Trends and Dynamics of COVID-19 in Zimbabwe: Implications for Selected Sustainable Development Goals

This study analysed the spatial and temporal trends and dynamics of COVID-19 to understand their implications on Sustainable Development Goals (SDGs) in Zimbabwe. Data on daily cases and mortality rates of COVID-19 were collected from the Worldometer website, whilst data on lockdown measures and travel restrictions were collected from Zimbabwe's Ministry of Health and Child Care. Exploratory and confirmatory analyses were employed on statistical data. COVID-19 statistical data were first tested for normality using the Kolmogorov-Smirnov test. Subsequently, the non-parametric Mann-Kendal (M-K) test was performed to determine the monthly average number of new cases and deaths trend from March 2020 to February 2022 using XLSTAT (2020). The study shows a significant increase (p = 0.00, α= 0.05) in COVID-19 cases between March 2020 and February 2022. The trend is characterised by sharp increases associated with wave periods. Although the results show no correlation between stringency index and COVID-19 cases, periods of high stringency are associated with a slightly lower number of cases. The spatial trends show that highly populated areas have high numbers of patient cases. Indeed, the lockdown measures put in place, among other factors, contributed to controlling the spread of the virus. The trends and dynamics of COVID-19 in Zimbabwe have implications for achieving SDG 1, SDG 2, SDG 3 and SDG 6. Thus, there is a need to factor in the temporal and spatial realities of COVID-19 in making a policy framework for effective control of the pandemic and promotion of sustainable development. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023.

The Impact of the COVID-19 Pandemic on Financial Condition and Mortality in Polish Regions

The study aimed to assess the impact of the COVID-19 pandemic on the financial condition and mortality in Polish voivodeships. To achieve this objective, the relationship between the number of deaths before and during the pandemic and the financial condition of the provinces in Poland was studied. The study covered the years 2017–2020, for which a one-way ANOVA was used to verify whether there was a relationship between the level of a province's financial condition and the number of deaths. The results of the study are surprising and show that before the COVID-19 pandemic, there was a higher number of deaths in provinces that were better off financially, but the relationship was not statistically significant. In contrast, during the pandemic, a statistically significant strong negative correlation between these values was proven, which, in practice, shows that regions with better financial conditions had a higher number of deaths during COVID-19.

Social solidarity in the COVID-19 pandemic

The purpose of this article is to investigate the administrative, economic and social legal dimensions of the coronavirus pandemic;examine how public policies aimed at emergency social rescue are being implemented. This qualitative research is carried out through national and foreign bibliographic consultations;assuming that this COVID-19 pandemic may be a turning point for economic, social and legal relations to turn to solidarity. It is observed that nations move large public countercyclical investments to overcome the crisis caused by social isolation, unemployment and scarcity. Companies and individuals try to make generous contributions to scientific vaccine research. Solidarity in the favelas was greater in the distribution of food. It is observed in the international experience that favela populations are more exposed to contamination and that the distribution of emergency aid in cash by governments is more efficient than the distribution of food. Despite the difficulties of governmental coordination to combat the pandemic in Brazil a lot has been done, but the solidarity is one the main driver of people and companies. This little extract from the pandemic does not exhaust the issue and does not manage to measure all the economic, social and legal consequences that will come, or even, what will be the number of deaths, but it contributes to the perception of size of problem and how to overcome the challenges.

COVID-19: Prediction, Prevalence, and the Operations of Vaccine Allocation

Problem definition: Mitigating the COVID-19 pandemic poses a series of unprecedented challenges, including predicting new cases and deaths, understanding true prevalence beyond what tests are able to detect, and allocating different vaccines across various regions. In this paper, we describe our efforts to tackle these issues and explore the impact on combating the pandemic in terms of case and death prediction, true prevalence, and fair vaccine distribution. Methodology/results: We present the methods we developed for predicting cases and deaths using a novel machine-learning-based aggregation method to create a single prediction that we call MIT-Cassandra. We further incorporate COVID-19 case prediction to determine true prevalence and incorporate this prevalence into an optimization model for efficiently and fairly managing the operations of vaccine allocation. We study the trade-offs of vaccine allocation between different regions and age groups, as well as first- and second-dose distribution of different vaccines. This also allows us to provide insights into how prevalence and exposure of the disease in different parts of the population can affect the distribution of different vaccine doses in a fair way. Managerial implications: MIT-Cassandra is currently being used by the Centers for Disease Control and Prevention and is consistently among the best-performing methods in terms of accuracy, often ranking at the top. In addition, our work has been helping decision makers by predicting how cases and true prevalence of COVID-19 will progress over the next few months in different regions and utilizing the knowledge for vaccine distribution under various operational constraints. Finally, and very importantly, our work has specifically been used as part of a collaboration with the Massachusetts Institute of Technology's (MIT's) Quest for Intelligence and as part of MIT's process to reopen the institute.

The Evolution of Excess Deaths in the United States During the First Two Years of the COVID-19 Pandemic.

Understanding consequences of the COVID-19 pandemic requires information on the excess mortality resulting from it. Multiple studies have examined excess deaths during the pandemic's initial stages, but how these have changed over time is unclear. This study used national and state-level death counts and population data from 2009-2022 to evaluate excess fatalities from 3/20-2/21 and 3/21-2/22, with deaths from earlier years used to project baseline counts. The outcomes were total, group-specific, cause-specific, and age-by-cause excess fatalities, and numbers and percentages directly involving COVID-19. Excess deaths declined from 655,735 (95% confidence interval: 619,028-691,980) during the first pandemic year to 586,505 (95% CI: 532,823-639,205) in the second. The reductions were particularly large for Hispanics, Blacks, Asians, seniors, and residents of states with high vaccination rates. Excess deaths increased from the first to second year for persons <65 and in low vaccination states. Excess mortality from some diseases declined but those from alcohol, drug, vehicle, and homicide causes likely grew between the first and second pandemic year, especially for prime-age and younger individuals. The share of excess fatalities involving COVID-19 decreased modestly over time, with little change in its role as an underlying versus contributing cause of death.

[Places of death of COVID-19 patients: an observational study based on evaluated death certificates from the city of Muenster, Germany (2021)]. / Sterbeorte von COVID-19-Patienten: eine Observationsstudie auf Grundlage ausgewerteter Todesbescheinigungen der Stadt Münster (2021).

INTRODUCTION: The places of death of COVID-19 patients have so far hardly been investigated in Germany. METHODS: In a places of death study in Westphalia (Germany), statistical evaluations were carried out in the city of Muenster on the basis of all death certificates from 2021. Persons who had died with or from a COVID-19 infection were identified by medical information on cause of death and analyzed with descriptive statistical methods using SPSS. RESULTS: A total of 4044 death certificates were evaluated, and 182 deceased COVID-19 patients were identified (4.5%). In 159 infected patients (3.9%), the viral infection was fatal, whereby the distribution of places of death was as follows: 88.1% in hospital (57.2% in the intensive care unit; 0.0% in the palliative care unit), 0.0% in hospice, 10.7% in nursing homes, 1.3% at home, and 0.0% in other places. All infected patients < 60 years and 75.4% of elderly patients ≥ 80 years died in hospital. Only two COVID-19 patients, both over 80 years old, died at home. COVID-19 deaths in nursing homes (17) affected mostly elderly female residents. Ten of these residents had received end-of-life care from a specialized outpatient palliative care team. DISCUSSION: The majority of COVID-19 patients died in hospital. This can be explained by the rapid course of the disease with a high symptom burden and the frequent young age of the patients. Inpatient nursing facilities played a certain role as a place of death in local outbreaks. COVID-19 patients rarely died at home. Infection control measures may be one reason why no patients died in hospices or palliative care units.

Record linkage studies of drug-related deaths among adults who were released from prison to the community: a scoping review.

BACKGROUND: There are public health concerns about an increased risk of mortality after release from prison. The objectives of this scoping review were to investigate, map and summarise evidence from record linkage studies about drug-related deaths among former adult prisoners. METHODS: MEDLINE, EMBASE, PsychINFO and Web of Science were searched for studies (January 2011- September 2021) using keywords/index headings. Two authors independently screened all titles and abstracts using inclusion and exclusion criteria and subsequently screened full publications. Discrepancies were discussed with a third author. One author extracted data from all included publications using a data charting form. A second author independently extracted data from approximately one-third of the publications. Data were entered into Microsoft Excel sheets and cleaned for analysis. Standardised mortality ratios (SMRs) were pooled (where possible) using a random-effects DerSimonian-Laird model in STATA. RESULTS: A total of 3680 publications were screened by title and abstract, and 109 publications were fully screened; 45 publications were included. The pooled drug-related SMR was 27.07 (95%CI 13.32- 55.02; I 2 = 93.99%) for the first two weeks (4 studies), 10.17 (95%CI 3.74-27.66; I 2 = 83.83%) for the first 3-4 weeks (3 studies) and 15.58 (95%CI 7.05-34.40; I 2 = 97.99%) for the first 1 year after release (3 studies) and 6.99 (95%CI 4.13-11.83; I 2 = 99.14%) for any time after release (5 studies). However, the estimates varied markedly between studies. There was considerable heterogeneity in terms of study design, study size, location, methodology and findings. Only four studies reported the use of a quality assessment checklist/technique. CONCLUSIONS: This scoping review found an increased risk of drug-related death after release from prison, particularly during the first two weeks after release, though drug-related mortality risk remained elevated for the first year among former prisoners. Evidence synthesis was limited as only a small number of studies were suitable for pooled analyses for SMRs due to inconsistencies in study design and methodology.

Missing Americans: Early death in the United States-1933-2021.

We assessed how many US deaths would have been averted each year, 1933-2021, if US age-specific mortality rates had equaled the average of 21 other wealthy nations. We refer to these excess US deaths as "missing Americans." The United States had lower mortality rates than peer countries in the 1930s-1950s and similar mortality in the 1960s and 1970s. Beginning in the 1980s, however, the United States began experiencing a steady increase in the number of missing Americans, reaching 622,534 in 2019 alone. Excess US deaths surged during the COVID-19 pandemic, reaching 1,009,467 in 2020 and 1,090,103 in 2021. Excess US mortality was particularly pronounced for persons under 65 years. In 2020 and 2021, half of all US deaths under 65 years and 90% of the increase in under-65 mortality from 2019 to 2021 would have been avoided if the United States had the mortality rates of its peers. In 2021, there were 26.4 million years of life lost due to excess US mortality relative to peer nations, and 49% of all missing Americans died before age 65. Black and Native Americans made up a disproportionate share of excess US deaths, although the majority of missing Americans were White.

Fear itself. Is fear a determinant of the efficacy oflockdowns?

Among non-pharmaceutical measures for fighting the COVID-19 pandemic, one of the most important is the implementation of lockdowns. The cost and effectiveness of this policy remains a much-debated topic in economics. In this study we investigate whether a 'fear effect' is at work in influencing the effectiveness of lockdowns. According to previous contributions on the topic, fear can increase protective habits, and for this reason we may imagine that a high number of COVID-19-caused deaths creates fear among the population, which may make people more likely to follow government prescriptions and observe lockdowns strictly. By means of a qualitative-quantitative analysis, we find that among the 46 countries that reported coronavirus-caused deaths before the implementation of a lockdown, the top quartile for per capita deaths has better results in terms of reducing new COVID-19 cases after a lockdown, compared to the worst quartile. This suggests that the number of reported deaths, as well as its communication to the population, are important determinants of the effectiveness of a lockdown.

Undiagnosed pulmonary TB and COVID in adults dying at home in a high TB burden setting, before and during pandemic COVID-19: an autopsy study.

BACKGROUND: Missing or undiagnosed patients with TB or COVID-19 are of concern. Identifying both infections in patients with no diagnosis prior to death contributes to understanding burdens of disease. To confirm reports of global reduction in TB incidence a 2012 autopsy study of adults dying at home of natural causes, in a high TB burden setting was repeated, including SARS-CoV-2 assessments after the first COVID-19 surge in South Africa. METHODS: Adult decedents who died at home with insufficient information to determine cause of death, no recent hospitalisation, and no current antemortem TB or COVID-19 diagnosis were identified between March 2019 and October 2020 with a 4 month halt during lockdown. A standardised verbal autopsy followed by minimally-invasive needle autopsy (MIA) was performed. Biopsies were taken for histopathology from liver, bilateral brain and lung; bronchoalveolar lavage was collected for Xpert (MTB/RIF) and mycobacterial culture, and blood for HIV polymerase chain reaction (PCR) testing. After the start of the COVID-19 pandemic, a nasopharyngeal swab and lung tissue were subjected to SARS-CoV-2 PCR testing. RESULTS: Sixty-six MIA were completed, 25 men and 41 women, overall median age 60 years. 68.2% had antemortem respiratory symptoms and 30.3% were people with HIV (PWH). Overall, TB was diagnosed in 11/66 (16.7%) and 14/41 (34.1%) in the COVID-19 pandemic were SARS-CoV-2 positive. CONCLUSION: Undiagnosed TB in adults dying at home has apparently decreased but remains unacceptably high. Forty percent of decedents had undiagnosed COVID-19 suggest estimates of excess deaths may underestimate the impact of SARS-CoV-2 on mortality.

COVID-19 Deaths in México: A Spatiotemporal Analysis

Officially named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19 was first reported in Wuhan, China, at the end of 2019. By February 2020, Mexico had registered its first confirmed case, and by March, its first death. This chapter examines the spatial and temporal patterns of COVID-19 cumulative deaths in Mexico by municipio and analyzes the spatio-temporal distribution and shifting trends of deaths. The analysis was based on a space-time cube with publicly available data from February 3, 2020, through February 8, 2021. The analysis shows the impact of population density and isolation on COVID-19 cumulative deaths in Mexico. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

COVID-19, "Black Lives Matter” and Indigenous Australians: A Tale of Two Intersecting Pandemics

The purpose of this chapter is to examine the impact COVID-19 has had on Aboriginal and/or Torres Strait Islander people and their communities. The Black Lives Matter protests occurred in the middle of the COVID-19 pandemic, therefore, it is necessary to explore the response(s) by the Aboriginal and/or Torres Strait Islander community in attending the protests and their engagement around the BLM movement and subsequent media attention. It is imperative to ensure Aboriginal and/or Torres Strait Islander voices are centered when researching issues that affect communities and individuals. This chapter will ensure the voices of Aboriginal and/or Torres Strait Islander people convey the issues, impacts and perspectives that COVID-19 and the implications of the BLM movement have and continue to have in community. Indigenous communities in Australia are not a monoculture;therefore, it is imperative to ensure the inclusion of the diverse Aboriginal and Torres Strait Islander experiences of the varying populations. The intersectionalities of fake news, Indigeneity and racism will be the main themes when researching the affects that COVID-19 has had, and may continue to have, on Aboriginal and/or Torres Strait Islander people and their communities. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Evaluation of concordance in estimation of excess mortality due to COVID-19 pandemic.

BACKGROUND: The World Health Organization (WHO) kept track of COVID-19 data at country level daily during the pandemic that included the number of tests, infected cases and fatalities. This daily record was susceptible to change depending on the time and place and impacted by underreporting. In addition to reporting cases of excess COVID-19-related deaths, the WHO also provided estimates of excess mortality based on mathematical models. OBJECTIVE: To evaluate the WHO reported and model-based estimate of excess deaths to determine the degree of agreement and universality. METHODOLOGY: Epidemiological data gathered from nine different countries between April 2020 and December 2021 are used in this study. These countries are India, Indonesia, Italy, Russia, United Kingdom, Mexico, the United States, Brazil and Peru and each of them recorded more than 1.5 million deaths from COVID-19 during these months. Statistical tools including correlation, linear regression, intraclass correlation and Bland-Altman plots are used to assess the degree of agreement between reported and model-based estimates of excess deaths. RESULTS: The WHO-derived mathematical model for estimating excess deaths due to COVID-19 was found to be appropriate for only four of the nine chosen countries, namely Italy, United Kingdom, the United States and Brazil. The other countries showed proportional biases and significantly high regression coefficients. CONCLUSION: The study revealed that, for some of the chosen nations, the mathematical model proposed by the WHO is practical and capable of estimating the number of excess deaths brought on by COVID-19. However, the derived approach cannot be applied globally.

Assessment of shifts in mortality age profile of adult population in Moscow during pandemic

Introduction. The COVID-19 pandemic induced the global crisis of mortality. Delayed medical care and reduced availability under quarantine restrictions have led to an increase in mortality not only from COVID-19, but also from chronic non-communicable diseases, affecting men and women of different ages to varying degrees. The study purpose is to assess shifts in mortality age profile of population aged 20+ in Moscow during COVID-19 pandemic. Materials and methods. Official vital statistics of Rosstat, operational information from civil registration database on death causes in Moscow. Results. The gain in mortality rate caused primarily by deaths from COVID-19 interrupted in 2020 the positive demographic dynamics that had developed over the previous years. In 2021, the increase in the mortality rate continued, but the loss of life expectancy was lower due to a decrease in mortality in older ages and the return of most indicators to the level of 2019. However, from a socio-economic point of view, the situation in 2021 developed more negatively, since the age structure of life expectancy losses is younger than in 2020. Limitations. The study results are based on operational information of the Moscow civil registration office and could be used for the development of managerial decisions for Moscow only. Conclusion. Against the pandemic demographic situation in Moscow has worsened. Due to mortality gain in the Russia's capital first in the past years recorded natural population decline. © 2022 Izdatel'stvo Meditsina. All rights reserved.

Relationship between COVID-19 and the Performance of Pharmaceutical Industry

The aim of the study was to determine how covid-19 affects the pharmaceutical stock market. The monthly data was used in this study span two years, from 2020 to 2022. For the study the independent variables were taken are daily new cases and daily deaths, market to book value and their effect on the market return of pharmaceutical industry. The results showed that the COVID-19 outbreak has had a significant impact on the sector's stock performance. Investors believe healthcare and pharmaceutical companies will benefit from this pandemic as they invest in research and development to prepare for the current epidemic and all subsequent pandemics. The results of this survey showed that investors will continue to invest in healthcare and pharmaceutical companies over time. [ FROM AUTHOR] Copyright of Journal of Pharmaceutical Negative Results is the property of ResearchTrentz and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

The Ethical Obligation to Prevent Maternal Mortality during the COVID-19 Pandemic and Beyond

The United States of America (USA) has the highest maternal mortality rate of all high-income countries, with over 80% found to be preventable. After leveling off around 2015, maternal mortality rates in the USA further increased due to coronavirus disease 2019 (COVID-19) related deaths starting in 2020 by about 20% from about 17-18/100,000 live births to about 24/100,000 live births with about one in seven maternal deaths due to COVID-19 infections. The vast majority of COVID-19-related maternal deaths were among unvaccinated pregnant patients. A total of 11% of postpartum maternal deaths were found to be associated with mental health issues, with the remainder usually due to medical issues such as hemorrhage and hypertension. As physicians, we have the ethical obligation to address perinatal and maternal mortality, especially preventable maternal mortalities, reduce the discrepancy between different races and ethnicities, recommend COVID-19 vaccinations, and develop approaches to address the causes.Copyright © The Author(s). 2023.

Unnatural Death Among Covid-19 Tested Positive Individuals: A Retrospective Study

Introducction:-Covid 19 started out as a fast-spreading viral disease, in Wuhan in 2019. Soon, it spread across the globe and WHO declared it a Pandemic. Various countries took various measures to control its spread and transmission. By the time, countries recovered from it, a new wave would come along with different expressions and pathophysiology. When Covid 19 began, various health agencies in India started making protocols and standard ooperating procedures including conducting autopsies in COVID-19 infected bodies. Aims and Objectives:-Aim of our study is to analyze cause of death among all covid 19 positive cases brought for medicolegal autopsies from the time of lockdown for a period of one year. Our aim is to see if there were any factors which could have prevented these deaths. Material(s) and Method(s): A retrospective study of 1 year conducted from 25th March 2020 to 24th March 2021, (1st wave of Covid 19) was done in a tertiary care hospital in Bangalore. (Bowring and Lady Curzon hospital) Results: 39 Covid-19-positive unnatural deaths were handled with the youngest being 18 years old and the oldest beings 83. The majority turned out to be suicides (51.28%), then RTAs, falls, and natural death. The commonest method of suicide was hanging (35.89%), followed by poison consumption, and falling from a height. Conclusion(s): COVID-19 is a viral infection with variable clinical signs and variable fatality rates. There is much to learn about it. However, suicides in COVID-19 cases might not have ended death if some care, timely diagnosis, and treatment were provided.Copyright © 2023, Institute of Medico-legal Publication. All rights reserved.

The Impact of COVID-19 Lockdown on Cases of and Deaths From AIDS, Gonorrhea, Syphilis, Hepatitis B, and Hepatitis C: Interrupted Time Series Analysis.

BACKGROUND: China implemented a nationwide lockdown to contain COVID-19 from an early stage. Previous studies of the impact of COVID-19 on sexually transmitted diseases (STDs) and diseases caused by blood-borne viruses (BBVs) in China have yielded widely disparate results, and studies on deaths attributable to STDs and BBVs are scarce. OBJECTIVE: We aimed to elucidate the impact of COVID-19 lockdown on cases, deaths, and case-fatality ratios of STDs and BBVs. METHODS: We extracted monthly data on cases and deaths for AIDS, gonorrhea, syphilis, hepatitis B, and hepatitis C between January 2015 and December 2021 from the notifiable disease reporting database on the official website of the National Health Commission of China. We used descriptive statistics to summarize the number of cases and deaths and calculated incidence and case-fatality ratios before and after the implementation of a nationwide lockdown (in January 2020). We used negative binominal segmented regression models to estimate the immediate and long-term impacts of lockdown on cases, deaths, and case-fatality ratios in January 2020 and December 2021, respectively. RESULTS: A total of 14,800,330 cases of and 127,030 deaths from AIDS, gonorrhea, syphilis, hepatitis B, and hepatitis C were reported from January 2015 to December 2021, with an incidence of 149.11/100,000 before lockdown and 151.41/100,000 after lockdown and a case-fatality ratio of 8.21/1000 before lockdown and 9.50/1000 after lockdown. The negative binominal model showed significant decreases in January 2020 in AIDS cases (-23.4%; incidence rate ratio [IRR] 0.766, 95% CI 0.626-0.939) and deaths (-23.9%; IRR 0.761, 95% CI 0.647-0.896), gonorrhea cases (-34.3%; IRR 0.657, 95% CI 0.524-0.823), syphilis cases (-15.4%; IRR 0.846, 95% CI 0.763-0.937), hepatitis B cases (-17.5%; IRR 0.825, 95% CI 0.726-0.937), and hepatitis C cases (-19.6%; IRR 0.804, 95% CI 0.693-0.933). Gonorrhea, syphilis, and hepatitis C showed small increases in the number of deaths and case-fatality ratios in January 2020. By December 2021, the cases, deaths, and case-fatality ratios for each disease had either reached or remained below expected levels. CONCLUSIONS: COVID-19 lockdown may have contributed to fewer reported cases of AIDS, gonorrhea, syphilis, hepatitis B, and hepatitis C and more reported deaths and case-fatality ratios of gonorrhea, syphilis, and hepatitis C in China.

Profiles of Independent-Comorbidity Groups in Senior COVID-19 Patients Reveal Low Fatality Associated with Standard Care and Low-Dose Hydroxychloroquine over Antivirals.

Introduction: The lack of feasible therapies and comorbidities aggravate the COVID-19 case-fatality rate (CFR). However, reports examining CFR associations with diabetes, concomitant cardiovascular diseases, chronic kidney disease, and chronic liver disease (CLD) are limited. More studies assessing hydroxychloroquine (Hcq) and antivirals are needed. Purpose: To examine associations of COVID-19 CFR in comorbid patient groups each with single comorbidities and after treatment with Hcq, favipiravir, and dexamethasone (Dex), either alone or in combination versus standard care. Methods: Using statistical analysis, we descriptively determined these associations among 750 COVID-19 patient groups during the last quarter of 2021. Results: A diabetes comorbidity (40%, n=299) showed twice the fatality (CFR 14%) of the others (CFR 7%; P=0.001). Hypertension (Htn) was the second-commonest comorbidity (29.5%, n=221), with similar CFR to diabetes (15% and 7% for Htn and non-Htn, respectively), but with higher significance (P=0.0006167). Although only 4% (n=30) heart failure (HF) was reported, the CFR (40%) was much higher than in those without it (8%). A similar rate (4%) for chronic kidney disease was reported, with CFRs of 33% and 9% among those with and without it, respectively (P=0.00048). Ischemic heart disease was 11% (n=74), followed by chronic liver disease (0.4%) and history of smoking (1%); however, these were not significant due to the sample sizes. Treatment indicated standard care and Hcq alone or in combination were superior (CFR of 4% and 0.5%, respectively) compared to favipiravir (25%) or Dex (38.5%) independently or in combination (35.4%). Furthermore, Hcq performed well (CFR 9%) when combined with Dex (9%; P=4.28-26). Conclusion: The dominance of diabetes and other comorbidities with significant association with CFR implied existence of a common virulence mechanism. The superiority of low-dose Hcq and standard care over antivirals warrants further studies.

Impact of COVID-19 on diagnosis of tuberculosis, multidrug-resistant tuberculosis, and on mortality in 11 countries in Europe, Northern America, and Australia. A Global Tuberculosis Network study.

OBJECTIVES: Although evidence is growing on the overall impact of the COVID-19 pandemic on tuberculosis (TB) services, global studies based on national data are needed to better quantify the extent of the impact and the countries' preparedness to tackle the two diseases. The aim of this study was to compare the number of people with new diagnoses or recurrence of TB disease, the number of drug-resistant (DR)-TB, and the number of TB deaths in 2020 vs 2019 in 11 countries in Europe, Northern America, and Australia. METHODS: TB managers or directors of national reference centers of the selected countries provided the agreed-upon variables through a validated questionnaire on a monthly basis. A descriptive analysis compared the incidence of TB and DR-TB and mortality of the pre-COVID-19 year (2019) vs the first year of the COVID-19 pandemic (2020). RESULTS: Comparing 2020 vs 2019, lower number of TB cases (new diagnosis or recurrence) was notified in all countries (except USA-Virginia and Australia), and fewer DR-TB notifications (apart from France, Portugal, and Spain). The deaths among TB cases were higher in 2020 compared to 2019 in most countries with three countries (France, The Netherlands, USA-Virginia) reporting minimal TB-related mortality. CONCLUSIONS: A comprehensive evaluation of medium-term impact of COVID-19 on TB services would benefit from similar studies in multiple settings and from global availability of treatment outcome data from TB/COVID-19 co-infected patients.