Assessment the Psychological Mindsets and Effectiveness of COVID-19 Vaccines, Occurrence and Severity of Covid-19 Infection among Vaccinated People in Iraq

Background: The World Health Organization had declared the release of COVID-19 vaccines in September 2020 and after. mRNA vaccine "Pfizer Biotech” and the adenoviral vector vaccine CoV-19 (AstraZeneca-Oxford) were granted emergency use. Researchers found that effectiveness of AstraZeneca and Pfizer vaccine is (70% and 95%) respectively. While the inactivated SARS-CoV-2 vaccine (Sinopharm) is safe, effective (effectiveness more than 50%) as WHO's declared. Sinopharm was the first vaccine that had been administered to Iraqi population. Only 2% of population had been vaccinated despite the efficacy and acceptability of it. Several studies conducted in different countries to assess the effectiveness of Covid-19 vaccines and its safety. Aim: This study done to assess the frequency of post vaccination infection with COVID-19 and accompanying signs and symptoms in different vaccine companies that are available in Iraq (Sinopharm, AstraZeneca-Oxford and Pfizer-BioNTech). Patients and methods: The study is a cross-sectional study conducted from 11th November 2021 to 15th March 2022 that included 500 Iraqi persons vaccinated with COVID-19 vaccine with either Pfizer, AstraZeneca or Sinopharm, Patients were chosen by Convenient sampling from different Iraqi governorate. All data management and analysis done by manual statistical methods. Results: From total 500 patients participated in the study with full doses vaccination (2 doses as recommended) there were (25%) person get covid-19 infection. Majority of infection occurred after 6 months of 2nd dose. Majority of postvaccination infections with Pfizer vaccine were with mild to moderate symptoms without need hospitalizations in comparison to (5.56%), (3.13%) hospitalizations rate and severe infection post AstraZeneca and Sinopharm vaccines respectively. Conclusion: Full vaccination of two doses of (Pfizer, AstraZeneca, Sinopharm) are highly effective in decrease the severity of COVID-19 infection signs and symptoms, decrease rate of hospitalizations. High efficacy of Pfizer vaccine than AstraZeneca and Sinopharm vaccines. © 2023,ournal for ReAttach Therapy and Developmental Diversities. All Rights Reserved.

Association between IL-6 rs1800795 and IL-1β rs 16944 gene polymorphisms with clinical severity of COVID-19 patients in Surakarta, Central Java, Indonesia

Background: Cytokine plays a pivotal role in the pathogenesis of coronavirus disease 2019 (COVID-19). Cytokine storm is characterized by rapid elevation of an inflammatory circulating cytokine such as interleukin-6 (IL-6) and IL-1. However, according to evidence, genetic variables may affect the development and course of infectious diseases. Multiple genetic polymorphisms, mostly single-nucleotide polymorphisms (SNPs), have been linked to this setting's predisposition to viral infections. This study aimed to determine the frequency distribution of IL-6 SNPs rs1800795 and IL-1β SNPs rs16944 and rs1143627 gene polymorphisms and their association with the clinical severity of COVID-19 patients in Surakarta, Indonesia. This study aims to determine the association between IL-6 rs1800795 and IL-1β rs16944 with COVID-19 clinical severity. Methods: This study used a cross sectional design conducted at Universitas Sebelas Maret Hospital and centralized isolation of the Donohudan Hajj Dormitory from May to November 2021. A total of 120 COVID-19 patients were divided into 3 groups: asymptomatic, mild-moderate, and severe-critical. The detection of IL-6 SNPs rs1800795 and IL-1β SNPs rs16944 was carried out by quantitative PCR (qPCR) examination, and IL-6 and IL-1β were determined by the ELISA method. Result: There was no significant association between IL-6 SNPs rs1800795 (p=1.000) and IL-1β SNPs rs16944 (p=0.119) with clinical severity. In IL-1β SNPs rs16944 gene polymorphisms, the GG genotype was more commonly found in the asymptomatic group. AG genotype was commonly found in the symptomatic group (mild to critical). There was a significant association between IL-1β levels and clinical severity (p=0.03), whereas the association between IL-6 levels and clinical severity is not significant (p=0.103). Conclusion: There was a correlation between IL-1β levels with clinical severity. In IL-1β SNPs rs16944, the GG genotype may act as a protective factor, whereas the AG genotype may act as a factor that increases the clinical severity of COVID-19. © 2023, Sanglah General Hospital. All rights reserved.

Evaluation of the Relationship Between Disease Severity and Viral Cycle Threshold Value in COVID-19 Patients

Objective: There is a positive and significant relationship between severity and viral load in some viral diseases. Studies on the relationship between SARS-CoV-2 viral load at diagnosis and severity of coronavirus disease-2019 (COVID-19) have yielded conflicting results. Therefore, we aimed to evaluate the relationship between viral load and the clinical status of patients with COVID-19.Methods: Data of the patients diagnosed with COVID-19 and admitted to our center between May 01 and June 31, 2020, were retrospectively reviewed. The patients were divided into two groups according to their clinical character-istics as mild-moderate and severe. The demographic, laboratory, clinical, and radiological data were retrieved from electronic folders.Results: The entire cohort included 285 patients;254 had a mild-moderate clinical course, and 31 had a severe course. Statistical analyses revealed that SARS-CoV-2 viral load was not associated with symptom duration and clinical status (p>0.05). According to multivariate logistic regression analysis, only ferritin, C-reactive protein, and lactate dehydro-genase elevations were positively correlated with severe clinical course. (p<0.05).Conclusion: We do not recommend using viral load to predict disease severity in COVID-19. We also found that only ferritin, C-reactive protein, and lactate dehydrogenase accompanied severe clinical course. Keywords: cycle threshold, COVID-19, clinical severity

The impact of vaccination to clinical severity and mortality of COVID-19 patients

Background: SARS-CoV-2 was discovered in December 2019 and later become global pandemic. Preliminary studies stated that broad vaccine coverage will suppress mortality and incidence of COVID-19. Therefore, we conduct a cross-sectional study to assess the efficacy of COVID-19 vaccination. Materials and Methods: We collected secondary data from electronic medical records of 343 COVID-19 positive patients confirmed via reverse transcription polymerase chain reaction from July 2021 to December 2021. We analyzed epidemiologic data, vaccination history, baseline symptoms, comorbidity, baseline vital signs, and outcome using hypothesis testing χ 2 and logistic regression. Results: Sex had an χ 2 of 9.34 (P 0.001) while type of vaccine had an χ 2 of 1.49 (P = 0.22) to clinical severity. Age, pulse rate, respiration rate, body temperature, and Glasgow coma scale were found to be significant risk factors to clinical severity. Number of vaccines previously received was found to be a protective factor to clinical severity (odds ratio (OR) = 0.49, 95% CI = 0.32-0.74, P 0.001). We also found that sex (χ 2 = 10.42, P 0.001) was a predictor to discharge condition. Moreover, age was also found to be a significant predictor (OR = 1.03, 95% CI = 1.03-1.05, P 0.001), as well as number of symptoms (OR = 0.66, P 0.001), comorbidities (OR = 1.64, P 0.001), pulse rate (OR = 1.04, P 0.001), respiration rate (OR = 1.17, P 0.001), and Glasgow coma scale (OR = 0.72, P = 0.03). Conclusion: Age, sex, number of vaccines received, number of symptoms, number of comorbidities, pulse rate, and respiration rate were significant predictors of clinical severity and outcome in COVID-19 patients. In addition, body temperature was also a predictor for clinical severity, while Glasgow coma scale was a predictor for outcome. © 2023 Bali Journal of Anesthesiology ;Published by Wolters Kluwer - Medknow.

Homologous and Heterologous Prime-Boost Vaccination: Impact on Clinical Severity of SARS-CoV-2 Omicron Infection among Hospitalized COVID-19 Patients in Belgium.

We investigated effectiveness of (1) mRNA booster vaccination versus primary vaccination only and (2) heterologous (viral vector-mRNA) versus homologous (mRNA-mRNA) prime-boost vaccination against severe outcomes of BA.1, BA.2, BA.4 or BA.5 Omicron infection (confirmed by whole genome sequencing) among hospitalized COVID-19 patients using observational data from national COVID-19 registries. In addition, it was investigated whether the difference between the heterologous and homologous prime-boost vaccination was homogenous across Omicron sub-lineages. Regression standardization (parametric g-formula) was used to estimate counterfactual risks for severe COVID-19 (combination of severity indicators), intensive care unit (ICU) admission, and in-hospital mortality under exposure to different vaccination schedules. The estimated risk for severe COVID-19 and in-hospital mortality was significantly lower with an mRNA booster vaccination as compared to only a primary vaccination schedule (RR = 0.59 [0.33; 0.85] and RR = 0.47 [0.15; 0.79], respectively). No significance difference was observed in the estimated risk for severe COVID-19, ICU admission and in-hospital mortality with a heterologous compared to a homologous prime-boost vaccination schedule, and this difference was not significantly modified by the Omicron sub-lineage. Our results support evidence that mRNA booster vaccination reduced the risk of severe COVID-19 disease during the Omicron-predominant period.

Alpha to Omicron: Disease Severity and Clinical Outcomes of Major SARS-CoV-2 Variants.

BACKGROUND: Four SARS-CoV-2 variants predominated in the United States since 2021. Understanding disease severity related to different SARS-CoV-2 variants remains limited. METHOD: Viral genome analysis was performed on SARS-CoV-2 clinical isolates circulating March 2021 through March, 2022 in Cleveland, Ohio. Major variants were correlated with disease severity and patient outcomes. RESULTS: 2779 patients identified with either alpha (N = 1153), gamma (N = 122), delta (N = 808) or omicron variants (N = 696) were selected for analysis. No difference in frequency of hospitalization, ICU admission, and death were found among alpha, gamma, and delta variants. However, patients with omicron infection were significantly less likely to be admitted to the hospital, require oxygen, or admission to the ICU (X2 = 12.8 p < 0.001, X2 = 21.6 p < 0.002, X2 = 9.6 p = 0.01, respectively). In patients whose vaccination status was known, a substantial number had breakthrough infections with delta or omicron variants (218/808 [26.9%] and 513/696 [73.7%], respectively). In breakthrough infections, hospitalization rate was similar regardless of variant by multivariate analysis. No difference in disease severity was identified between omicron sub-variants BA.1 and BA.2. CONCLUSIONS: Disease severity associated with alpha, gamma, and delta variants is comparable while omicron infections are significantly less severe. Breakthrough disease is significantly more common in patients with omicron infection.

COVID-19 increased in Italian children in the autumn and winter 2021-2022 period when Omicron was the dominant variant.

AIM: We examined the prevalence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children during the autumn and winter season from 1 September 2021 to 30 January 2022 and compared it with the same period in 2020-2021. METHODS: This study was carried out int the paediatric emergency department (PED) of a tertiary Italian hospital. We compared the clinical and demographical features of all children who presented during the two study periods and tested positive for SARS-CoV-2. RESULTS: During the 2021-2022 autumn and winter season 5813 children presented to the PED, 19.0% were tested for SARS-CoV-2 and 133 (12.0%) of those tested positive. In 2020-2021, 2914 presented to the PED, 12.3% were tested, and 30 (8.3%) of those tested positive. There were no statistically significant differences in clinical severity during the two study periods, despite a higher percentage of neurological symptoms in 2020-2021. Of the SARS-CoV-2-positive cases, 29/133 (21.8%) were hospitalised during the 2021-2022 season and 10/30 (33.3%) during the previous one. Only 3/163 children required intensive care. CONCLUSION: The greater spread of SARS-CoV-2 was probably due to the greater transmissibility of the Omicron variant, but the symptoms were mild and only 3 children required intensive care.

Highly Prevalent SARS-CoV-2 Antigenemia in COVID-19 Patients

Background:Many issues, such as severity assessment and antibody responses, remain to be answered eagerly for evaluation and understanding of COVID-19. Immune lesion is one of key pathogenesis of the disease. It would be helpful to understand the disease if an investigation on antigenemia and association was conducted in the patients with SARS-CoV-2 infection.Methods:A total of 156 patients admitted to the First People's Hospital of Hefei or Anhui Provincial Hospital on January to February 2020 were involved in this study. SARS-CoV-2 nucleocapsid (NP) antigen, specific IgM/IgG antibodies, and RNA were detected in sequential sera from three COVID-19 patients, and additional 153 COVID-19 patients by means of NP-antigen capture enzyme-linked immunosorbent assay, colloidal gold quick diagnosis, and real-time RT-PCR, respectively. The clinical types of COVID-19 patients were classified into asymptomatic, mild, moderate, severe, and critical, following on the Chinese guideline of COVID-19 diagnosis and treatment. The demographic and clinical data of patients were obtained for comparable analysis.Results:NP antigen was detected in 5 of 20 sequential sera collected from three COVID-19 patients with typically clinical symptoms, and 60.13% (92/153) expanded samples collected within 17 days after illness onset. No SARS-CoV-2 RNA segment was detected in these sera. The NP positive proportion reached a peak (84.85%, 28/33) on 6 to 8 days after illness onset. Both NP concentration and positive proportion were increased with the increase of clinical severity of COVID-19. Compared to NP negative patients, NP positive patients had older age [years, medians (interquartile ranges (IQR)), 49 (6) vs. 31 (11)], lower positive proportion of NP specific IgM [27.17% (25/92) vs. 59.02% (36/61)], and IgG [21.74% (20/92) vs. 59.02% (36/61)] antibodies, and longer duration [days, medians (IQR), 24 (10) vs. 21 (13)] from illness to recovery.Conclusions:SARS-CoV-2 NP antigenemia occurred in COVID-19, and presented highly prevalent at early stage of the disease. The antigenemia was related to clinical severity of the disease, and may be responsible for the delay of detectable SARS-Cov-2 IgM. © 2022 Journal of Bone and Joint Surgery Inc.. All rights reserved.

Evaluation of the Relationship Between Disease Severity and Viral Cycle Threshold Value in COVID-19 Patients

Objective: There is a positive and significant relationship between severity and viral load in some viral diseases. Studies on the relationship between SARS-CoV-2 viral load at diagnosis and severity of coronavirus disease-2019 (COVID-19) have yielded conflicting results. Therefore, we aimed to evaluate the relationship between viral load and the clinical status of patients with COVID-19. Method(s): Data of the patients diagnosed with COVID-19 and admitted to our center between May 01 and June 31, 2020, were retrospectively reviewed. The patients were divided into two groups according to their clinical characteristics as mild-moderate and severe. The demographic, laboratory, clinical, and radiological data were retrieved from electronic folders. Result(s): The entire cohort included 285 patients;254 had a mild-moderate clinical course, and 31 had a severe course. Statistical analyses revealed that SARS-CoV-2 viral load was not associated with symptom duration and clinical status (p>0.05). According to multivariate logistic regression analysis, only ferritin, C-reactive protein, and lactate dehydro-genase elevations were positively correlated with severe clinical course. (p<0.05). Conclusion(s): We do not recommend using viral load to predict disease severity in COVID-19. We also found that only ferritin, C-reactive protein, and lactate dehydrogenase accompanied severe clinical course. Copyright © 2022, DOC Design and Informatics Co. Ltd.. All rights reserved.

The Association Between Clinical Severity and Incubation Period of SARS-CoV-2 Delta Variants: Retrospective Observational Study.

BACKGROUND: As of August 25, 2021, Jiangsu province experienced the largest COVID-19 outbreak in eastern China that was seeded by SARS-CoV-2 Delta variants. As one of the key epidemiological parameters characterizing the transmission dynamics of COVID-19, the incubation period plays an essential role in informing public health measures for epidemic control. The incubation period of COVID-19 could vary by different age, sex, disease severity, and study settings. However, the impacts of these factors on the incubation period of Delta variants remains uninvestigated. OBJECTIVE: The objective of this study is to characterize the incubation period of the Delta variant using detailed contact tracing data. The effects of age, sex, and disease severity on the incubation period were investigated by multivariate regression analysis and subgroup analysis. METHODS: We extracted contact tracing data of 353 laboratory-confirmed cases of SARS-CoV-2 Delta variants' infection in Jiangsu province, China, from July to August 2021. The distribution of incubation period of Delta variants was estimated by using likelihood-based approach with adjustment for interval-censored observations. The effects of age, sex, and disease severity on the incubation period were expiated by using multivariate logistic regression model with interval censoring. RESULTS: The mean incubation period of the Delta variant was estimated at 6.64 days (95% credible interval: 6.27-7.00). We found that female cases and cases with severe symptoms had relatively longer mean incubation periods than male cases and those with nonsevere symptoms, respectively. One-day increase in the incubation period of Delta variants was associated with a weak decrease in the probability of having severe illness with an adjusted odds ratio of 0.88 (95% credible interval: 0.71-1.07). CONCLUSIONS: In this study, the incubation period was found to vary across different levels of sex, age, and disease severity of COVID-19. These findings provide additional information on the incubation period of Delta variants and highlight the importance of continuing surveillance and monitoring of the epidemiological characteristics of emerging SARS-CoV-2 variants as they evolve.

Estimation of disease burden and clinical severity of COVID-19 caused by Omicron BA.2 in Shanghai, February-June 2022.

An outbreak of COVID-19 caused by the SARS-CoV-2 Omicron BA.2 sublineage occurred in Shanghai, China from February 26 to June 30, 2022. We use official reported data retrieved from Shanghai municipal Health Commissions to estimate the incidence of infections, severe/critical infections, and deaths to assess the disease burden. By adjusting for right censoring and RT-PCR sensitivity, we provide estimates of clinical severity, including the infection fatality ratio, symptomatic case fatality ratio, and risk of developing severe/critical disease upon infection. The overall infection rate, severe/critical infection rate, and mortality rate were 2.74 (95% CI: 2.73-2.74) per 100 individuals, 6.34 (95% CI: 6.02-6.66) per 100,000 individuals and 2.42 (95% CI: 2.23-2.62) per 100,000 individuals, respectively. The severe/critical infection rate and mortality rate increased with age, noted in individuals aged 80 years or older. The overall fatality ratio and risk of developing severe/critical disease upon infection were 0.09% (95% CI: 0.09-0.10%) and 0.27% (95% CI: 0.24-0.29%), respectively. Having received at least one vaccine dose led to a 10-fold reduction in the risk of death for infected individuals aged 80 years or older. Under the repeated population-based screenings and strict intervention policies implemented in Shanghai, our results found a lower disease burden and mortality of the outbreak compared to other settings and countries, showing the impact of the successful outbreak containment in Shanghai. The estimated low clinical severity of this Omicron BA.2 epidemic in Shanghai highlight the key contribution of vaccination and availability of hospital beds to reduce the risk of death.

Effect of vitamin A supplementation on the outcome severity of COVID-19 in hospitalized patients: A pilot randomized clinical trial.

INTRODUCTION: Vitamin A is one of the vitamins that is suggested as adjuvant therapy in viral infections due to its immune enhancing role. In the present clinical trial, we intended to assess the effect of vitamin A supplementation on Coronavirus disease-2019 (COVID-19) in hospitalized patients. METHODS: The present pilot randomized controlled clinical trial was conducted on 30 hospitalized patients with COVID-19. Patients in the intervention group received 50000 IU/day intramuscular vitamin A for a maximum of two weeks. Patients in the control group continued their common treatment protocols. All participants were followed up until discharge from the hospital or death. The primary outcome of the study was time to achieve clinical response based on the six classes of an ordinal scale. Time to clinical response was calculated based on the days needed to improve two scores on the scale or patient's discharge. RESULTS: The time to clinical response was not significantly different between the two groups (7.23 ± 2.14 vs. 6.75 ± 1.85 days, respectively, p = 0.48). There was no significant difference between the groups regarding clinical response (hazard ratio: 1.76 [95% CI: 0.73, 4.26]). There were no significant differences between groups regarding the need for mechanical ventilation, duration of hospitalization, or death in the hospital. CONCLUSION: The results of this pilot clinical trial showed no benefit of vitamin A compared with the common treatment on outcome severity in hospitalized patients with COVID-19. Although the results are negative, there is still a great need for future clinical studies to provide a higher level of evidence.

Proportion of asymptomatic infection and nonsevere disease caused by SARS-CoV-2 Omicron variant: A systematic review and analysis.

SARS-CoV-2 Omicron variant seemed to cause milder disease compared to previous predominated variants. We aimed to conduct a meta-analysis to assess the pooled proportion of nonsevere disease and asymptomatic infection among COVID-19 patients infected with Omicron and Delta. We searched PubMed, Embase, Web of Science, and China National Knowledge Infrastructure (CNKI) databases. We included studies of SARS-CoV-2 Omicron infection from November 1, 2021, to April 18, 2022, and studies of Delta infection from October 1, 2020, to June 30, 2022. Studies without corresponding data, with less than 50 patients, or obviously biased concerning main outcome were excluded. Meta-analysis was performed in R 4.2.0 with the "meta" package. Subgroup analyses were conducted by study group and vaccination status. The pooled proportion of asymptomatic infection and nonsevere disease with Omicron were 25.5% (95% confidence interval [CI] 17.0%-38.2%) and 97.9% (95% CI 97.1%-98.7%), significantly higher than those of Delta with 8.4% (95% CI 4.4%-16.2%) and 91.4% (95% CI 87.0%-96.0%). During Omicron wave, children and adolescents had higher proportion of asymptomatic infection, SOTR and the elderly had lower proportion of nonsevere disease, vaccination of a booster dose contributed to higher proportion of both asymptomatic infection and nonsevere disease. This study estimates the pooled proportion of asymptomatic infection and nonsevere disease caused by SARS-CoV-2 Omicron compared to other predominant variants. The result has important implications for future policy making.

Analysis of Chitinase-3-Like Protein 1, IL-1-Alpha, and IL-6 as Novel Inflammatory Biomarkers for COVID-19.

The aim of our study was to investigate the potential role of IL-1-alpha, IL-6, and chitinase 3-like protein-1 (CHI3L1) as potential biomarkers for COVID-19. Sixty adult SARS Cov-2 PCR-positive patients (22 mild, 25 moderate, and 13 severe) and 50 healthy controls were included in this study. The serum levels of CHI3L1, IL-1-alpha, and IL-6 for all study participants were measured by protein-specific ELISAs. Mean serum CHI3L1 levels in patients with severe disease (7,185.5 ± 1,109.4) were significantly higher than in the moderate (3,977.4 ± 1,260.3), mild (1,379.5 ± 598.8), and control (329.5 ± 128.4) groups (P = 0.001). There was no difference in IL-1-alpha levels between the patient and control groups (P = 0.083). IL-6 levels differed significantly, being lowest in the control group (35.9 ± 13.7), 89.1 ± 23.4 in the mild group, 156.2 ± 29.6 in the moderate group, and the highest in the severe group (214.9 ± 28.1) (P = 0.001). A strong significant correlation was found between disease severity and serum IL-6 and CHI3L1 values (r = 0.894 and r = 0.905, respectively, and P < 0.001 for both). Serum CHI3L1 and IL-6 levels exhibited a linear correlation with the clinical course of COVID-19 infection. These results indicate that inhibitors of IL-6 and/or CHI3L1 may provide useful treatments for COVID-19.

Assessing the clinical severity of the Omicron variant in the Western Cape Province, South Africa, using the diagnostic PCR proxy marker of RdRp target delay to distinguish between Omicron and Delta infections - a survival analysis.

BACKGROUND: At present, it is unclear whether the extent of reduced risk of severe disease seen with SARS-Cov-2 Omicron variant infection is caused by a decrease in variant virulence or by higher levels of population immunity. METHODS: RdRp target delay (RTD) in the Seegene AllplexTM 2019-nCoV PCR assay is a proxy marker for the Delta variant. The absence of this proxy marker in the transition period was used to identify suspected Omicron infections. Cox regression was performed for the outcome of hospital admission in those who tested positive for SARS-CoV-2 on the Seegene AllplexTM assay from November 1 to December 14, 2021 in the Western Cape Province, South Africa, in the public sector. Adjustments were made for vaccination status and prior diagnosis of infection. RESULTS: A total of 150 cases with RTD and 1486 cases without RTD were included. Cases without RTD had a lower hazard of admission (adjusted hazard ratio [aHR], 0.56; 95% confidence interval [CI], 0.34-0.91). Complete vaccination was protective against admission, with an aHR of 0.45 (95% CI, 0.26-0.77). CONCLUSION: Omicron has resulted in a lower risk of hospital admission compared with contemporaneous Delta infection, when using the proxy marker of RTD. Under-ascertainment of reinfections with an immune escape variant remains a challenge to accurately assessing variant virulence.

Association of COVID-19 Vaccination and Clinical Severity of Patients Infected with Delta or Omicron Variants - China, May 21, 2021-February 28, 2022.

What is already known about this topic?: Compared with the international mRNA and adenovirus-vectored coronavirus disease 2019 (COVID-19) vaccines, there is less real-world research data about breakthrough cases in people vaccinated with China-made COVID-19 vaccines. Analyses of clinical outcomes of breakthrough cases will be an important supplement to the clinical trial efficacy and observational effectiveness data of China-made COVID-19 vaccines. What is added by this report?: COVID-19 vaccine age-eligible individuals (≥3 years old) who received full primary series and a booster dose of China-made COVID-19 vaccines had good protection from pneumonia caused by Delta variant infection. There was only one serious Delta case in children (unvaccinated), but among adults 18 years and older, there was good protection from serious illness with primary vaccination and booster vaccination. Among people ≥60 years, full vaccination and booster vaccination were associated with protection from pneumonia and risk of serious COVID-19 caused by Omicron variant infection. There were few serious Omicron cases. What are the implications for public health practice?: Everyone 3 years and older without contraindications should be fully vaccinated against COVID-19; schedule-eligible adults should receive booster doses. The pace of booster dose administration, especially among the elderly, should be accelerated.

Early Biochemical Markers in Predicting the Clinical Outcome of COVID-19 Patients Admitted in Tertiary Care Hospital.

Introduction An array of routinely accessible serum biomarkers was assessed to explore their overall impact on severity and mortality in coronavirus disease 2019. Materials and Methods A retrospective analysis of 1,233 adults was conducted. The study groups comprised 127 nonsurvivors and 1,106 survivors. Data for demographic details, clinical presentations, and laboratory reports were recorded from the medical record section. The predictors were analyzed for their influence on mortality. Results The mean (+ standard deviation) age of the patients in the nonsurvivor group was 58.8 (13.8) years. The mean age (56.4 years) was highest in severe grade patients. The odds ratio for death was 2.72 times for patients above the age of 40 years. About 46% of nonsurvivors died within 5 days of admission. Males were found to be more prone to death than females by a factor of 1.36. Serum urea depicted highest sensitivity (85%) for nonsurvival at 52.5 mg/dL. Serum albumin (3.23 g/dL), albumin-to-globulin ratio (0.97), and C-reactive protein-to albumin ratio (CAR) (2.08) showed a sensitivity of more than 70% for mortality outcomes. The high hazard ratio (HR) for deceased patients with hyperkalemia was 2.419 (95% confidence interval [CI] = 1.96-2.99; p < 0.001). The risk for nonsurvival was increased with elevated serum creatinine by 15.6% and uric acid by 21.7% ( p < 0.001). The HR for hypoalbuminemia was 0.254 (95% CI: 0.196-0.33; p < 0.001) and CAR was 1.319 (95% CI: 1.246-1.397; p < 0.001). Saturation of oxygen ( p < 0.001), lactate dehydrogenase ( p = 0.006), ferritin ( p = 0.004), hyperuricemia ( p = 0.027), hyperkalemia ( p < 0.001), hypoalbuminemia ( p = 0.002), and high CAR values (0.031) served as potential predictors for mortality. Conclusion Adjusting for all the predictor variables, serum uric acid, potassium, albumin, and CAR values at the time of admission were affirmed as the potential biomarkers for mortality.

Does COVID-19 Clinical Status Associate with Outcome Severity? An Unsupervised Machine Learning Approach for Knowledge Extraction.

Since the beginning of the COVID-19 pandemic, 195 million people have been infected and 4.2 million have died from the disease or its side effects. Physicians, healthcare scientists and medical staff continuously try to deal with overloaded hospital admissions, while in parallel, they try to identify meaningful correlations between the severity of infected patients with their symptoms, comorbidities and biomarkers. Artificial intelligence (AI) and machine learning (ML) have been used recently in many areas related to COVID-19 healthcare. The main goal is to manage effectively the wide variety of issues related to COVID-19 and its consequences. The existing applications of ML to COVID-19 healthcare are based on supervised classifications which require a labeled training dataset, serving as reference point for learning, as well as predefined classes. However, the existing knowledge about COVID-19 and its consequences is still not solid and the points of common agreement among different scientific communities are still unclear. Therefore, this study aimed to follow an unsupervised clustering approach, where prior knowledge is not required (tabula rasa). More specifically, 268 hospitalized patients at the First Propaedeutic Department of Internal Medicine of AHEPA University Hospital of Thessaloniki were assessed in terms of 40 clinical variables (numerical and categorical), leading to a high-dimensionality dataset. Dimensionality reduction was performed by applying a principal component analysis (PCA) on the numerical part of the dataset and a multiple correspondence analysis (MCA) on the categorical part of the dataset. Then, the Bayesian information criterion (BIC) was applied to Gaussian mixture models (GMM) in order to identify the optimal number of clusters under which the best grouping of patients occurs. The proposed methodology identified four clusters of patients with similar clinical characteristics. The analysis revealed a cluster of asymptomatic patients that resulted in death at a rate of 23.8%. This striking result forces us to reconsider the relationship between the severity of COVID-19 clinical symptoms and the patient's mortality.

Epidemiological features of COVID-19 patients with prolonged incubation period and its implications for controlling the epidemics in China.

BACKGROUND: COVID-19 patients with long incubation period were reported in clinical practice and tracing of close contacts, but their epidemiological or clinical features remained vague. METHODS: We analyzed 11,425 COVID-19 cases reported between January-August, 2020 in China. The accelerated failure time model, Logistic and modified Poisson regression models were used to investigate the determinants of prolonged incubation period, as well as their association with clinical severity and transmissibility, respectively. RESULT: Among local cases, 268 (10.2%) had a prolonged incubation period of > 14 days, which was more frequently seen among elderly patients, those residing in South China, with disease onset after Level I response measures administration, or being exposed in public places. Patients with prolonged incubation period had lower risk of severe illness (ORadjusted = 0.386, 95% CI: 0.203-0.677). A reduced transmissibility was observed for the primary patients with prolonged incubation period (50.4, 95% CI: 32.3-78.6%) than those with an incubation period of ≤14 days. CONCLUSIONS: The study provides evidence supporting a prolonged incubation period that exceeded 2 weeks in over 10% for COVID-19. Longer monitoring periods than 14 days for quarantine or persons potentially exposed to SARS-CoV-2 should be justified in extreme cases, especially for those elderly.

Highly Sensitive Quantification of Plasma Severe Acute Respiratory Syndrome Coronavirus 2 RNA Sheds Light on its Potential Clinical Value.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a global public health problem that has already caused more than 662 000 deaths worldwide. Although the clinical manifestations of COVID-19 are dominated by respiratory symptoms, some patients present other severe damage such as cardiovascular, renal and liver injury, and/or multiple organ failure, suggesting a spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in blood. Recent ultrasensitive polymerase chain reaction (PCR) technology now allows absolute quantification of nucleic acids in plasma. We intend to use the droplet-based digital PCR technology to obtain sensitive detection and precise quantification of plasma SARS-CoV-2 viral load (SARS-CoV-2 RNAemia) in hospitalized COVID-19 patients. METHODS: Fifty-eight consecutive COVID-19 patients with pneumonia 8 to 12 days after onset of symptoms and 12 healthy controls were analyzed. Disease severity was categorized as mild to moderate in 17 patients, severe in 16, and critical in 26. Plasma SARS-CoV-2 RNAemia was quantified by droplet digital Crystal Digital PCR next-generation technology (Stilla Technologies, Villejuif, France). RESULTS: Overall, SARS-CoV-2 RNAemia was detected in 43 (74.1%) patients. Prevalence of positive SARS-CoV-2 RNAemia correlated with disease severity, ranging from 53% in mild-to-moderate patients to 88% in critically ill patients (P = .036). Levels of SARS-CoV-2 RNAemia were associated with severity (P = .035). Among 9 patients who experienced clinical deterioration during follow-up, 8 had positive SARS-CoV-2 RNAemia at baseline, whereas only 1 critical patient with undetectable SARS-CoV-2 RNAemia at the time of analysis died at day 27. CONCLUSION: SARS-CoV-2 RNAemia measured by droplet-based digital PCR constitutes a promising prognosis biomarker in COVID-19 patients.