Cost-effective boosting allocations in the post-Omicron era of COVID-19 management (preprint)

BackgroundFollowing widespread exposure to Omicron variants, COVID-19 has transitioned to endemic circulation. Populations now have diverse infection and vaccination histories, resulting in heterogeneous immune landscapes. Careful consideration of vaccination is required through the post-Omicron phase of COVID-19 management to minimise disease burden. We assess the impact and cost-effectiveness of targeted COVID-19 vaccination strategies to support global vaccination recommendations. MethodsWe integrated immunological, transmission, clinical and cost-effectiveness models, and simulated populations with different characteristics and immune landscapes. We calculated the expected number of infections, hospitalisations and deaths for different vaccine scenarios. Costs (from a healthcare perspective) were estimated for exemplar country income level groupings in the Western Pacific Region. Results are reported as incremental costs and disability-adjusted life years averted compared to no additional vaccination. Parameter and stochastic uncertainty were captured through scenario and sensitivity analysis. FindingsAcross different population demographics and income levels, we consistently found that annual elder-targeted boosting strategies are most likely to be cost-effective or cost-saving, while paediatric programs are unlikely to be cost-effective. Results remained consistent while accounting for uncertainties in the epidemiological and economic models. Half-yearly boosting may only be cost-effective in higher income settings with older population demographics and higher cost-effectiveness thresholds. InterpretationThe seresults demonstrate the value of continued booster vaccinations to protect against severe COVID-19 disease outcomes across high and middle-income settings and show that the biggest health gains relative to vaccine costs are achieved by targeting older age-groups. FundingFunded by the World Health Organization. O_TEXTBOXResearch in context Evidence before this studyWith COVID-19 now globally endemic, populations exhibit varying levels of natural and vaccine-acquired immunity to SARS-CoV-2. With widespread, if variable, immunity resulting in reduced severity of COVID-19 disease, re-evaluation of the ongoing value of vaccination is required. COVID-19 vaccination strategies must consider the cost-effectiveness of gains from vaccination given prior immunity, and in the context of income and health system capacity to manage COVID-19 alongside other pressing concerns. Few articles examine cost-effectiveness of COVID-19 vaccination strategies in populations with diverse characteristics and waning hybrid immunity, though there is a large body of literature that considers some combination of these elements or focus on one particular country. Consensus is that allocating vaccine doses to older age groups and those at higher risk of severe disease is most beneficial, albeit assuming either only past natural immunity or no waning immunity. These studies have either not included a cost-effectiveness analysis or, where present, have typically assumed a base case zero-vaccination scenario. Added value of this studyWe consider the contemporary situation where populations have varying degrees of hybrid immunity resulting from both prior infection and vaccination, and where the relevant cost-effectiveness analysis considers only future primary and booster doses in the population. We describe multiple demographics, using exemplar older and younger populations, in conjunction with low to high past vaccination coverage, low to high past natural infection incidence, and low to high income levels. Under these settings, we determine the cost-effectiveness of a range of targeted boosting strategies (who, when, what). Implications of all the available evidenceOur study highlights how future COVID-19 booster doses targeted towards older age groups at risk of severe outcomes can be cost-effective or cost-saving in high-income settings with populations that have a higher proportion of individuals at risk. In younger, lower-resourced settings, annual boosting of older age groups may still be cost-effective or cost-saving in some scenarios. We consistently find that pediatric vaccination is not cost-effective. Given the benefits of vaccination, especially to reduce severe disease, we show the importance of ongoing global efforts to provide and equitably distribute vaccines and strengthen adult immunisation programs. C_TEXTBOX

Modified Hospital Elder Life Program at Intensive Care Unit

Stress and coping among elderly during the COVID-19 pandemic in Sulaimanya city in Kurdistan region of Iraq

This study aimed to find out the level of stress and coping methods among elderly in Sulaimanya city during the pandemic COVID-19. Through the snowballing sampling method, 394 elders were included to this study. After validation, two scales were used in this study;stress subscale from Depression, Anxiety and Stress Scale (DASS-21) and a culture-bound scale for determining coping methods. The results of this study showed that participants experienced a mild level of stress. Male participants, elders who live with their family, unvaccinated elders, physically passive elders have had higher stress level than female, elderly home, vaccinated, physical active elders. The findings also indicated that spiritual connection was the most common coping method used by the sample. Results of this study are the first and foremost way to share elder's unexpressed messages;it also can be a way for verbalizing their unspoken feelings. These results may also inform the elder's caregivers that elder's stress level and illness anxiety was not very high, strengthening their social support and spiritual connection may help them to reduce their distress into a lesser degree.

Association Between Fear of COVID-19 and Death Anxiety with Moderator Role of Self-Regulation Among Older Adults Residing in Qazvin.

Background and Objectives: Fear of COVID-19 is common among older adults and negatively impacts on their physical and mental health. Self-regulation is an essential factor for controlling or managing excitement and anxiety. So, this study aimed to determine the relationship between fear of COVID-19 and death anxiety with the moderator role of self-regulation among the elderly residing in Qazvin. Method(s): This descriptive and cross-sectional study was performed on 430 elderly aged 60 and over living in Qazvin in 2021. Samples were selected by cluster sampling method. The demographic checklist, Templer death anxiety scale, fear of COVID-19 questionnaire, and Self-Regulation Inventory were used for collecting the data. The data were analyzed using the Path Analyze test. Result(s): The mean age of the elder participants in the study was 66.88 +/- 6.40 years old. The results showed a significant and positive relationship between fear of COVID-19 and death anxiety (beta=0.60, P<0.001) and an inverse association between fear of COVID-19 (beta=-0.24, P=0.021) and death anxiety (beta=-0.10, P=0.021) with self-regulation. Furthermore, the results of the Path analysis confirmed the moderator role of self-regulation in the association between fear of Covid-19 and death anxiety among the elderly residing in Qazvin, Iran. Conclusion(s): Given the mediator role of self-regulation in the relationship between fear of COVID-19 and death anxiety, it is suggested to use teaching strategies to the older adults to improve self-regulation to control and mitigate the negative impacts of the fear of COVID-19 in this vulnerable population.Copyright © 2022 The Authors.

Clinicians' Perceptions of a Modified Hospital Elder Life Program for Delirium Prevention During COVID-19.

The Hospital Elder Life Program (HELP) is a multicomponent delirium prevention program targeting delirium risk factors of cognitive impairment, vision and hearing impairment, malnutrition and dehydration, immobility, sleep deprivation, and medications. We created a modified and extended version of the program, HELP-ME, deployable under COVID-19 conditions, for example, patient isolation and restricted staff and volunteer roles. We explored perceptions of interdisciplinary clinicians who implemented HELP-ME to inform its development and testing. Qualitative descriptive study of HELP-ME among older adults on medical and surgical services during the COVID-19 pandemic. HELP-ME staff at 4 pilot sites across the United States who implemented HELP-ME.We held five 1-hour video focus groups (5-16 participants/group) to review specific intervention protocols and the overall program. We asked participants open-endedly about positive and challenging aspects of protocol implementation. Groups were recorded and transcribed. We used directed content analysis to analyze data. Participants identified general, technology-related, and protocol-specific positive and challenging aspects of the program. Overarching themes included the need for enhanced customization and standardization of protocols, need for increased volunteer staffing, digital access to family members, patient technological literacy and comfort, variation in the feasibility of remote delivery among intervention protocols, and preference for a hybrid program model. Participants offered related recommendations. Participants felt that HELP-ME was successfully implemented, with some modifications needed to address limitations of remote implementation. A hybrid model combining remote and in-person aspects was recommended as the preferred option.

Mitigating the Risk of Digital Financial Exploitation.

The article by Zhang and colleagues in this issue of The Journal calls attention to an important but underrecognized problem facing today's seniors and their loved ones. The risk of digital financial exploitation, particularly in the wake of the COVID-19 pandemic, has risen considerably in recent years and continues to rise today. Zhang et al. provide a helpful analysis of assessment tools currently available to forensic psychiatrists for the evaluation of financial capacity. Although many of these tools were not originally intended to encompass technologically based transactions, the risks of fraud and scams associated with payment apps, social media, and electronic fund transfers are considerable and growing. Fraudsters frequently target vulnerable older adults, and victims have lost large sums through some of the more prevalent schemes. Several strategies can help to mitigate the risk of severe losses and to increase the likelihood that lost assets can be recovered. Proactive education through increased awareness will prove helpful, but given the growing sophistication of modern digital cons, such as romance scams, increased technological safeguards are warranted in the setting of reduced financial capacity. When losses do occur, there are some resources for recovery and for filing complaints against perpetrators.

Sambucus ebulus (Elderberry) Fruits Modulate Inflammation and Complement System Activity in Humans.

Sambucus ebulus (SE) fruits are used for immune stimulation and amelioration of gastrointestinal inflammatory conditions. Currently, there is no scientific evidence of their effects on various aspects of the immune response mechanisms in humans. The purpose of this study was to evaluate the immunomodulatory potential of SE fruit infusion intake in healthy humans. Anthocyanin content was determined with UPLC-ESI-MS/MS. Fifty-three volunteers enrolled in a 4-week SE infusion intake intervention. Blood count, serum total protein, Interleukin 1 beta (IL-1ß), Interleukin 6 (IL-6), Tumor Necrosis Factor Alpha (TNFα), High-sensitivity C-reactive protein (hs-CRP), C3, and C4 levels were measured on automatic analyzers, and Interleukin 8 (IL-8) was measured manually with an ELISA kit. Cyanidin-3-O-galactoside (48.15 mg/g DW), followed by cyaniding-3-sambubioside (43.41 ± 1.07 mg/g DW), were the most abundant anthocyanins in SE samples. A significant decrease in total protein (2.82%), IL-6 (20.15%), TNFα (5.38%), IL-8 (5.50%), C3 (4.16%), and C4 (14.29%) was established in the whole group. Total protein, IL-8, TNFα, and C4 decreased in women (3.11%, 4.76%, 5.09%, and 11.11%), and IL-6 decreased (40.61%) in men. Hb (1.20%) and hematocrit (1.55%) levels decreased in the whole group and in the women group (1.61% and 2.20%). SE fruits exert immune-modulatory activity as revealed by decreased pro-inflammatory status and complement activity markers in healthy volunteers after a 4-week intervention.

Quality of life and intrinsic capacity in patients with post-acute COVID-19 syndrome is in relation to frailty and resilience phenotypes.

The objective of this study was to characterize frailty and resilience in people evaluated for Post-Acute COVID-19 Syndrome (PACS), in relation to quality of life (QoL) and Intrinsic Capacity (IC). This cross-sectional, observational, study included consecutive people previously hospitalized for severe COVID-19 pneumonia attending Modena (Italy) PACS Clinic from July 2020 to April 2021. Four frailty-resilience phenotypes were built: "fit/resilient", "fit/non-resilient", "frail/resilient" and "frail/non-resilient". Frailty and resilience were defined according to frailty phenotype and Connor Davidson resilience scale (CD-RISC-25) respectively. Study outcomes were: QoL assessed by means of Symptoms Short form health survey (SF-36) and health-related quality of life (EQ-5D-5L) and IC by means of a dedicated questionnaire. Their predictors including frailty-resilience phenotypes were explored in logistic regressions. 232 patients were evaluated, median age was 58.0 years. PACS was diagnosed in 173 (74.6%) patients. Scarce resilience was documented in 114 (49.1%) and frailty in 72 (31.0%) individuals. Predictors for SF-36 score < 61.60 were the phenotypes "frail/non-resilient" (OR = 4.69, CI 2.08-10.55), "fit/non-resilient" (OR = 2.79, CI 1.00-7.73). Predictors for EQ-5D-5L < 89.7% were the phenotypes "frail/non-resilient" (OR = 5.93, CI 2.64-13.33) and "frail/resilient" (OR = 5.66, CI 1.93-16.54). Predictors of impaired IC (below the mean score value) were "frail/non-resilient" (OR = 7.39, CI 3.20-17.07), and "fit/non-resilient" (OR = 4.34, CI 2.16-8.71) phenotypes. Resilience and frailty phenotypes may have a different impact on wellness and QoL and may be evaluated in people with PACS to identify vulnerable individuals that require suitable interventions.

Evaluation and Treatment of Severe SARS-CoV-2 Pneumonia: A Scoping Review (preprint)

Purpose: Severe SARS-CoV-2 pneumonia remains incompletely understood. We aimed to summarize current evidence regarding clinical features, laboratory findings, and treatment of severe SARS-CoV-2 pneumonia. Methods: Online databases were searched from December 1, 2019, to April 15, 2020. Studies performed in adults, with the definition of severe SARS-CoV-2 pneumonia, enough case number (>10), and data on clinical features or laboratory findings were included. Data were extracted independently by two reviewers. Results: Eighteen articles of 2,435 severe cases were eligible for analysis, with the average ages ranging from 49 to 70 years old, hypertension as the most common comorbidity, fever as the most common manifestation, and acute respiratory distress syndrome (ARDS) as the most common complication. As compared to non-severe cases, severe pneumonia was featured with the lower counts of lymphocytes, CD8+ and CD4+ T cells, and higher levels of D-dimer, lactate dehydrogenase (LDH), IL-6 and IL-10. Antiviral therapy was the mainstay of treatment for severe SARS-CoV-2 pneumonia, and oseltamivir was the most commonly used antiviral reagent. Ventilation therapy, especially mechanical ventilation, was the primary and effective treatment. Conclusions: This study represents the first systematic summarization of the aspects of severe SARS-CoV-2 pneumonia, and its comparison with non-severe cases in symptoms and laboratory findings. Research including elder cases and from regions outside China, especially western countries, would generate benefits in a full understanding of severe SARS-CoV-2 pneumonia. High-quality studies are urgently required to confirm or exclude the possibility of a treatment benefit.

Emergent circulation patterns from anonymized mobility data: Clustering Italy in the time of Covid (preprint)

Using anonymized mobility data from Facebook users and publicly available information on the Italian population, we model the circulation of people in Italy before and during the early phase of the SARS-CoV-2 pandemic (COVID-19). We perform a spatial and temporal clustering of the movement network at the level of fluxes across provinces on a daily basis. The resulting partition in time successfully identifies the first two lockdowns without any prior information. Similarly, the spatial clustering returns 11 to 23 clusters depending on the period ("standard" mobility vs. lockdown) using the greedy modularity communities clustering method, and 16 to 30 clusters using the critical variable selection method. Fascinatingly, the spatial clusters obtained with both methods are strongly reminiscent of the 11 regions into which emperor Augustus had divided Italy according to Pliny the Elder. This work introduces and validates a data analysis pipeline that enables us: i) to assess the reliability of data obtained from a partial and potentially biased sample of the population in performing estimates of population mobility nationwide; ii) to identify areas of a Country with well-defined mobility patterns, and iii) to distinguish different patterns from one another, resolve them in time and find their optimal spatial extent. The proposed method is generic and can be applied to other countries, with different geographical scales, and also to similar networks (e.g. biological networks). The results can thus represent a relevant step forward in the development of methods and strategies for the containment of future epidemic phenomena.

Assessing the Zoom learning experience of the elderly under the effects of COVID in Hong Kong: application of the IPO model

PurposeThis study aims to investigate the perceptions of elderly learners in experiencing Zoom learning under the effects of COVID in the case of Hong Kong. Design/methodology/approachAn online survey and focus group interviews have been conducted with quantitative and qualitative approaches, respectively. The survey design was based on the input-process-output (IPO) model conceptual framework and used to assess students' perceptions regarding their Zoom learning experiences at the Elder Academy of Hong Kong Metropolitan University. Thereafter, selected students were invited to participate in focus group interviews to offer more in-depth comments for analysis purposes. Statistical Product and Service Solutions software and SmartPLS were used for data analysis of the survey, and content analysis was used to summarize opinions from the focus group interviews;thus, a comprehensive picture of elderly learners' learning experiences on Zoom is presented. FindingsAn overall positive perception was the result of elderly learners' Zoom learning journeys, particularly in the "input" and "process" stages of the IPO model. Yet, their perception of the "learning outcomes achieved" level in the "output" stage was lower among the rest, thus strongly affected by the factors of "interactions" and "teaching" experienced by elderly learners on Zoom. Although the perception of the youngest age group was more positive, none have agreed that Zoom learning was more favourable when compared with the traditional face-to-face mode. Originality/valueGiven Zoom as the short-term replacement option under the COVID pandemic, this study will provide recommendations for educators/institutions to improve their design of the whole learning process for elderly learners on the Zoom platform.

Sustainable, Smart and Safe Mobility at the Core of Sustainable Tourism in Six European Islands

Transport and tourism are rising economic sectors based on their mutual growth on reliable technological tools, affordable energy sources in relatively peaceful decades. This growing trend, faced along years of sudden slowdown caused mainly by the financial and health crisis;one of the most severe and recent episodes was theCOVID-19 pandemic.The pandemic outbreak is representing a global turning point for both international markets of tourism and transport which can be addressed with innovative solutions looking to retake the growing trends. In such a changing framework CIVITAS DESTINATIONS European project addressed the main challenges of tourism and resident mobility at local (rural, urban area, large city) and regional levels, focusing on six European islands (Malta, Cyprus, Elba, Crete, Gran Canaria, Madeira) aiming to implement and evaluate 83 different sustainablemobility measures. The project proves to have a cumulative relevant impact on environmental indicators such as CO2 emission avoided, fossil fuel saved and energy saved. Additionally, the project findings focus on the quality of life and economic development to grant long-run environmental and financial sustainability of tourism and transport at the local and regional levels. The main aspects observed were related to public participation and governance models in touristic mobility integrated with the residents' needs, touristic mobility the island, role of technologies to focus on final user needs, growing trends of elder and disabled people, new integrated and innovative business in tourism and mobility markets, health at the core of future trends. © The Editor(s) (if applicable) and The Author(s) 2022.

SARS-CoV-2 VIRAL LOAD IN NEWBORNS WITH COVID-19

The article presents the results of investigation of SARS-CoV-2 viral load in newborns with RT-PCR confirmed COVID-19 of different severity. It has been revealed that total amount of SARS-CoV-2 RNA on nasopharyngeal mucosa of newborns is significantly higher as compared to elder children and is not associated with disease severity and lung injury.