Genome-wide screening of sex-biased genetic variants potentially associated with COVID-19 hospitalization.

Sex-biased difference in coronavirus disease 2019 (COVID-19) hospitalization has been observed as that male patients tend to be more likely to be hospitalized than female patients. However, due to the insufficient sample size and existed studies that more prioritized to sex-stratified COVID-19 genome-wide association study (GWAS), the searching for sex-biased genetic variants showing differential association signals between sexes with COVID-19 hospitalization was severely hindered. We hypothesized genetic variants would show potentially sex-biased genetic effects on COVID-19 hospitalization if they display significant differential association effect sizes between male and female COVID-19 patients. By integrating two COVID-19 GWASs, including hospitalized COVID-19 patients vs. general population separated into males (case = 1,917 and control = 221,174) and females (case = 1,343 and control = 262,886), we differentiated the association effect sizes of each common single nucleotide polymorphism (SNP) within the two GWASs. Twelve SNPs were suggested to show differential COVID-19 associations between sexes. Further investigation of genes (n = 58) close to these 12 SNPs resulted in the identification of 34 genes demonstrating sex-biased differential expression in at least one GTEx tissue. Finally, 5 SNPs are mapped to 8 genes, including rs1134004 (GADD45G), rs140657166 (TRIM29 and PVRL1), rs148143613 (KNDC1 and STK32C), rs2443615 (PGAP2 and TRIM21), and rs2924725 (CSMD1). The 8 genes display significantly differential gene expression in blood samples derived from COVID-19 patients compared to healthy controls. These genes are potential genetic factors contributing to sex differences in COVID-19 hospitalization and warranted for further functional studies.

The Effect of CoViD-19 Pandemic on the Hospitalization of a Department of Oncology of an Italian Hospital

In the last years, the entire world has been affected by the SARS-COV-2 pandemic, that represents the etiologic agent of Coronavirus disease 2019 (CoViD-19), which degenerated into a global pandemic in 2020. CoViD-19 has also had a strong impact on cancer patients. Our analysis has been performed at the Department of Oncology of the AORN "Cardarelli” in Naples, collecting data from all patients who had access in 2019–2020. We aim to understand how CoViD-19 affected hospital admissions. The statistical analysis showed that between 2019 and 2020 there was an increase in urgent hospitalizations and a decrease in scheduled hospitalization, probably to decrease the risk of infection, particularly in this category of susceptible patients. Indeed, as recommended by the European Society of Medical Oncology, during the pandemic, it was necessary to reorganize healthcare activities, ensure adequate care for patients infected with CoViD-19. Therefore telemedicine services were implemented and clinic visits were reduced. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

A Bicentric Study to Investigate the Impact of COVID-19 on Urological Patients

In December 2019, SARS-CoV-2 broke out, which raised great attention worldwide. In fact, it was essential to reorganize the management of economic, infrastructural and medical resources to deal with the inadequate preparation of medical practitioners for this emergency. It was evident that the global health, medical and scientific communities were not adequately prepared for this emergency, so during the pandemic. In this paper, data extracted from hospital discharge records of the Department of Urology of the A.O.R.N "Cardarelli” in Naples, Italy, were used. This work is an extension of a previous work, whose goal concerned how admission procedure in the Urology department of the "San Giovanni di Dio and Ruggi d'Aragona” hospital has been affected by COVID-19 pandemic. In this work we compare the results obtained for the patients of the University Hospital "San Giovanni di Dio and Ruggi d'Aragona” of Salerno and the patients of the A.O.R.N. "Antonio Cardarelli” of Naples (Italy). Data have been extracted from both hospitals discharge records of the Departments of Urology. Experimental analysis performed comparing pre-pandemic data with those collected during the epidemic showed an in-crease in the number of emergency hospitalizations and a decrease in planned pre-admission hospitalizations. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Applicability of the ROX index in decision-making for hospitalization in COVID-19 patients: ROX index in the outpatient COVID-19 cases

Aim: Data on the outpatient follow-up of COVID-19 cases is still scarce. Also, the significance of the ROX index in decision-making for hospitalization in the ambulatory COVID-19 cases remains unknown. The aim of this study is to determine the general characteristics of COVID-19 patients treated as outpatients and to investigate whether the ROX index is applicable in hospitalization decisions. Material(s) and Method(s): This retrospective cohort study was conducted in confirmed adult COVID-19 cases between 15 October 2020 and 01 March 2021. A total of 5240 confirmed COVID-19 patients were included in the present study. Factors affecting hospitalization were investigated. Result(s): The study population was divided into two groups as those who require hospitalization (n=672) and those who did not (n=4568). The number of male patients and the mean age of the patients were significantly higher in hospitalized patients group (p=0.046, p<0.001). ROX index that was calculated at the home visit on the third day of disease was found significantly lower in the group of hospitalized patients (p<0.001). There was a significant correlation between ROX index and inflammatory biomarkers in the present study (p<0.001). The ROX index was found the most accurate parameter for decision-making for hospitalization in ambulatory COVID-19 patients (AUC=0.794 CI=0.773-0.814, p<0.001). Discussion(s): The ROX index can be a useful and objective clinical tool for decision making for hospitalization in the ambulatory COVID-19 cases.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Prevalence of hyponatremia in hospitalized patients with coronavirus disease 2019, a multicenter study

Introduction: In patients with coronavirus disease 2019 (COVID-19), the prevalence of hyponatremia has been reported with varying outcomes. Objective(s): The aim of this study was to evaluate the prevalence of hyponatremia in hospitalized patients with COVID-19. Patients and Methods: In this multicenter cross-sectional study, information about hospitalized patients with COVID-19 admitted between March 2020 and September 2020, including age, gender, and serum levels of sodium, creatinine, and potassium, as well as blood urea nitrogen (BUN), was analyzed, while P value level less than 0.05 was considered significant. Result(s): A total of 667 hospitalized patients with COVID-19 were enrolled in the study, of which 54.4% were male. The median age of patients was 63 years old. About 39.4% of patients had hyponatremia on admission day. More than 80% of patients had mild hyponatremia. The median age of the hyponatremia group was significantly higher than that of eunatremia group. Conclusion(s): Our data showed that hyponatremia is observed in hospitalized patients with COVID-19 and is often mild.Copyright © 2023 The Author(s);Published by Society of Diabetic Nephropathy Prevention.

Hospitalization and bed occupancy rate in a COVID-19 intensive care unit

Most people develop mild or moderate symptoms of COVID-19, but some people develop severe symptoms, leading to hospitalizations. The objective of the research was to analyze the prevalence of confirmed cases of COVID-19, hospitalization for this disease in Intensive Care Units, and the occupancy rate of beds resulting from the same in these units in the municipality of Rondonopolis, Mato Grosso. This was a cross-sectional, descriptive study with a quantitative approach, with data from secondary sources of epidemiological bulletins in Rondonopolis, Mato Grosso, from June 2020 to May 2021. The average number of hospitalized cases per month and the occupancy rate of intensive care beds were calculated. All cases reported with COVID-19 and hospitalized in the Intensive Care Unit of public hospitals in the municipality were included. Analyses were performed with R Software and the chi-square goodness-of-fit test and Kendall's correlation were performed. A total of 28,443 new cases of COVID-19 were reported during the study period, with the highest average of hospitalizations in the intensive care unit in the public health network was in May 2021 (n=51.1) and the bed occupancy rate was in September 2020 (129.17%). In all regions analyzed in comparison with this study, the ICUs operated in a state of calamity with high occupancy rates. A relationship between the increase in the number of cases and hospitalizations and occupancy rates of Intensive Care Units was identified, which are findings that indicate the need to control COVID-19. © 2022 Centro Universitario Sao Camilo. All rights reserved.

The Effect of Play Activities for COVID-19 Positive and MIS-C Pediatric Patients on the Anxiety and Fear of Children and Their Parents

Aim: This study aims to determine the effects of play activities for COVID-19 positive and MIS-C pediatric patients on the anxiety and fear of children and their parents. Method(s): This is an experimental study that was prepared through STROBE. The study population consisted of 38 children treated in a university hospital COVID-19 unit. The Children's Anxiety Meter-State and the Children's Fear Scale were administered before and after the play activities. The parents' fear and anxiety were assessed using the COVID-19 Phobia Scale and the Beck Anxiety Inventory. The book and coloring set was prepared in advance and delivered to the experimental group in a package. After the sets were given to the parents, the parents read the book to their children the same day. Afterward, they were asked to color pictures of coronavirus precautions together with the children. SPSS 22.00 package program was used to analyze the study data. The Mann-Whitney U test was used to compare independent groups, and Wilcoxon analysis was used to analyze dependent variables before and after the play activities. Result(s): Based on the children's anxiety and fear scores in the experimental group, significant differences were found before and after the play activities and significant differences between the anxiety scores (<0.05) of parents and children. However, no significant difference was found between post-play anxiety and fear scores of children in the experimental group and the scores of the control group. Discussion(s): The experimental group had low mean anxiety and fear scores after the play activities. Play activities should be used to reduce the anxiety and fear of children who are treated in isolation in hospitals during the COVID-19 pandemic. Even if children are restricted to isolation rooms, their daily routines should be maintained, and their parents should be supported.Copyright © 2021 Croatian Paediatric Society. All rights reserved.

Clinical Presentations of the Survivor and Non-survivor Hospitalized Patients with COVID-19 in the Golestan Province of Iran during the First Peak of the Epidemics

Background: Considering the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, which causes coronavirus disease 2019 (COVID-19), we aimed to report the clinical features of 427 patients with COVID-19 and the outcomes after one-month admission to major teaching hospitals in the northeast of Iran. Material(s) and Method(s): Data of patients hospitalized with COVID-19 from 20 February 2020 to 20 April 2020 was analyzed using the R software. The cases and their outcomes were monitored up to one month following their admission. Result(s): Among 427 patients with a median age of 53 years (50.8% male), 81 (19%) were directly admitted to the ICU ward, and 68 (16%) died during the study. The mean (SD) lengths of hospital stay were significantly higher in the non-survivors (6 (9) days) than survivors (4 (5) days) (P = 0.018). Ventilation need was reported in 67.6% of the non-survivors and 0.8% of the survivors (P < 0.001). Cough (72.8%), fever (69.3%), and dyspnea (64.0%) were the most common symptoms. There were more comorbidities in the severe cases (73.5%) and non-survivor (77.5%). Liver and kidney damage were significantly more common in non-survivors. Ninety percent of the patients had at least one abnormal chest CT scan finding, including crazy paving and consolidation patterns (27.1%), followed by the ground-glass opacity (24.7%). Conclusion(s): Results showed that the patients' age, underlying comorbidities, levels of SpO2, and laboratory findings at the time of admission may predict the progress of the disease and can be considered mortality-related factors.Copyright © 2022 NRITLD, National Research Institute of Tuberculosis and Lung Disease, Iran.

Accounting for Potential Unmeasured Confounding in the Association between Influenza vaccination and COVID-19 Hospitalization: Sensitivity Analysis Using E-value Method

Background: Unmeasured confounding is the primary obstacle to causal inference in observational research. We aimed to illuminate the association between exposure to influenza vaccination (IV) within six months before contracting the coronavirus disease (COVID-19) and COVID-19 hospitalization in relation to unmeasured confounding using the E-value method. Material(s) and Method(s): Information about 367 patients, 103 of whom (28.07 %) had received IV, and confounders included sex, age, occupation, cigarette smoking, opium, and comorbidities were collected. We estimated the interest association using the inverse probability weighted (IPW) method. There was no information on some potential unmeasured confounders, such as socio-economic status. Therefore, we computed E-value as a sensitivity analysis, which is the minimum strength of unmeasured confounding to explain away an exposure-outcome association beyond the measured confounders completely. Result(s): IPW denoted 1.12 (95% CI: 0.71 to 1.29) times greater risk of COVID-19 hospitalization in patients exposed to IV than in unexposed individuals. Sensitivity analysis demonstrated that an E-value (95% CI) of 1.49 (1.90 to 2.15) is required to shift the RR and the corresponding confidence Interval (CI) lower and upper limits toward the null. Moreover, if they had been omitted, the most computed E-values for measured confounders were relatively larger than for unmeasured confounders. Conclusion(s): According to the context of the measured confounders, if they had been omitted, an E-value of 1.16 to 1.76, a weaker confounding could fully explain away the reported association, suggesting that no relationship exists between IV and COVID-19 hospitalization.Copyright © 2022 NRITLD.

Glucocorticoid Therapy in COVID-19-Induced Organizing Pneumonia: A Rare Occurrence.

Background Although the incidence of post-COVID-19 organizing pneumonia (OP) is low, the mortality and morbidity in select patients appear to be high. Anticipating specific populations who may be at higher risk and initiating treatment earlier could reduce mortality. Research question Does treatment with high dose, standard dose, or no glucocorticoids for COVID-19 infection impact the incidence and clinical outcome in COVID-19-induced OP? Study design and methods This was a single-center, retrospective, observational cohort study conducted from 03/01/2020 to 06/30/2021 in hospitalized patients over the age of 18 with confirmed COVID-19 infection and computed tomography (CT) scan evidence of OP. Institutional review board (IRB) approval was obtained from the institution (STUDY00002241). Patients' demographics and oxygen requirements at the time of diagnosis, at the time of discharge, and at one, three, six, 10, and 12 months post-discharge were obtained. The dose, duration, and choice of glucocorticoid therapy were recorded for each subject, as well as oxygen requirements during hospitalization. Despite radiological evidence of OP, patients on minimal supplemental oxygen requirements did not receive high-dose or long-duration glucocorticoid therapy. Results A total of 881 patients were admitted with COVID-19, of which 42 met the study criteria. Three patients underwent a lung biopsy to confirm the diagnosis of organizing pneumonia. All other patients were diagnosed based on CT imaging and clinical presentation. Of the patients, 17% did not receive any steroid treatment, while 36% received dexamethasone and 43% received prednisone. The most common oxygen requirement at the time of discharge for steroid-treated patients was nasal cannula (55%) and room air (29%). The incidence of OP in this patient population was 0.05 with a mortality rate of 14%. Interpretation and relevance The incidence of post-COVID-19 OP appears to be lower than anticipated. Steroids for patients on lower supplemental oxygen requirements were discontinued although they had radiological evidence of OP. Patients who were on higher supplemental oxygen requirements at 10 days were continued on steroids regardless of imaging. The decision to continue steroids should be based on individual patient characteristics such as oxygen requirements. In the future, larger multicenter cohort studies would help understand further treatment of post-COVID-19-associated OP. Anticipating specific populations who may be at higher risk and starting treatment earlier could help reduce mortality.

Hospitalizations for COVID-19 Among American Indian and Alaska Native Adults (≥ 18 Years Old) - New Mexico, March-September 2020.

To assess the presence of racial disparity during the COVID-19 pandemic, the New Mexico Department of Health (NMDOH) sought to compare the case rate and risk of hospitalization between persons of American Indian and Alaska Native (AI/AN) race and persons of other races in New Mexico from March 1 through September 30, 2020. Using NMDOH COVID-19 surveillance data, age-standardized COVID-19 case and hospitalization risks were compared between adults (≥ 18 years old) of AI/AN and other races. We compared age, sex, and comorbidities between hospitalized adults of AI/AN and other races. Among AI/AN persons, age-standardized COVID-19 case and hospitalization risks were 3.7 (95% CI 3.6-3.8) and 10.5 (95% CI 9.8-11.2) times as high as persons of other races. Hospitalized AI/AN patients had higher proportions of diabetes mellitus (48% vs. 33%, P < 0.0001) and chronic liver disease (8% vs. 5%, P = 0.0004) compared to hospitalized patients of other races. AI/AN populations have disproportionately higher risk of COVID-19 hospitalization compared to other races in New Mexico. By identifying etiologic factors that contribute to inequity, public health partners can implement culturally appropriate health interventions to mitigate disease severity within AI/AN communities.

Trends in disparities in COVID hospitalizations among community-dwelling residents of two counties in Connecticut, before and after vaccine introduction, March 2020-September 2021.

BACKGROUND: Prior to the introduction of vaccines, COVID-19 hospitalizations of non-institutionalized persons in Connecticut disproportionately affected communities of color and individuals of low socioeconomic status (SES). Whether the magnitude of these disparities changed 7-9 months after vaccine rollout during the Delta wave is not well documented. METHODS: All initially hospitalized patients with laboratory-confirmed COVID-19 during July-September 2021 were obtained from the Connecticut COVID-19-Associated Hospitalization Surveillance Network database, including patients' geocoded residential addresses. Census tract measures of poverty and crowding were determined by linking geocoded residential addresses to the 2014-2018 American Community Survey. Age-adjusted incidence and relative rates of COVID-19 hospitalization were calculated and compared with those from July to December 2020. Vaccination levels by age and race/ethnicity at the beginning and end of the study period were obtained from Connecticut's COVID vaccine registry, and age-adjusted average values were determined. RESULTS: There were 708 COVID-19 hospitalizations among community residents of the two counties, July-September 2021. Age-adjusted incidence was the highest among non-Hispanic Blacks and Hispanic/Latinx compared with non-Hispanic Whites (RR 4.10 [95% CI 3.41-4.94] and 3.47 [95% CI 2.89-4.16]). Although RR decreased significantly among Hispanic/Latinx and among the lowest SES groups, it increased among non-Hispanic Blacks (from RR 3.2 [95% CI 2.83-3.32] to RR 4.10). Average age-adjusted vaccination rates among those ≥12 years were the lowest among non-Hispanic Blacks compared with Hispanic/Latinx and non-Hispanic Whites (50.6% vs. 64.7% and 66.6%). CONCLUSIONS: Although racial/ethnic and SES disparities in COVID-19 hospitalization have mostly decreased over time, disparities among non-Hispanic Blacks increased, possibly due to differences in vaccination rates.

Patient Perceptions of their COVID-19 Inpatient Hospital Experience: a Survey Exploring Inequities in Healthcare Delivery.

BACKGROUND: Compared with White patients, Black and Latinx patients have higher infection, hospitalization, and mortality rates from COVID-19; yet, little is known about their perspective before, during, and after a COVID-19 hospitalization. The objective of this study conducted in White, Black, and Latinx patients was to assess perceptions of their COVID-19-related hospitalization from onset of symptoms through the post-discharge period to identify disparities in their perceived care. METHODS: A cross-sectional observational study using an online survey from May 19 to June 23, 2021, was conducted by The Harris Poll in 200 White, 200 Black, and 201 Latinx patients hospitalized for COVID-19 in the US. Main measures obtained included baseline demographic variables, socioeconomic status, and social determinants of health. Survey questions were specific to key aspects of the patient experience before, during, and after a COVID-19-related hospitalization. RESULTS: Compared with White patients, Latinx and Black patients faced unique challenges in their healthcare journey including higher likelihood of delaying their hospitalization (10% Black vs. 4% White patients, respectively, P = 0.025), lower perceived satisfaction with care (82% Latinx vs 91% White patients, P = 0.002), and lower trust in providers following their hospitalization (85% White vs. 65% Latinx [P = 0.027] and 73% Black [P = 0.050] patients). CONCLUSIONS: Patient perceptions of their COVID-19 hospitalization experience revealed disparities in perceived quality of care among minority groups. These findings offer insights that health inequities still exist, and strategies need to be taken to make health care delivery more equitable.

High vaccine effectiveness against severe COVID-19 in the elderly in Finland before and after the emergence of Omicron.

BACKGROUND: The elderly are highly vulnerable to severe COVID-19. Waning immunity and emergence of Omicron have caused concerns about reduced effectiveness of COVID-19 vaccines. The objective was to estimate vaccine effectiveness (VE) against severe COVID-19 among the elderly. METHODS: This nationwide, register-based cohort analysis included all residents aged 70 years and over in Finland. The follow-up started on December 27, 2020, and ended on March 31, 2022. The outcomes of interest were COVID-19-related hospitalization and intensive care unit (ICU) admission timely associated with SARS-CoV-2 infection. VE was estimated as one minus the hazard ratio comparing the vaccinated and unvaccinated and taking into account time since vaccination. Omicron-specific VE was evaluated as the effectiveness observed since January 1, 2022. RESULTS: The cohort included 896,220 individuals. Comirnaty (BioNTech/Pfizer) VE against COVID-19-related hospitalization was 93% (95% CI 89-95%) and 85% (95% CI 82-87%) 14-90 and 91-180 days after the second dose; VE increased to 95% (95% CI 94-96%) 14-60 days after the third dose. VE of other homologous and heterologous three dose series was similar. Protection against severe COVID-19 requiring ICU treatment was even better. Since January 1, 2022, Comirnaty VE was 98% (95% CI 92-99%) and 92% (95% CI 87-95%) 14-90 and 91-180 days after the second and 98% (95% CI 95-99%) 14-60 days after the third dose. CONCLUSIONS: VE against severe COVID-19 is high among the elderly. It waned slightly after two doses, but a third restored the protection. VE against severe COVID-19 remained high even after the emergence of Omicron.

Breakthrough infections, hospital admissions, and mortality after major COVID-19 vaccination profiles: A prospective cohort study.

Background: Several COVID-19 vaccination rollout strategies are implemented. Real-world data from the large-scale, government-mandated Central Vaccination Center (CVC), Thailand, could be used for comparing the breakthrough infection, across all available COVID-19 vaccination profiles. Methods: This prospective cohort study combined the vaccine profiles from the CVC registry with three nationally validated outcome datasets to assess the breakthrough COVID-19 infection, hospitalization, and death among Thais individuals who received at least one dose of the COVID-19 vaccine. The outcomes were analyzed by comparing vaccine profiles to investigate the shot effect and homologous effect. Findings: Of 2,407,315 Thais who had at least one dose of COVID-19 vaccine, 63,469 (2.75%) had breakthrough infection, 42,001 (1.79%) had been hospitalized, and 431 (0.02%) died. Per one vaccination shot added, there was an 18% risk reduction of breakthrough infection (adjusted hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.80-0.82), a 25% risk reduction of hospitalization (HR 0.75, 95% CI 0.73-0.76), and a 96% risk reduction of mortality (HR 0.04, 95% CI 0.03-0.06). The heterologous two-shot vaccine profiles had a higher protective effect against infection, hospitalization, and mortality compared to the homologous counterparts. Interpretation: COVID-19 breakthrough infection, hospitalization, and death differ across vaccination profiles that had a different number of shots and types of vaccines. Funding: This study did not involve any funding.

Risk of Severe Coronavirus Disease 2019 Disease in Individuals With Down Syndrome: A Matched Cohort Study From a Large, Integrated Health Care System.

BACKGROUND: Down syndrome (DS) is associated with an increased risk of infections attributed to immune defects. Whether individuals with DS are at an increased risk of severe coronavirus disease 2019 (COVID-19) remains unclear. METHODS: In a matched cohort study, we evaluated the risk of COVID-19 infection and severe COVID-19 disease in individuals with DS and their matched counterparts in a pre-COVID-19 vaccination period at Kaiser Permanente Southern California. Multivariable Cox proportion hazard regression was used to investigate associations between DS and risk of COVID-19 infection and severe COVID-19 disease. RESULTS: Our cohort included 2541 individuals with DS and 10 164 without DS matched on age, sex, and race/ethnicity (51.6% female, 53.3% Hispanic, median age 25 years [interquartile range, 14-38]). Although the rate of COVID-19 infection in individuals with DS was 32% lower than their matched counterparts (adjusted hazard ratio [aHR], 0.68; 95% confidence interval [CI], .56-.83), the rate of severe COVID-19 disease was 6-fold higher (aHR, 6.14; 95% CI, 1.87-20.16). CONCLUSIONS: Although the risk of COVID-19 infection is lower, the risk of severe disease is higher in individuals with DS compared with their matched counterparts. Better infection monitoring, early treatment, and promotion of vaccine for COVID-19 are warranted for DS populations.

Disease Severity in Vaccinated Adults Hospitalized with Breakthrough COVID-19.

Background: Vaccination against SARS-CoV-2 is widely used and confers protection against morbidity and mortality in COVID-19. Little is known about disease severity and outcomes in fully vaccinated patients during hospitalization for COVID-19. Aim: To determine whether vaccination status and time from vaccination-to-hospitalization impacted disease severity in patients admitted with COVID-19. Methods: A multicenter retrospective cohort study was conducted on hospitalized adults with COVID-19 between January 1 and September 8, 2021, in Rhode Island, USA. Vaccination status and markers of disease severity, including C-reactive protein, D-Dimer values, and supplemental oxygen use during hospitalization, were obtained. Results: Two thousand three hundred forty-four patients were included. For every vaccinated patient, three unvaccinated patients were matched for a total of 424 patients in the analytic sample. Vaccinated patients had lower peak C-reactive protein (beta = -39.10, 95% CI [-79.10, -0. 65]) and supplemental oxygen requirements (beta = -38.14, 95% CI [-61.62, -9.91]) compared to unvaccinated patients. Patients who had a greater discrepancy between date of vaccination and admission had higher C-reactive protein (beta = 0.37, 95% CI [0.02, 0.71]) and supplemental oxygen requirements (beta = 0.44, 95% CI [0.15, 0.75]. Conclusion: Vaccination against SARS-CoV-2 was associated with a protective effect on disease severity during hospitalization for breakthrough COVID-19. Time elapsed since vaccination was associated with indicators of greater disease severity suggestive of waning protection over time.

Depression, worry, and loneliness are associated with subsequent risk of hospitalization for COVID-19: a prospective study.

BACKGROUND: Pre-pandemic psychological distress is associated with increased susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but associations with the coronavirus disease 2019 (COVID-19) severity are not established. The authors examined the associations between distress prior to SARS-CoV-2 infection and subsequent risk of hospitalization. METHODS: Between April 2020 (baseline) and April 2021, we followed 54 781 participants from three ongoing cohorts: Nurses' Health Study II (NHSII), Nurses' Health Study 3 (NHS3), and the Growing Up Today Study (GUTS) who reported no current or prior SARS-CoV-2 infection at baseline. Chronic depression was assessed during 2010-2019. Depression, anxiety, worry about COVID-19, perceived stress, and loneliness were measured at baseline. SARS-CoV-2 infection and hospitalization due to COVID-19 was self-reported. Relative risks (RRs) were calculated by Poisson regression. RESULTS: 3663 participants reported a positive SARS-CoV-2 test (mean age = 55.0 years, standard deviation = 13.8) during follow-up. Among these participants, chronic depression prior to the pandemic [RR = 1.72; 95% confidence interval (CI) 1.20-2.46], and probable depression (RR = 1.81, 95% CI 1.08-3.03), being very worried about COVID-19 (RR = 1.79; 95% CI 1.12-2.86), and loneliness (RR = 1.81, 95% CI 1.02-3.20) reported at baseline were each associated with subsequent COVID-19 hospitalization, adjusting for demographic factors and healthcare worker status. Anxiety and perceived stress were not associated with hospitalization. Depression, worry about COVID-19, and loneliness were as strongly associated with hospitalization as were high cholesterol and hypertension, established risk factors for COVID-19 severity. CONCLUSIONS: Psychological distress may be a risk factor for hospitalization in patients with SARS-CoV-2 infection. Assessment of psychological distress may identify patients at greater risk of hospitalization. Future work should examine whether addressing distress improves physical health outcomes.

Association of Treatment with Remdesivir and 30-day Hospital Readmissions in Patients Hospitalized with COVID-19.

BACKGROUND: Since the beginning of COVID-19 pandemic, there has been a widespread use of remdesivir in adults and children. There is little known information about remdesivir's role in reducing 30-day readmissions after hospitalization with COVID-19. This study aimed to determine whether treatment with remdesivir was associated with reduced risk of 30-day readmission after index hospitalization with COVID-19. METHODS: The study was a multi-center cohort study in Rhode Island, USA. Patients included all adults that were discharged after hospital treatment for COVID-19 between April 1st and December 31st, 2020. The main study outcomes were length of hospital stay, 30-day readmission, and post-discharge 30 days mortality. RESULTS: A total of 2,062 patients (2,279 hospitalizations) were included in the analytic sample. Patients were less likely to be readmitted within 30 days if they received remdesivir relative to not receiving remdesivir; associations were strongest for those with mild disease (RR: 0.31; 95% CI: 0.13,0.75). Remdesivir treatment was associated with reduction in all-cause mortality (HR: 0.65; 95% CI: 0.49,0.85) and an increase in length of stay (estimated average increase of 3.27 days; 95% CI: 2.11,4.44). LIMITATION: Unmeasured factors such as time-to-treatment and severity of disease prior to initiation of remdesivir. CONCLUSIONS: Remdesivir may be an effective strategy for reducing progression to severe COVID-19 disease and limiting morbidity associated with readmission to hospital. Larger prospective studies are justified to study the role of remdesivir in mild or early COVID-19 with high risk of disease progression and readmission to hospital within 30 days.

Pressure on the Health-Care System and Intensive Care Utilization During the COVID-19 Outbreak in the Lombardy Region of Italy: A Retrospective Observational Study in 43,538 Hospitalized Patients.

During the spring of 2020, the coronavirus disease 2019 (COVID-19) epidemic caused an unprecedented demand for intensive-care resources in the Lombardy region of Italy. Using data on 43,538 hospitalized patients admitted between February 21 and July 12, 2020, we evaluated variations in intensive care unit (ICU) admissions and mortality over the course of 3 periods: the early phase of the pandemic (February 21-March 13), the period of highest pressure on the health-care system (March 14-April 25, when numbers of COVID-19 patients exceeded prepandemic ICU bed capacity), and the declining phase (April 26-July 12). Compared with the early phase, patients aged 70 years or more were less often admitted to an ICU during the period of highest pressure on the health-care system (odds ratio (OR) = 0.47, 95% confidence interval (CI): 0.41, 0.54), with longer ICU delays (incidence rate ratio = 1.82, 95% CI: 1.52, 2.18) and lower chances of dying in the ICU (OR = 0.47, 95% CI: 0.34, 0.64). Patients under 56 years of age had more limited changes in the probability of (OR = 0.65, 95% CI: 0.56, 0.76) and delay to (incidence rate ratio = 1.16, 95% CI: 0.95, 1.42) ICU admission and increased mortality (OR = 1.43, 95% CI: 1.00, 2.07). In the declining phase, all quantities decreased for all age groups. These patterns may suggest that limited health-care resources during the peak phase of the epidemic in Lombardy forced a shift in ICU admission criteria to prioritize patients with higher chances of survival.