effects assessed the relative monthly within-hospital reduction in surgical encounters in 2020 compared with 2019. Main Outcomes and Measures: Outcomes were the monthly relative reduction in overall surgical encounters and across surgical urgency cohorts and race and ethnicity. Results: The sample included 13 175 087 inpatient and outpatient surgical encounters. There was a 12.6% relative reduction in surgical use in 2020 compared to 2019. Across all surgical cohorts, the most prominent decreases in encounters occurred during Spring 2020 . For example, elective encounters began falling in March, reached a trough in April, and subsequently recovered but never to prepandemic levels (March: -26.8%; 95% CI, -29.6% to -23.9%; April: -74.6%; 95% CI, -75.5% to -73.5%; December: -13.3%; 95% CI, -16.6%, -9.8%). Across all operative surgical urgency cohorts, White patients had the largest relative reduction in encounters. Conclusions and Relevance: As shown by this cohort study, the COVID-19 pandemic resulted in large disruptions to surgical care across all categories of operative urgency, especially elective procedures. Racial and ethnic minority groups experienced less of a disruption to surgical care than White patients. Further research is needed to explore whether the decreased surgical use among White patients was owing to patient discretion and to document whether demand for surgical care will rebound to baseline levels.


Subject(s)
COVID-19 , COVID-19/epidemiology , Cohort Studies , Ethnicity , Humans , Minority Groups , Pandemics , SARS-CoV-2
18.
World J Gastrointest Surg ; 13(11): 1293-1314, 2021 Nov 27.
Article in English | MEDLINE | ID: covidwho-1598642

ABSTRACT

Being one of the most common causes of the acute abdomen, acute appendicitis (AA) forms the bread and butter of any general surgeon's practice. With the recent advancements in AA's management, much controversy in diagnostic algorithms, possible differential diagnoses, and weighing the management options has been generated, with no absolute consensus in the literature. Since Alvarado described his eponymous clinical scoring system in 1986 to stratify AA risk, there has been a burgeoning of additional scores for guiding downstream management and mortality assessment. Furthermore, advancing literature on the role of antibiotics, variations in appendicectomy, and its adjuncts have expanded the surgeon's repertoire of management options. Owing to the varied presentation, diagnostic tools, and management of AA have also been proposed in special groups such as pregnant patients, the elderly, and the immunocompromised. This article seeks to raise the critical debates about what is currently known about the above aspects of AA and explore the latest controversies in the field. Considering the ever-evolving coronavirus disease 2019 situation worldwide, we also discuss the pandemic's repercussions on patients and how surgeons' practices have evolved in the context of AA.

19.
Med Hypotheses ; 159: 110752, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1586986

ABSTRACT

During the coronavirus disease 2019 (COVID-19) pandemic, it were reported that COVID-19 patients could have cutaneous symptoms, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was observed on the skin of COVID-19 patients, which indicated that the skin is one target of SARS-CoV-2. Meanwhile, reports about SARS-CoV-2 transmission through food cold-chain overpacks emerged. With the fact that SARS-CoV-2 could survive on the skin for more than 9 h, the skin could be implicated in SARS CoV-2 transmission. Angiotensin-converting enzyme 2 (ACE2), a critical membrane protein for SARS-CoV-2 that enters a host cell, was recognized to be associated with the risk of SARS-CoV-2 infection. Therefore, tissues that express ACE2 might have the potential to be infected by and transmit SARS-CoV-2. The skin is one such tissue that expresses ACE2. However, unlike the lung that expresses ACE2 on the upper-most epithelial layer, the skin is composed of different layers of cells that function as a barrier, and cells under the top epidermal layer express ACE2. Since the skin barrier is the first line of protection, the typical position of ACE2-expressing cells in the skin implies that the skin barrier function could be the mediator of SARS-CoV-2. In our study, we found that ACE2 could be expressed in the skin, and its expression level is increased in psoriasis, an inflammatory disease of the skin with barrier dysfunction. Additionally, by applying the SARS-CoV-2 pseudovirus on mouse models with or without deteriorated skin barrier, we found that the SARS-CoV-2 pseudovirus could infect the skin and lungs of mouse models, and when the skin barrier was impaired, more SARS-CoV-2-infected cells could be found. Thus, we hypothesized that a deteriorated condition of the skin barrier might increase the risk of SARS-CoV-2 infection through the skin.


Subject(s)
COVID-19 , SARS-CoV-2 , Animals , Humans , Lung , Mice , Pandemics , Peptidyl-Dipeptidase A
20.
Intern Med J ; 51(11): 1773-1780, 2021 11.
Article in English | MEDLINE | ID: covidwho-1526371

ABSTRACT

The objective of the present study is to investigate the incidence, characteristics and outcomes of patients who were readmitted to hospital emergency departments or required re-hospitalisation following an index hospitalisation with a diagnosis of COVID-19. A systematic review of PubMed, EMBASE and pre-print websites was conducted between 1 January and 31 December 2020. Studies reporting on the incidence, characteristics and outcomes of patients with COVID-19 who represent or require hospital admission were included. Two authors independently performed study selection and data extraction. Study quality was assessed with the Newcastle-Ottawa Scale. Discrepancies were resolved by consensus or through an independent third reviewer. Data were synthesised according to the Preferred Reporting Items for Systematic Reviews guidelines. Six studies reporting on 547 readmitted patients were included. The overall incidence was 4.4%, most common in males (57.2%), and due to respiratory distress or prolonged COVID-19. Readmitted patients had a shorter initial hospital length of stay (LOS) compared with those with a single hospitalisation (8.1 ± 10.6 vs 13.9 ± 10.2 days). The mean time to readmission was 7.6 ± 6.0 days; the mean LOS on re-hospitalisation was 6.3 ± 5.6 days. Hypertension (odds ratio (OR) = 2.08; 95% confidence interval (CI) 1.69-2.55; P < 0.001; I2 = 0%), diabetes mellitus (OR = 1.77; 95% CI 1.38-2.27; P < 0.001; I2 = 0%) and chronic renal failure (OR = 2.37; 95% CI 1.09-5.14; P < 0.001; I2 = 0%) were more common in these patients. Intensive care admission rates were similar between the two groups; 12.8% (22/172) of readmitted patients died. In summary, readmitted patients following an index hospitalisation for COVID-19 were more commonly males with multiple comorbidities. Shorter initial hospital LOS and unresolved primary illness may have contributed to readmission.


Subject(s)
COVID-19 , Humans , Length of Stay , Male , Patient Readmission , Risk Factors , SARS-CoV-2 , Survivors
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