Faith, Hope, and Love in the Time of COVID: A Journal of Bible and Theology

This essay is a reflection on COVID-19 in the United States, specifically in the state of Alabama, and among marginalized populations with whom I work. Past generations have demonstrated living in faith, hope, and love in the midst of and despite great suffering and turmoil. This essay includes my thoughts about how faith manifests itself individually and corporately and raises ongoing questions about how believers may promote radical change and confront societal inequities—especially in light of COVID-19.

Fournier's Gangrene as a Possible Surgical Complication of COVID-19: Two Case Reports and Literature Review

Fournier's gangrene (FG) is a rare form of necrotizing fasciitis affecting the perineal, perianal, or genital areas. The infection is usually seen in diabetic, alcoholic, or immunosuppressed patients. Urgent debridement and broad-spectrum antibiotics are the first-line therapy, where in some cases soft tissue reconstruction is required. We report two patients who developed FG during COVID-19 infection. None of the patients had a history of diabetes mellitus, alcoholism, or immune deficiency. The only reported health condition was COVID-19 infection. Emergent debridement and elective reconstruction were performed for both of the patients. High index of suspicion is required during the examination of the perineum and the genitalia of suspected patients with COVID-19 infection for early diagnosis and prevention of further complications. Larger studies are required to indicate the exact incidence of FG in patients with COVID 19 infection.

Diverse feature extraction techniques in internet search query to forecast tourism demand: An in-depth comparison

It is an effective approach to improve forecasting by extracting effective information from large panels of search query data. Feature extraction techniques (FETs) can extract information from all features by creating new fewer features based on algebraic transformation;however, they have not been extensively investigated and compared for tourism forecasting. We employ five FETs to process multi-dimensional search query data, and build a bunch of models based on econometrics, machine learning, ensemble learning and hybrid methods. The improving performances of FETs based on tourism demand forecasting in Sanya after COVID-19 and in Macau before COVID-19 are evaluated. The results show that forecasting models with FETs outperform the benchmark model SARIMAX without FETs, which demonstrates the efficacy of FETs in search query data extraction. This study provides meaningful guidance for improving the quality of multi-dimensional data and optimizing tourism forecasting. © 2023 Elsevier Ltd

Sepsis presentation and pathophysiology

As a disease process sepsis represents an interplay between pathogen and host immune response. This interaction results in characteristic physical exam findings that can differ based on pathology. Early recognition and proper understanding of the underlying disease pathology is imperative to effective treatment and prevention of long-term complications. This chapter reviews disease presentation, pathophysiology, and current standard of care treatment for patients with sepsis, including those with COVID-19 pneumonia. Utilizing the most up-to-date guideline recommendations, this overview covers both medical and surgical causes of sepsis along with their treatments, while providing a molecular and cellular understanding for the disease process. © 2023 Elsevier Inc. All rights reserved.

SARS-CoV-2 immune complex triggers human monocyte necroptosis.

We analyzed the ability of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) itself and SARS-CoV-2-IgG immune complexes to trigger human monocyte necroptosis. SARS-CoV-2 was able to induce monocyte necroptosis dependently of MLKL activation. Necroptosis-associated proteins (RIPK1, RIPK3 and MLKL) were involved in SARS-CoV-2N1 gene expression in monocytes. SARS-CoV-2 immune complexes promoted monocyte necroptosis in a RIPK3- and MLKL-dependent manner, and Syk tyrosine kinase was necessary for SARS-CoV-2 immune complex-induced monocyte necroptosis, indicating the involvement of Fcγ receptors on necroptosis. Finally, we provide evidence that elevated LDH levels as a marker of lytic cell death are associated with COVID-19 pathogenesis.

Choir Singers Without Rehearsals and Concerts? A Questionnaire Study on Perceived Losses From Restricting Choral Singing During the Covid-19 Pandemic.

BACKGROUND: Choir singing is an activity that engages individuals all over the world with a broad demographic representation. Both qualitative and quantitative studies have examined the benefits of the activity but very few have examined the effects when someone loses access to it and stops singing. OBJECTIVES: Examining the governmental and organisational responses precipitated by the COVID-19 pandemic, we asked what happens when a choir singer loses all of their routines associated with regular participation in choir singing. MATERIALS AND METHODS: One national choir organization in Sweden (n = 3163) and one in Norway (n = 1881) were approached with a short survey. This comprised questions relating to the issue "what do you as a choir singer misses the most?" Each participant was asked to rate the importance of a number of elements that pertain to the experience of choir singing. RESULTS: The social aspect of singing emerged as having the strongest weight in terms of perceived loss that is, it was the element that the participants missed the most. Professional singers report that they miss the aesthetic experiences, flow, and all the physical aspects (physical training, voice training, and breathing training) to a greater degree as compared to reports from the amateurs. The importance of aesthetic experiences and physical components appeared to rise with increasing number of years that an individual had engaged with choir singing. CONCLUSION: In the Scandinavian setting, the social aspect has a stronger weight than the other components and this seemed to be more significant in Norway compared to Sweden.

Comprehensive evaluation of six interventions for hospitalized patients with COVID-19: A propensity score matching study.

Purpose: The purpose of this study was to evaluate the effectiveness of either hydroxychloroquine, triple combination therapy (TCT), favipiravir, dexamethasone, remdesivir, or COVID-19 convalescent plasma (CCP) in comparison with standard-of-care for hospitalized patients with COVID-19 using real-world data from Saudi Arabia. Patients and methods: A secondary database analysis was conducted using the Saudi Ministry of Health database for patients with COVID-19. Adult (≥18 years) hospitalized patients with COVID-19 between March 2020 and January 2021 were included in the analysis. A propensity score matching technique was used to establish comparable groups for each therapeutic approach. Lastly, an independent t-test and chi-square test were used to compare the matching groups in the aspects of the duration of hospitalization, length of stay (LOS) in intensive care units (ICU), in-hospital mortality, and composite poor outcome. Multilevel logistic regression model was used to assess the association between the severity stage of COVID-19 and the outcomes while using the medication or intervention used as a grouping variable in the model. Results: The mean duration of hospitalization was significantly longer for patients who received TCT, favipiravir, dexamethasone, or CCP compared to patients who did not receive these therapies, with a mean difference ranging between 2.2 and 4.9 days for dexamethasone and CCP, respectively. Furthermore, the use of favipiravir or CCP was associated with a longer stay in ICU. Remdesivir was the only agent associated with in-hospital mortality benefit. A higher risk of mortality and poorer composite outcome were associated with the use of favipiravir or dexamethasone. However, the logistic regression model reveled that the difference between the two matched cohorts was due to the severity stage not the medication. Additionally, the use of hydroxychloroquine, TCT, or CCP had no impact on the incidence of in-hospital mortality or composite poor outcomes. Conclusion: Remdesivir was the only agent associated with in-hospital mortality benefit. The observed worsened treatment outcomes associated with the use of dexamethasone or FPV shall be attributed to the severity stage rather than the medication use. In light of these varied results, additional studies are needed to continue evaluating the actual benefits of these therapies.

Corrigendum: IgG anti-spike antibodies and surrogate neutralizing antibody levels decline faster 3 to 10 months after BNT162b2 vaccination than after SARS-CoV-2 infection in healthcare workers.

[This corrects the article DOI: 10.3389/fimmu.2022.909910.].

Assessment of Predictors of Mortality in COVID-19 Patients Treated with Tocilizumab

Background: A hypersensitivity condition called cytokine storm is the main cause of death in COVID-19 patients. A monoclonal antibody called tocilizumab may be able to suppress the Interleukin-6 receptors (IL-6R) and lessen the likelihood that the body would have a hypersensitive immune response. Aim(s): To evaluate the mortality advantages of tocilizumab in individuals with COVID-19. Study design: Retrospective study. Place and duration of study: Bahria Town International Hospital Lahore from 16th June 2020 to 17th September 2021. Methodology: Patients with 96 confirmed instances of COVID-19 were enrolled. Two groups of patients were created. A single dosage of tocilizumab was administered to 52 participants in the first group, referred to as the survivors, and 44 patients in the second group, who passed away within 14 days. From the patients' medical records, the demographic information, co-morbid conditions, and laboratory values were obtained. The hospital's institutional review board and ethics committee (IRBEC) gave its approval for this study. The permission was ignored because this was a retroactive analysis. Result(s): 54.24 16.58 was the average age, and 54 (56.25%) of the population were men. 52 (54.16%) patients were survivors, compared to 44(45.83%) patients in the non-survivor group. In non-survivors compared to survivors, the older age group was shown to be statistically significant (62.78+/-12.86 vs. 51.65+/-11.68, p=0.003). Additionally, non-survivors had a greater BMI (p=0.006). In our study, hypertension and diabetes were the two co-morbid conditions that were most frequently detected (35.24% and 28.94%, respectively). The mortality rates among patients with diabetes, asthma, COPD, and cancer were all considerably higher (P=0.01, 0.006, and 0.004, respectively). Cancer and type-2 diabetes patients had death rates that were considerably higher (p=0.05 and p=0.01, respectively). C-reactive protein (CRP), D. Dimer, procalcitonin (PCT), and IL-6 were discovered to be the significant predictors of mortality (p 0.0001, 0.05, 0.001, and 0.004 respectively). Conclusion(s): Even though tocilizumab is authorised and has been shown to have positive results, people with diabetes, COPD, and asthma are more likely to experience negative results even after getting a single dosage of the medication. Similar to CRP, D. Dimer levels are reliable indicators of death. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

IgG Anti-Spike Antibodies and Surrogate Neutralizing Antibody Levels Decline Faster 3 to 10 Months After BNT162b2 Vaccination Than After SARS-CoV-2 Infection in Healthcare Workers.

Background: IgG anti-spike (S) antibodies arise after SARS-CoV-2 infection as well as vaccination. Levels of IgG anti-S are linked to neutralizing antibody titers and protection against (re)infection. Methods: We measured IgG anti-S and surrogate neutralizing antibody kinetics against Wild Type (WT) and 4 Variants of Concern (VOC) in health care workers (HCW) 3 and 10 months after natural infection ("infection", n=83) or vaccination (2 doses of BNT162b2) with ("hybrid immunity", n=17) or without prior SARS-CoV-2 infection ("vaccination", n=97). Results: The humoral immune response in the "vaccination" cohort was higher at 3 months, but lower at 10 months, compared to the "infection" cohort due to a faster decline. The "hybrid immunity" cohort had the highest antibody levels at 3 and 10 months with a slower decline compared to the "vaccination" cohort. Surrogate neutralizing antibody levels (expressed as %inhibition of ACE-2 binding) showed a linear relation with log10 of IgG anti-S against WT and four VOC. IgG anti-S corresponding to 90% inhibition ranged from 489 BAU/mL for WT to 1756 BAU/mL for Beta variant. Broad pseudoneutralization predicted live virus neutralization of Omicron BA.1 in 20 randomly selected high titer samples. Conclusions: Hybrid immunity resulted in the strongest humoral immune response. Antibodies induced by natural infection decreased more slowly than after vaccination, resulting in higher antibody levels at 10 months compared to vaccinated HCW without prior infection. There was a linear relationship between surrogate neutralizing activity and log10 IgG anti-S for WT and 4 VOC, although some VOC showed reduced sensitivity to pseudoneutralization.

The Psychological Impact of COVID-19 Admission on Families: Results from a Nationwide Sample in Greece.

The aim of the present study was to assess the psychological impact of hospitalization during the COVID-19 pandemic on parents and their offspring. We performed a nationwide cross-sectional study in Greece based on an Internet questionnaire survey. A convenience sample of parents whose offspring had been hospitalized due to COVID-19 (including multisystem inflammatory syndrome in children, MIS-C), diagnosed with COVID-19 but not hospitalized, and hospitalized for another reason during the pandemic were enrolled. Parental stress was assessed using the Perceived Stress Scale (PSS) and the Revised Impact of Event Scale (IES-R) tools, and childhood mental wellbeing with the Children's Revised Impact of Event 13 (CRIES-13) scale. Out of 214 received responses, stress levels were significantly higher in parents whose children had been admitted for COVID-19 or MIS-C versus those not admitted or admitted for other reasons (p < 0.001, for PSS/IES-R). Parental and childhood stress levels were correlated. In the multivariable linear regression analysis, children's hospitalization because of COVID-19 or MIS-C, younger parental age, the existence of comorbidities, and another family member's hospitalization because of COVID-19 were independent factors for higher stress. In light of the above, stricter hospital admission criteria for COVID-19 could be implemented, and psychological support for eventually admitted families may be beneficial.

Characteristics of PM2.5 concentration and water-soluble ions in the typical town of southern Gansu

In order to study the pollution levels of PM2.5 and water-soluble inorganic ions（WSIIs）in the towns of southern Gansu, PM2.5 samples were collected quarterly in Cheng County of Gansu from April 2019 to February 2020. Their characteristics of variation were analyzed, and the sources were apportioned using correlation and principal component analysis. The results showed that the mean annual mass concentration of PM2.5 was（57.2±26.9）μg·m-3 in Cheng County of Gansu Province. The seasonal variation of PM2.5 concentration was represented by winter>spring>autumn>summer during the sampling period, and the concentrations in winter were about 1.9 times than that in summer. The annually good air quality rate was 81%, of which 100% in summer. The ranking of WSII concentrations was SO42->NO3->Na+>NH4+>Ca2+>K+>Cl->Mg2+.SNA is the highest water-soluble ions, accounting for 70.1% of the concentration of eight main water-soluble ions. The mean ratio of ρ（NO3-）/ρ（SO42-）was 0.6, indicating that fixed sources such as industrial and agricultural production and fossil fuel combustion emissions, was the major source for particulate pollution. During the 2019 coronavirus epidemic, control measures had a significant impact on the concentration of PM2.5 and SNA in water-soluble ions, and the mean concentration of PM2.5 was reduced by 44.2%. Source apportionment showed that WSIIs in PM2.5 were mainly from fossil fuel combustion, biomass combustion, secondary formation and road construction dust, etc. © 2022 Science Press. All rights reserved.

Estimating conditional vaccine effectiveness.

Vaccine effectiveness for COVID-19 is typically estimated for different outcomes that often are hierarchical in severity (e.g. any documented infection, symptomatic infection, hospitalization, death) and subsets of each other. Conditional effectiveness for a more severe outcome conditional on a less severe outcome is the protection offered against the severe outcome (e.g. death) among those who already sustained the less severe outcome (e.g. documented infection). The concept applies also to the protection offered by previous infection rather than vaccination. Formulas and a nomogram are provided here for calculating conditional effectiveness. Illustrative examples are presented from recent vaccine effectiveness studies, including situations where effectiveness for different outcomes changed at different pace over time. E(death | documented infection) is the percent decrease in the case fatality rate and E(death | infection) is the percent decrease in the infection fatality rate (IFR). Conditional effectiveness depends on many factors and should not be misinterpreted as a causal effect estimate. However, it may be used for better personalized communication of the benefits of vaccination, considering also IFR and epidemic activity in public health decision-making and communication.

Teachers during Covid-19 Lockdown: Telework and Online Teaching

Aims. The aim of this paper is to show the situation in which primary school teachers found themselves in the course of their work during the school closure when the teaching process took place online and the home of teachers was the place of work. The paper aims to identify the sources of work demands in time of teleworking and online teaching and to point out the newly gained skills of teachers. Method. The research sample consisted of 490 primary school teachers. In September 2020, primary school teachers throughout Slovakia were contacted electronically individually or in groups with a request to fill in an online questionnaire. In this paper, we analyse the answers of primary school teachers to two open questions of the online questionnaire in the context of the Covid-19 pandemic: i) What caused you the greatest burden in performing telework? ii) What new skills did you learn while performing telework? Responses were categorized by conventional content analysis. Results. The burden put on teachers was evident especially due to insufficient ICT and unstable quality of internet connection but also due to working time and family demands. It is therefore striking that teachers in many cases were not provided with the necessary support from school management and competent institutions in this difficult situation. However, the positives that teleworking has brought to teachers cannot be overlooked, for example, thanks to newly acquired skills and competences. Above all, it was the gained experience in conducting online teaching and teleworking, adopting new ways of teaching and communication. Conclusions. Despite the uncertainty and work demands teachers continued to pursue the profession during the COVID-19 pandemic, also in the form of teleworking and online teaching. Globally, telework is perceived as a suitable (alternative) form of work but in the performance of the teaching profession several factors of the online teaching process come into play and in its long-term application it is necessary to take them into account and correct their effects. Limits. The limit of the study is the sample selection which was occasional and the questionnaire was filled in by teachers with the online connection and experienced with the online questionnaires.

Cross-Sectional Study of University Students' Attitudes to 'On Campus' Delivery of COVID-19, MenACWY and MMR Vaccines and Future-Proofing Vaccine Roll-Out Strategies.

University students are a critical group for vaccination programmes against COVID-19, meningococcal disease (MenACWY) and measles, mumps and rubella (MMR). We aimed to evaluate risk factors for vaccine hesitancy and views about on-campus vaccine delivery among university students. Data were obtained through a cross-sectional anonymous online questionnaire study of undergraduate students in June 2021 and analysed by univariate and multivariate tests to detect associations. Complete data were obtained from 827 participants (7.6% response-rate). Self-reporting of COVID-19 vaccine status indicated uptake by two-thirds (64%; 527/827), willing for 23% (194/827), refusal by 5% (40/827) and uncertain results for 8% (66/827). Hesitancy for COVID-19 vaccines was 5% (40/761). COVID-19 vaccine hesitancy was associated with Black ethnicity (aOR, 7.01, 95% CI, 1.8-27.3) and concerns about vaccine side-effects (aOR, 1.72; 95% CI, 1.23-2.39). Uncertainty about vaccine status was frequently observed for MMR (11%) and MenACWY (26%) vaccines. Campus-associated COVID-19 vaccine campaigns were favoured by UK-based students (definitely, 45%; somewhat, 16%) and UK-based international students (definitely, 62%; somewhat, 12%). Limitations of this study were use of use of a cross-sectional approach, self-selection of the response cohort, slight biases in the demographics and a strict definition of vaccine hesitancy. Vaccine hesitancy and uncertainty about vaccine status are concerns for effective vaccine programmes. Extending capabilities of digital platforms for accessing vaccine information and sector-wide implementation of on-campus vaccine delivery are strategies for improving vaccine uptake among students. Future studies of vaccine hesitancy among students should aim to extend our observations to student populations in a wider range of university settings and with broader definitions of vaccine hesitancy.

Spatial growth rate of emerging SARS-CoV-2 lineages in England, September 2020-December 2021.

This paper uses a robust method of spatial epidemiological analysis to assess the spatial growth rate of multiple lineages of SARS-CoV-2 in the local authority areas of England, September 2020-December 2021. Using the genomic surveillance records of the COVID-19 Genomics UK (COG-UK) Consortium, the analysis identifies a substantial (7.6-fold) difference in the average rate of spatial growth of 37 sample lineages, from the slowest (Delta AY.4.3) to the fastest (Omicron BA.1). Spatial growth of the Omicron (B.1.1.529 and BA) variant was found to be 2.81× faster than the Delta (B.1.617.2 and AY) variant and 3.76× faster than the Alpha (B.1.1.7 and Q) variant. In addition to AY.4.2 (a designated variant under investigation, VUI-21OCT-01), three Delta sublineages (AY.43, AY.98 and AY.120) were found to display a statistically faster rate of spatial growth than the parent lineage and would seem to merit further investigation. We suggest that the monitoring of spatial growth rates is a potentially valuable adjunct to outbreak response procedures for emerging SARS-CoV-2 variants in a defined population.

Predictors of intensive care unit admission and mortality in SARS-CoV-2 infection: A cross sectional study at a tertiary care hospital.

Background: The transmissibility and associated morbidity and mortality of severe acute respiratory syndrome-related coronavirus (SARS-Cov-2), have overwhelmed worldwide healthcare systems, resulting in an urgent need to understand this virus and its associated effects. The aim of our study was to identify patient symptoms, clinical characteristics, laboratory, and radiology findings that are associated with serious morbidity and mortality in COVID-19 patients. Methods: A cross sectional study was conducted in Jaber Al Ahmad Hospital, the designated COVID-19 center in Kuwait between August 1st, 2020 and January 31st, 2021. The main outcomes measured in this study were to identify variables associated with intensive care unit (ICU) admission, as proxy for serious morbidity, and in hospital mortality. Results: Two hundred and seventy-six patients were included in the study. Thirty-six (13%) patients were admitted to intensive care unit (ICU) and 33 (12%) patients expired. On multivariate analysis we found having elevated fibrinogen [OR 1.39, 95% CI 1.08-1.64, P = 0.04], low estimated glomerular filtration rate (eGFR) [OR 0.89, 95% CI 0.81-0.95, P = 0.02], and having bilateral patchy lung shadowing [OR 6.68, 95% CI 1.85-15.28, P < 0.01] to be significantly associated with increase odds of ICU admission. Elevated CRP [OR 1.25, 95% CI 1.10-1.98, P < 0.01], low eGFR [OR 0.95, 95% CI 0.90-0.99, P = 0.05] and having ischemic heart disease [OR 7.03, 95% CI 1.60-46.42, P = 0.04] were independently associated with increased odds of mortality. Conclusion: Certain inflammatory and coagulopathy markers, and having certain lung radiological features, in addition to having medical comorbidities, specifically, ischemic heart disease and renal impairment are key predictors for serious morbidity and mortality in patients infected with COVID-19. These should be incorporated into medical institutes risk assessment tools used by physicians and policy makers to instigate, prioritize, and reprioritize care in patients with COVID-19 and instigate preventative strategy to reduce the impact of future outbreak.

The role of managed care clinical pharmacists in improving COVID-19 vaccination rates for culturally specific Medicaid populations.

Clinical pharmacists are an untapped resource in the fight against health disparities. As frontline workers, they are embedded in communities and interact on a regular basis with patients managing chronic conditions. In particular, managed care clinical pharmacists have access to population-wide data to identify gaps and mobilize resources to proactively address disparities across their community. Amid the current pandemic, there have been vast inequities regarding access to the coronavirus disease 2019 (COVID-19) vaccine, particularly for low income and underserved culturally specific populations. The pandemic has provided a case study for how clinical pharmacists can collaborate across managed care and community-based settings to work toward achieving health equity. Recent data indicates that culturally specific populations have received less COVID-19 vaccines than the White population. To address this inequity, a team of clinical pharmacists at CareOregon, a health plan in Oregon that serves Medicaid, collaborated with retail pharmacists from both chain and independent pharmacies to improve COVID-19 vaccination rates for this unique population. This paper describes the process and strategies implemented to ensure vaccine access for culturally specific populations enrolled with CareOregon. Strategies to expand vaccine access to this population involved data sharing with community pharmacists, direct scheduling of culturally specific members for vaccine appointments and partnering with other stakeholders such as community-based organizations (CBOs) to provide COVID-19 vaccine confidence training. This paper also highlights the impact of the strategies to improve COVID-19 vaccination rates for this population. Lastly, challenges and barriers are addressed, as well as lessons learned from this process.

Managing a COVID-Positive Health-Care Worker with Recent Suicide Attempt through Telepsychiatry

COVID-19 pandemic has emerged as a major problem for the health-care workers (HCWs). Many HCWs are facing adverse psychological outcomes, during the COVID pandemic. HCWs are not only expected to carry out duties in COVID areas but are also expected to stay in isolation during the period of quarantine. Various models have been proposed to address the psychological issues in HCWs using telepsychiatry. However, there are no clear-cut guidelines, for managing people with suicidal behavior. In this report we present a HCW, diagnosed with recurrent depressive disorder, current episode severe depression without psychotic symptoms, who attempted self-harm and was shortly diagnosed with COVID-19 infection leading her to getting admitted in the COVID-19 ward. She was managed with supportive psychotherapy during her COVID ward stay through telepsychiatry. We discuss the challenges faced and how these were handled.