Features of the COVID-19 Epidemic Process in Each of the of the Five Waves of Morbidity in Russia

Relevance. An assessment of the characteristics of the different phases of the COVID-19 pandemic is clearly of interest. Aim. To assess the intensity of the epidemic process in each of the five waves of COVID-19 in Russia. Materials and methods. The data on morbidity, hospitalization and deaths from COVID-19 of the population as a whole and by age groups from 48 (in the I rise) to 54 cities (in the V wave) and data from the website of the Russian consortium for sequencing coronavirus genomes were analyzed. Results. The nature of the course of the first 5 waves in the incidence of COVID-19 in Russia remains undulating. The waves in morbidity began in megacities, and the direction of spread across the FD differed in different waves of morbidity. The results of gene sequencing showed the participation of the main genovariants of the coronavirus in the etiology of diseases up to 3-4 waves. Some genovariants identified earlier received maximum distribution in the following wave. In Russia, the European descendants of the Wuhan strain (74.4%) were dominant in the I wave in morbidity, in the II wave – its daughter genovariants (68.5%), in the III – AY.122 (80.1%), in the IV – AY.122 (84.7%) and in the V wave – Omicron (76.7%). Conclusions. The features of each wave in the incidence of COVID-19 depended on the properties of the dominant genovariants: their ability to transmit from person to person and virulence. The rate of spread of the epidemic by FD, the susceptibility of all age groups and the intensity of epidemics were maximal during the period of the V wave in morbidity with the Omicron gene variant. Mortality was minimal in the I wave of morbidity, maximal in the IV with AY.122 strains and low in the V wave with Omicron genovariants. The influence of the season of the year was manifested in the summer season by an increase in the incidence of COVID-19 earlier in the Russian Federation as a whole (immediately after megacities) than in most federal districts, but with a lower incidence. © 2023, Numikom. All rights reserved.

USES OF THE SKEW-LOGISTIC FUNCTION FOR MULTI-WAVE FUNCTIONS

The Skew-Logistic (SL) function has been proposed to model a real-life dynamic process which rises monotonically to a peak followed by a monotonic falling back. It was introduced to model the first stage of the Covid-19 pandemic to forecast its behaviour. Then, with different controls and variants, Covid-19 - rose and fell in what might be called a Multi-Wave (MW) behaviour;with waves not necessarily the same size. This paper shows how using the SL function for one wave can be easily modified to model the MW situation. We apply it to two examples. One is to Covid-19, to examine its most recent behaviour. We also apply it to climate change, the most serious issue of our time. Ensuring that the world simply achieves carbon-equality is not enough. We have to rapidly achieve carbon-negativity to prevent bringing an end to the known world. © SW 2023.All rights reserved

Pulmonary Rehabilitation Outcomes of Post-Acute COVID-19 Patients during Different Waves of the Pandemic.

(1) Background: Between the beginning of the coronavirus pandemic and summer 2022, we distinguished four pandemic waves, with different characteristics of the affected patients. This study investigated the impact of patient characteristics on the outcome of inpatient pulmonary rehabilitation (PR). (2) Methods: Using a prospective approach, the characteristics of post-acute COVID-19 patients of the different waves who participated in inpatient PR were compared based on their assessments and results collected as part of PR (Cumulative Illness Rating Scale (CIRS), six-minute walk test (6-MWT), Pulmonary Function Testing (PFT), and Functional Independent Measurement (FIM). (3) Results: A total of 483 patients were included in the analysis (Wave 1 n = 51, Wave 2 n = 202, Wave 3 n = 84, Wave 4 n = 146). Compared to Wave 3 + 4, patients of Wave 1 + 2 were older (69 vs. 63 years; p < 0.001), had a significantly lower CIRS (13.0 vs. 14.7 points; p = 0.004), had significant better PFT (FVC: 73 vs. 68%pred; p = 0.009; DLCOSB: 58 ± 18 vs. 50 ± 17%pred; p = 0.001), and showed significantly more comorbidities (2.0 vs. 1.6 n/pers.; p = 0.009). Wave 3 + 4 showed significantly greater improvements according to the 6-MWT (147 vs. 188 m; p < 0.001) and the FIM (5.6 vs. 21.1 points; p < 0.001). (4) Conclusions: Patients of the COVID-19 infection waves differed significantly according to their anthropometric data, incidence of comorbidities, and impact of the infection. All cohorts achieved clinically relevant and significant functional improvements during PR, with significant higher improvements in Wave 3 + 4.

COVID-19 Waves and Politics in Costa Rica

In 2018, the government that came to power in Costa Rica quickly began to promote socially regressive policies, which directly favored the oligarchic groups, at the expense of the working classes and the middle sectors. The COVID-19 pandemic, instead of stopping this process, accentuated it. After a very moderate first wave of infections (March-May 2020), the disease spread steadily during a second wave (June 2020-February 2021). A third wave (so far May-June 2021) has brought the public health system to the brink of collapse. With the social protests neutralized by health measures to contain COVID-19, authorities took advantage of this situation to promote new reforms that deteriorate labor rights, reduce wages and deepen inequalities. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Comparative Study of the Myocardium of Patients from Four COVID-19 Waves.

BACKGROUND: Few studies have compared COVID-19 patients from different waves. This study aims to conduct a clinical and morphological analysis of patients who died from COVID-19 during four waves. METHODS: The study involved 276 patients who died from COVID-19 during four waves, including 77 patients in the first wave, 119 patients in the second wave, and 78 patients in the third wave. We performed a histological examination of myocardium samples from autopsies and additionally analyzed the samples by PCR. We conducted immunohistochemistry of the myocardium for 21 samples using antibodies against CD3, CD45, CD8, CD68, CD34, Ang1, VWF, VEGF, HLA-DR, MHC1, C1q, enteroviral VP1, and SARS-CoV-2 spike protein. We also did immunofluorescent staining of three myocardial specimens using VP1/SARS-CoV-2 antibody cocktails. Further, we ran RT-ddPCR analysis for 14 RNA samples extracted from paraffin-embedded myocardium. Electron microscopic studies of the myocardium were also performed for two samples from the fourth wave. RESULTS: Among the 276 cases, active myocarditis was diagnosed in 5% (15/276). Of these cases, 86% of samples expressed VP1, and individual cells contained SARS-CoV-2 spike protein in 22%. Immunofluorescence confirmed the co-localization of VP1 and SARS-CoV-2 spike proteins. ddPCR did not confidently detect SARS-CoV-2 RNA in the myocardium in any myocarditis cases. However, the myocardium sample from wave IV detected a sub-threshold signal of SARS-CoV-2 by qPCR, but myocarditis in this patient was not confirmed. Electron microscopy showed several single particles similar to SARS-CoV-2 virions on the surface of the endothelium of myocardial vessels. A comparison of the cardiovascular complication incidence between three waves revealed that the incidence of hemorrhage (48 vs. 24 vs. 17%), myocardial necrosis (18 vs. 11 vs. 4%), blood clots in the intramural arteries (12 vs. 7 vs. 0%), and myocarditis (19 vs. 1 vs. 6%) decreased over time, and CD8-T-killers appeared. Immunohistochemistry confirmed the presence of endotheliitis in all 21 studied cases. CONCLUSIONS: This study compared myocardial damage in patients who died during three COVID-19 waves and showed a decrease in the incidence of endotheliitis complications (thrombosis, hemorrhage, necrosis) and myocarditis over time. However, the connection between myocarditis and SARS-CoV-2 infection remains unproven.

Resurgence COVID-19 in Indonesia: Response to the Critical Waves of Pandemic

Indonesia has experienced the third wave of the COVID-19 pandemic. The number of people who have been confirmed positive has now approached 5, 505, 000 with the number of deaths approaching 148, 000 people per February 26, 2022. About 52% out of more than 208 million targeted people had completed the 2nd vaccination. Our paper aims to provide detailed reporting and analyses of the present rapid responses to COVID-19 up to the end of February 2022 in Indonesia. We particularly highlight responses taken by the governments, non-government organizations, and the community. We outline gaps and limitations of Indonesia's responses to the development of the COVID-19 pandemic and the success stories to overcoming it. We present some strategies and recommendations toward more rapid, effective, and comprehensive current responses as well as for post-epidemic. © TheEditor(s) (ifapplicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2021, 2022.

A new look at stock price-exchange rate nexus: Analysis of COVID-19 pandemic waves in advanced and emerging economies.

This study takes a new look at the stock price-exchange rate nexus and attempts contributions to the extant studies in a number of intuitive ways. First, we analyze the reverse relationships given the theory-backed two-way causality between the two variables. We reassess the nexus across the First, Second and Third Waves of the COVID-19 pandemic, as well as comparison between advanced and emerging economies. Third, we adopt a panel modeling approach that simultaneously takes nonstationarity, cross sectional dependence, and asymmetry into account. The data analyses show that the relationship is statistically negative for the two nexuses. The magnitudes were higher during the crisis (the COVID-19 pandemic) although the relationship broke down during the Second Wave as the Delta variant surged. We identify relevant investment and policy implications of the findings.

Molecular determinants associated with temporal succession of SARS-CoV-2 variants in Uttar Pradesh, India.

The emergence and rapid evolution of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) caused a global crisis that required a detailed characterization of the dynamics of mutational pattern of the viral genome for comprehending its epidemiology, pathogenesis and containment. We investigated the molecular evolution of the SASR-CoV-2 genome during the first, second and third waves of COVID-19 in Uttar Pradesh, India. Nanopore sequencing of the SARS-CoV-2 genome was undertaken in 544 confirmed cases of COVID-19, which included vaccinated and unvaccinated individuals. In the first wave (unvaccinated population), the 20A clade (56.32%) was superior that was replaced by 21A Delta in the second wave, which was more often seen in vaccinated individuals in comparison to unvaccinated (75.84% versus 16.17%, respectively). Subsequently, 21A delta got outcompeted by Omicron (71.8%), especially the 21L variant, in the third wave. We noticed that Q677H appeared in 20A Alpha and stayed up to Delta, D614G appeared in 20A Alpha and stayed in Delta and Omicron variants (got fixed), and several other mutations appeared in Delta and stayed in Omicron. A cross-sectional analysis of the vaccinated and unvaccinated individuals during the second wave revealed signature combinations of E156G, F157Del, L452R, T478K, D614G mutations in the Spike protein that might have facilitated vaccination breach in India. Interestingly, some of these mutation combinations were carried forward from Delta to Omicron. In silico protein docking showed that Omicron had a higher binding affinity with the host ACE2 receptor, resulting in enhanced infectivity of Omicron over the Delta variant. This work has identified the combinations of key mutations causing vaccination breach in India and provided insights into the change of [virus's] binding affinity with evolution, resulting in more virulence in Delta and more infectivity in Omicron variants of SARS-CoV-2. Our findings will help in understanding the COVID-19 disease biology and guide further surveillance of the SARS-CoV-2 genome to facilitate the development of vaccines with better efficacies.

Comparison of COVID-19 Severity and Mortality Rates in the First Four Epidemic Waves in Hungary in a Single-Center Study with Special Regard to Critically Ill Patients in an Intensive Care Unit.

Different variants of coronavirus 2 (SARS-CoV-2), a virus responsible for severe acute respiratory syndrome, caused several epidemic surges in Hungary. The severity of these surges varied due to the different virulences of the variants. In a single-center, retrospective, observational study, we aimed to assess and compare morbidities and mortality rates across the epidemic waves I to IV with special regard to hospitalized, critically ill patients. A significant difference was found between the surges with regard to morbidity (p < 0.001) and ICU mortality (p = 0.002), while in-hospital mortality rates (p = 0.503) did not differ significantly. Patients under invasive ventilation had a higher incidence of bloodstream infection (aOR: 8.91 [4.43-17.95] p < 0.001), which significantly increased mortality (OR: 3.32 [2.01-5.48]; p < 0.001). Our results suggest that Waves III and IV, caused by the alpha (B.1.1.7) and delta (B.1.617.2) variants, respectively, were more severe in terms of morbidity. The incidence of bloodstream infection was high in critically ill patients. Our results suggest that clinicians should be aware of the risk of bloodstream infection in critically ill ICU patients, especially when invasive ventilation is used.

Clinical Characteristics and Outcomes of Patients with Acute Respiratory Failure Due to SARS-CoV-2 Interstitial Pneumonia Treated with CPAP in a Medical Intermediate Care Setting: A Retrospective Observational Study on Comparison of Four Waves.

BACKGROUND: In COVID-19 patients non-invasive-positive-pressure-ventilation (NIPPV) has held a challenging role to reduce mortality and the need for invasive mechanical ventilation (IMV). The aim of this study was to compare the characteristics of patients admitted to a Medical Intermediate Care Unit for acute respiratory failure due to SARS-CoV-2 pneumonia throughout four pandemic waves. METHODS: The clinical data of 300 COVID-19 patients treated with continuous positive airway pressure (CPAP) were retrospectively analysed, from March-2020 to April-2022. RESULTS: Non-survivors were older and more comorbid, whereas patients transferred to ICU were younger and had fewer pathologies. Patients were older (from 65 (29-91) years in I wave to 77 (32-94) in IV, p < 0.001) and with more comorbidities (from Charlson's Comorbidity Index = 3 (0-12) in I to 6 (1-12) in IV, p < 0.001). No statistical difference was found for in-hospital mortality (33.0%, 35.8%, 29.6% and 45.9% in I, II, III and IV, p = 0.216), although ICU-transfers rate decreased from 22.0% to 1.4%. CONCLUSIONS: COVID-19 patients have become progressively older and with more comorbidities even in critical care area; from risk class analyses by age and comorbidity burden, in-hospital mortality rates remain high and are thus consistent over four waves while ICU-transfers have significantly reduced. Epidemiological changes need to be considered to improve the appropriateness of care.

Interplay of pandemic and seasonal parameters in dental emergency service.

BACKGROUND: To evaluate the relationship between pandemic events and dental emergency service frequentation. Utilization patterns in the scope of the COVID-19 pandemic were analyzed and considered in regard of seasonal parameters. METHODS: All outpatients seeking treatment in a university hospital's dental emergency service were analyzed in the years 2019, 2019 and 2020 according to demographic data and emergencies were subdivided into "absolute" and "relative". The years 2018 and 2019 were used to compare COVID-19 and non-COVID-19 phases. Defined waves of the pandemic were compared with equivalent prior-year periods. RESULTS: Our study includes 11,219 dental emergency patients over a period of three years with a slight surplus of male patients. Comparing the pre-COVID-19 years and 2020 as a year of pandemic, the total count of cases decreased by more than 25%. The share of absolute emergencies in 2020 was higher than in the years before (p < 0.0001). The under-utilization during the waves was more pronounced during the first wave compared to the second waves. CONCLUSIONS: Additionally to the clear decrease by more than 25% in 2020, we found an inverse dependency of 7-day-incidence of COVID-19 and number of visits. This effect was more distinct for relative emergencies, while the number of patients with absolute emergencies remains rather constant. Probably, there is an acclimatization effect regarding the waves. Patients older than 60 years who suffered from relative emergencies showed an under-utilzation during 2020. During a pandemic such as COVID-19, the effect of under-utilization is more pronounced among elderly patients. However, a pandemic acclimatization effect seems to occur. This can be taken into account in the administration of this kind of circumstances in the future.

Five waves of the COVID-19 pandemic and green-blue spaces in urban and rural areas in Poland.

Several waves of COVID-19 caused by different SARS-CoV-2 variants have been recorded worldwide. During this period, many publications were released describing the influence of various factors, such as environmental, social and economic factors, on the spread of COVID-19. This paper presents the results of a detailed spatiotemporal analysis of the course of COVID-19 cases and deaths in five waves in Poland in relation to green‒blue spaces. The results, based on 380 counties, reveal that the negative correlation between the indicator of green‒blue space per inhabitant and the average daily number of COVID-19 cases and deaths was clearly visible during all waves. These relationships were described by a power equation (coefficient of determination ranging from 0.83 to 0.88) with a high level of significance. The second important discovery was the fact that the rates of COVID-19 cases and deaths were significantly higher in urban counties (low values of the green-blue space indicator in m2/people) than in rural areas. The developed models can be used in decision-making by local government authorities to organize anti-COVID-19 prevention measures, including local lockdowns, especially in urban areas.

Time Series Analysis of COVID-19 Waves in India for Social Good

In the past decade, the world has seen rapid advancements in the field of healthcare services due to the state of the arts in technologies. Several real-time health monitoring applications and products are designed to assist the human to take the timely precautionary measures to avoid the unseen abnormalities. However, current healthcare monitoring infrastructures are not ready to provide efficient health services during the sudden and unknown pandemic situations such as COVID-19. The COVID-19 started in the later part of 2019, rapidly spread across the countries and labeled as a pandemic in the very early part of the 2020. Several people died due to the lack of the healthcare infrastructure and lack of access to health facilities. This book chapter explores the various technologies such as augmented reality, connected e-health along with the time series analysis of COVID-19 waves in India to know the implication of COVID-19 on society for a social good. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Stock market in the age of COVID19: Mere acclimatization or Stockholm syndrome?

We investigate the behavior of stock prices to variations in COVID19 infection rate over time. To study the inter-temporal impact of the pandemic on major stock indexes, we apply factor model, and disaggregate the sample period in three COVID19 waves. We bring interesting evidence on the so-called immune behavior of stock indexes. While no signs of stock market immunity to the disease were confirmed, the opportunities created by the pandemic would help new winners, causing a shift of sectoral gains. Distinguishing the surges from plunges in the COVID19 infections, we observe the behavior of stock indexes towards different scenarios during the pandemic. While the conventional wisdom may lead to an overall probable pessimistic outcome, we find that diversity and speedy adjustment based on new business models resulted in sizable theoretical inconsistencies and asymmetries in the response of stock indexes to the pandemic.

The impacts of the COVID-19 pandemic on surface passenger transport and related CO2 emissions during different waves

The coronavirus pandemic has severely impacted our day-to-day activities and brought about significant change in all major sectors, especially surface passenger transport. Lockdowns and stay-at-home restrictions have significantly reduced energy demand and consequently CO2 emissions of surface passenger transport. The change in CO2 emissions is calculated from near-real-time activity change data as a function of 3 confinement levels. The activity change and related emission trends reflect changes in the mode of transport during different waves, this can be used to understand mobility trends and patterns when stringent measures are imposed. Consequently, constructive use of this data can help prepare and develop the transport sector in case of another epidemic outbreak or other unprecedented calamities and to build a resilient transport infrastructure post-COVID-19. This study estimates and analyzes the changes in CO2 emissions associated with the public (bus and rail) and private surface passenger transport from March 1(st), 2020 to Jan 31(st), 2021 in 21 countries. The research period covers the 1(st) and the 2(nd) waves of COVID-19 in these countries. A higher activity reduction and consequently CO2 emission reduction is displayed during the 1(st) wave compared to the 2(nd) for most countries despite implementing stringent measures during both waves. This is in line with countries adapting to the 'new normal' and restarting socio-economic activities. Similarly, public transport recovery is slower than private transport recovery, making it essential to focus on reinforcement and adaptation of public transport infrastructure for the future. The results show that a cumulative 510 Mt CO2 has been reduced over 11 months in 21 countries, compared to pre-pandemic levels. This reduction brings about a 6% drop in transport CO2 emissions and a 1.5% drop in global CO2 emissions. This analysis sheds light on mobility trends and travel behavior of surface passenger transport modes and related CO2 emissions in different countries which can be used to exemplify the path to recovery based on near-real-time data.

The psychological response and perception of stress during the COVID-19 pandemic in Slovenia: Three-wave repeated cross-sectional study.

In addition to COVID-19 being a health threat, its longevity and restrictions act as significant stressors and risk for mental health. In the current study, we take a look at how psychological response, both its positive aspects, for example, mental well-being and life satisfaction, and its negative aspects, for example, anxiety and COVID-19 anxiety, have changed as the pandemic has continued (first three waves in Slovenia). Additionally, we are interested in whether the psychological response is associated with the perception of stress level in waves 2 and 3 as less, equally or more stressful when compared to the stress level in wave 1 and what shapes these perceptions. An online questionnaire battery (COVID-19 stress level comparison, Warwick-Edinburgh Mental Well-being Scale; LAOM Anxiety Scale; Global Life Satisfaction scale; COVID-19 anxiety), with ANOVA and qualitative analysis of the open-ended question on reasons for perceiving wave 2 and wave 3 as more stressful when compared to wave 1, was used on a Slovene convenience adult sample (wave 1: N = 364, 83.5% female; wave 2: N = 987, 85.5% female; wave 3: N = 467, 78.5% female). The findings show (a) a significant increase in COVID-19 anxiety from wave 1 to wave 3, with a peak in wave 2, and a significant decrease in mental well-being from wave 1 to wave 3; (b) the level of anxiety, mental well-being, and life satisfaction differs significantly between individuals who perceive wave 2 and 3 as more stressful compared to individuals who perceive wave 2 and wave 3 as equally or less stressful when compared to wave 1; (c) reasons for perceiving the succeeding waves of the pandemic as more stressful compared to wave 1 are diverse, with some being reported in both succeeding waves (e.g., negative emotional response to the pandemic, negative perceptions of measures). The findings highlight the important role of stress analysis in identifying the support mechanisms for dealing with the challenges of the COVID-19 pandemic.

Wave comparisons of clinical characteristics and outcomes of COVID-19 admissions - Exploring the impact of treatment and strain dynamics.

OBJECTIVES: Dexamethasone has now been incorporated into the standard of care for COVID-19 hospital patients. However, larger intensive care unit studies have failed to show discernible improvements in mortality in the recent wave. We aimed to investigate the impacts of these factors on disease outcomes in a UK hospital study. METHODS: This retrospective observational study reports patient characteristics, interventions and outcomes in COVID-19 patients from a UK teaching hospital; cohort 1, pre 16th June-2020 (pre-dexamethasone); cohort 2, 17th June to 30th November-2020 (post-dexamethasone, pre-VOC 202,012/01 as dominant strain); cohort 3, 1st December-2020 to 3rd March-2021 (during establishment of VOC202012/01 as the dominant strain). RESULTS: Dexamethasone treatment was more common in cohorts 2 and 3 (42.7% and 51.6%) compared with cohort 1 (2.5%). After adjusting for risk, odds of death within 28 days were 2-fold lower in cohort 2 vs 1 (OR:0.47,[0.27,0.79],p = 0.006). Mortality was higher cohort 3 vs 2 (20% vs 14%); but not significantly different to cohort 1 (OR: 0.86,[0.64, 1.15],p = 0.308). CONCLUSIONS: The real world finding of lower mortality following dexamethasone supports the published trial evidence and highlights ongoing need for research with introduction of new treatments and ongoing concern over new COVID-19 variants.

Incidence of Pneumothorax and Pneumomediastinum in 497 COVID-19 Patients with Moderate-Severe ARDS over a Year of the Pandemic: An Observational Study in an Italian Third Level COVID-19 Hospital.

(1) Background: COVID-19 is a novel cause of acute respiratory distress syndrome (ARDS). Indeed, with the increase of ARDS cases due to the COVID-19 pandemic, there has also been an increase in the incidence of cases with pneumothorax (PNX) and pneumomediastinum (PNM). However, the incidence and the predictors of PNX/PMN in these patients are currently unclear and even conflicting. (2) Methods: The present observational study analyzed the incidence of barotrauma (PNX/PNM) in COVID-19 patients with moderate-severe ARDS hospitalized in a year of the pandemic, also focusing on the three waves occurring during the year, and treated with positive-pressure ventilation (PPV). We collected demographic and clinical data. (3) Results: During this period, 40 patients developed PNX/PNM. The overall incidence of barotrauma in all COVID-19 patients hospitalized in a year was 1.6%, and in those with moderate-severe ARDS in PPV was 7.2% and 3.8 events per 1000 positive-pressure ventilator days. The incidence of barotrauma in moderate-severe ARDS COVID-19 patients during the three waves was 7.8%, 7.4%, and 8.7%, respectively. Treatment with noninvasive respiratory support alone was associated with an incidence of barotrauma of 9.1% and 2.6 events per 1000 noninvasive ventilator days, of which 95% were admitted to the ICU after the event, due to a worsening of respiratory parameters. The incidence of barotrauma of ICU COVID-19 patients in invasive ventilation over a year was 5.8% and 2.7 events per 1000 invasive ventilator days. There was no significant difference in demographics and clinical features between the barotrauma and non-barotrauma group. The mortality was higher in the barotrauma group (17 patients died, 47.2%) than in the non-barotrauma group (170 patients died, 37%), although this difference was not statistically significant (p = 0.429). (4) Conclusions: The incidence of PNX/PNM in moderate-severe ARDS COVID-19 patients did not differ significantly between the three waves over a year, and does not appear to be very different from that in ARDS patients in the pre-COVID era. The barotrauma does not appear to significantly increase mortality in COVID-19 patients with moderate-severe ARDS if protective ventilation strategies are applied. Attention should be paid to the risk of barotrauma in COVID-19 patients in noninvasive ventilation because the event increases the probability of admission to the intensive care unit (ICU) and intubation.

Efficacy and Safety of Remdesivir over Two Waves of the SARS-CoV-2 Pandemic.

The aim of this study is to describe the features, the outcomes, and the clinical issues related to Remdesivir administration of a cohort of 220 patients (pts) with COVID-19 hospitalized throughout the last two pandemic waves in Italy. One hundred and nine pts were enrolled from 1 September 2020, to 28 February 2021 (Group A) and 111 from 1 March to 30 September 2021 (Group B). Notably, no differences were reported between the two groups neither in the timing of hospitalization. nor in the timing of Remdesivir administration from symptoms onset. Remarkably, a higher proportion of pts with severe COVID-19 was observed in Group B (25% vs. 10%, p < 0.001). At univariate and multivariate analysis, rather than the timing of Remdesivir administration, age, presence of coexisting conditions, D-dimers, and O2 flow at admission correlated positively to progression to non-invasive ventilation, especially for patients in Group B. However, the rate of admission in the Intensive Care Unit and/or death was comparable in the two groups (7% vs. 4%). Negligible variations in serum GOT, GPT, GGT, and eGFR levels were detected. A mean reduction in heart rate was noticed within the first three days of antiviral treatment (p < 0.001). Low rate of ICU admission, high rate of clinical recovery, and good drug safety were observed in COVID-19 patients treated with Remdesivir during two diverse pandemic waves.