Value-Added Tax (VAT) Development and Reform History—A Study of VAT Evolution Around the World and in China

Value-added Tax (VAT), a turnover tax levied on the value appreciated in commodities production, circulation and sale, has been widely practiced by economies worldwide for its neutrality. From the international perspective, European Union VAT and New Zealand VAT stand out as characteristic models of VAT development and reform history. With changing economic development models and the growth of e-commerce businesses, VAT systems have been upgraded to meet taxation challenges brought about by the digital economy. Recently, VAT policies and measures have been introduced particularly to combat the COVID-19 impact. In China, the VAT system has been reformed constantly over the past 40 years and has been converging with international practice. China now needs to address emerging VAT issues through legislation, tax incentives, and tax-rate grades so as to meet challenges in VAT collection and management and to suit the "new normal” of economic development. © 2022 Brill Academic Publishers. All rights reserved.

Do South Africa's e-commerce VAT rules measure up to international trends and OECD guidelines?

Orientation: The taxability of e-commerce transactions have been the subject of many studies to protect governments from Value-Added Tax (VAT) erosion, illegal recovery and fraud. Research purpose: This study critically analyses the challenges posed by e-commerce transactions in South Africa's VAT Act . Recommendations are made for amendments to the VAT Act to improve rules to effectively tax e-commerce transactions occurring in South Africa. Motivation for the study: Globally, including in South Africa, enforcing relevant VAT legislation to target output tax collections and input tax credits from e-commerce transactions aptly remains a challenge. Research approach/design and method: By integrating qualitative literature reviews and comparative synthesis, this study employed a comparative legal methodology. VAT levied on e-commerce transactions in South Africa is compared to the Organisation for Economic Co-operation and Development's guidelines as well as New Zealand's and Australia's Goods and Services Tax legislations. Main Findings: While the South African VAT Act aligns with international best practices on the use of intermediaries, there are some differences as detailed in the study. Practical/managerial implications: To align with international trade counterparts, the South African VAT Act should differentiate between business-to-business and business-to-consumer sales. A provision concerning the place of consumption for bundled goods should be included in the VAT Act . The VAT Act should contain a provision that allows bad debts to be claimed on cash sales made instead of total sales made. Contribution/value-add: This study harmonises South African VAT legislation with international best practices within the context of continual advancement of e-commerce transactions.

Firm informality during the COVID-19 crisis in Argentina: perception of commercial entrepreneurs and public accountants

Este trabajo analiza el impacto de la crisis del COVID-19 en la informalidad de las micro, pequeñas y medianas empresas argentinas a partir de la percepción de empresarios comerciales y contadores públicos de la ciudad de Bahía Blanca (Argentina). Utilizando datos primarios recopilados a través de entrevistas semiestructuradas, se realizó un análisis de contenido cualitativo combinando codificación basada en teoría y basada en datos. A pesar del uso generalizado de pagos electrónicos, los hallazgos sugieren un aumento tanto en la subdeclaración de ingresos como en la cantidad de empresas no registradas, lo que respalda el comportamiento contracíclico del sector informal durante dicha crisis. El artículo contribuye a una mayor comprensión de la informalidad a través de un enfoque microeconómico-cualitativo e integrando la perspectiva de dos actores diferentes. Los resultados son relevantes para la formulación de políticas tendientes a la reducción de la informalidad empresarial.Alternate abstract:Este artigo analisa o impacto da crise do COVID-19 na informalidade das micro, pequenas e médias empresas argentinas com base na percepção de empresários comerciais e contadores públicos da cidade de Bahía Blanca (Argentina). Utilizando dados primários coletados por meio de entrevistas semiestruturadas, foi realizada uma análise de conteúdo qualitativa combinando codificação baseada em teoria e dados. Apesar do uso generalizado de pagamentos eletrônicos, os resultados sugerem um aumento tanto na subdeclaração de renda quanto no número de negócios não registrados, corroborando o comportamento anticíclico do setor informal durante a referida crise. O artigo contribui para uma melhor compreensão da informalidade por meio de uma abordagem microeconômica-qualitativa e integrando a perspectiva de dois atores distintos. Os resultados são relevantes para a formulação de políticas voltadas à redução da informalidade empresarial.Alternate abstract:This article analyzes the impact of the COVID-19 crisis on the informality of Argentinian micro-, small-, and medium-sized enterprises based on the perception of commercial entrepreneurs and public accountants from Bahía Blanca (Argentina). Using primary data collected through semi-structured interviews, a qualitative content analysis was performed combining theory-oriented and data-based coding. Despite the widespread use of electronic payments, the findings suggest an increase in income underreporting and the number of unregistered companies, thus supporting the countercyclical behavior of the informal sector during that crisis. The article contributes to a better understanding of informality through a microeconomic-qualitative approach by integrating the perspective of two different actors. Empirical findings are relevant for policymakers seeking to reduce the levels of informality during periods of crisis.

Pesticide tax – the new challenge in Europe's green tax policy

The Covid 19 pandemic profoundly affected society's social and economic life. At the same time, it accelerated another long-delayed process. This is the need to modernise taxation. The European tax legislation in income taxation has stayed the same for a long time. To some extent, it is outdated. It does not correspond to the modern societal changes and the realisation of new types of income not covered by the law. Many European countries rely heavily on their income taxes on the budget's revenue side. The forecasts point to fewer and fewer opportunities to generate income due to the ageing working-age population. All these arguments determine the need for modernisation and gradual replacement of income taxes. The present study defends the thesis that a promising opportunity to compensate for the reduced revenues from income taxation is related to strengthening the environmental function of taxes. The possibility of limiting environmentally harmful substances such as pesticides through taxes has been analysed. This change the authors propose to achieve this in two ways. The first one requires eliminating dif-ferentiated reduced VAT rates for pesticides, plant protection materials and fertilisers unless the latter are organic. The second one proposes the possibility of introducing a tax on pesticides. Such a tax could limit their use as well as generate new revenue. In this regard, the experience of the few countries applying a pesticide tax is analysed. The various options for determining the tax base as a critical point in defining the tax are argued. © 2023, Agricultural Academy, Bulgaria. All rights reserved.

Translational design for limited resource settings as demonstrated by Vent-Lock, a 3D-printed ventilator multiplexer.

BACKGROUND: Mechanical ventilators are essential to patients who become critically ill with acute respiratory distress syndrome (ARDS), and shortages have been reported due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We utilized 3D printing (3DP) technology to rapidly prototype and test critical components for a novel ventilator multiplexer system, Vent-Lock, to split one ventilator or anesthesia gas machine between two patients. FloRest, a novel 3DP flow restrictor, provides clinicians control of tidal volumes and positive end expiratory pressure (PEEP), using the 3DP manometer adaptor to monitor pressures. We tested the ventilator splitter circuit in simulation centers between artificial lungs and used an anesthesia gas machine to successfully ventilate two swine. RESULTS: As one of the first studies to demonstrate splitting one anesthesia gas machine between two swine, we present proof-of-concept of a de novo, closed, multiplexing system, with flow restriction for potential individualized patient therapy. CONCLUSIONS: While possible, due to the complexity, need for experienced operators, and associated risks, ventilator multiplexing should only be reserved for urgent situations with no other alternatives. Our report underscores the initial design and engineering considerations required for rapid medical device prototyping via 3D printing in limited resource environments, including considerations for design, material selection, production, and distribution. We note that optimization of engineering may minimize 3D printing production risks but may not address the inherent risks of the device or change its indications. Thus, our case report provides insights to inform future rapid prototyping of medical devices.

THE IMPACT OF COVID-19 ON VAT TAX RATES IN EUROPEAN UNION COUNTRIES. EVIDENCE FROM BULGARIA

Bu makale, koronavirüs krizinden etkilenen Avrupa Birliǧi ülkelerinin vergi oranlarındaki deǧişikliklere dikkat çekmeyi amaçlamaktadır. Analizin gerçekleştirildiǧi dönem Mart 2020 - Aralık 2020'dir. 28 Üye Devletin her biri ayrı ayrı Íncelenmekte ve bireysel sektörlerde KDV vergi oranındaki deǧişiklikler tespit edilmektedir. Toplanan verilere ve belirli bir döneme ilişkin analizlere göre, ülkelerin bir yandan krizden en çok etkilenen ekonomik sektörleri desteklemeye, diǧer yandan ekonomik istikrarlarını nispeten iyi sınırlar içinde tutmaya çalıştıkları görülmektedir. KDV, tahsilatı Avrupa Birliǧi'nin her Üye Devletinin bütçesinde önemli bir gelir kalemi olan çok aşamalı bir vergidir. Düzenleyici yapısındaki veya vergi oranındaki herhangi bir deǧişiklik, sırasıyla tahsilat ve bütçe üzerindeki mali etkisi olmak üzere vergilendirme yöntemlerine yansır. Bununla birlikte, koronavirüs krizi ve dükkan, restoran, otel ve diǧer gelir kaynaklarının kilitlenmesi, Avrupa Birliǧi'nin tüm ülkelerinde vergi mükelleflerinin üzerindeki vergi yükünün hafifletilmesini gerektirdi. Muafiyet, belirli ürünler ve ekonomik faaliyetler için vergi oranında bir indirimdir.Alternate :This article aims to point out the changes in the tax rates of the European Union countries affected by the coronavirus crisis. The period during which the analysis is carried out is March 2020 - December 2020. Each of the 28 Member States is examined separately and changes in the VAT tax rate are identified in individual industries. Based on the collected data and their analysis for the specific period, it is noticed that the countries try to support the most affected economic sectors from the crisis on the one hand, and on the other hand to keep their economic stability within relatively good limits. VAT is a multi-stage tax, the collection of which is a major revenue item in the budget of each Member State of the European Union. Any change in its regulatory nature or tax rate reflects on the methods of taxation, respectively its collection and financial effect on the budget. However, the crisis with the coronavirus and the lockdown of shops, restaurants, hotels and other sources of income has necessitated easing the tax burden on taxpayers in all countries of the European Union. The relief is a reduction in the tax rate for certain products and economic activities.

Public support for tax policies in COVID-19 times: evidence from Luxembourg.

We study attitudes towards the introduction of hypothetical new taxes to finance the cost of the COVID-19 pandemic. We rely on survey data collected in Luxembourg in 2020. The survey asks for the agreement of respondents over: a one-time net wealth tax, an inheritance tax, a temporary solidarity income tax, and a temporary increase in VAT. All questions include different and randomly assigned tax attributes (tax rates and exemption amounts). We find a clear divide with relatively high support for new wealth and inheritance taxes on the one hand and a low support for increases in VAT and income taxes on the other hand. While 58% of respondents agree or strongly agree with a one-time tax levied on net worth, only 24% are in favor of a small increase in VAT. Support for any tax is however negatively associated with the size of the tax as measured by the predicted revenues. Our results indicate that a one-time wealth tax could raise substantial revenues and still garner public support. Supplementary Information: The online version contains supplementary material available at 10.1007/s10797-022-09744-y.

Analysis on the Steady Growth Effect of China’s Fiscal Policy from a Dynamic Perspective

Under the goal of a “new development pattern”, it is of great practical significance to accurately identify the economic growth effect of fiscal and tax policies. This paper constructs a TVP-FAVAR model to measure the economic effects of China’s fiscal and tax policies at the aggregate and structural levels. The results show that the reduction in total tax has a positive effect on real variables such as output and consumption;especially at the present stage, the promotion effect of total tax reduction on economic growth is relatively strong, but the stimulation effect on price is relatively weak. Further, the tax structure in which the ratio of direct tax to total tax increases and the ratio of indirect tax to total tax decreases is more conducive to the increase in output and consumption, and will not strongly stimulate the rise of price level. Therefore, at this stage, China should continue to vigorously implement the tax reduction policy and ensure the continuity of the tax reduction policy. At the same time, we should continue to optimize the tax structure and give better play to the regulatory role of fiscal and tax policies in income redistribution, so as to achieve the goal that fiscal and tax policies help build a “new development pattern” and promote high-quality economic development.

TAX SYSTEMS OF UKRAINE AND EU COUNTRIES DURING THE COVID-19 PANDEMIC: CURRENT STATUS AND PROSPECTS

At the start of 2020, the world faced major challenges due to the COVID-19 pandemic. International institutions, governments and various organizations are forced to apply unprecedented restrictive measures in many areas of activity. The answer to these challenges by the governments of almost all countries of the world is actively manifested in tax measures aimed at supporting citizens and businesses. The article was devoted to the study of the level of taxation for certain taxes in Ukraine and EU countries in a crisis. The study proves the relevance of determining the optimal level of taxes to fill the budget. This study uses the method of comparative analysis, which compares the levels of tax rates in Ukraine and some EU countries. The optimal level of tax revenues to the state budget has been determined. The level of tax revenues to the Consolidated Budget of Ukraine has been analyzed and the main directions for improving the tax system of Ukraine have been identified. The necessity of focusing on the experience of highly developed EU countries in the field of taxation with the obligatory consideration of national characteristics is proved.

Why do SMEs switch suppliers?

Purpose>Combining a conceptual framework with empirical evidence, this study aims to offer insights into why small and medium-sized enterprises (SMEs) in the business-to-business beauty sector switch suppliers, due to pricing considerations.Design/methodology/approach>Data gathered from 475 telephone surveys of Spanish hairdressers provide the input for discrete choice models for testing the proposed hypotheses.Findings>The SMEs that change suppliers tend to be sensitive to promotions, express less satisfaction with a current supplier’s offerings and serve fewer customers who buy professional products for their in-home use. If SMEs are satisfied with the supplier’s services though, they are less likely to change and more prone to negotiate with that supplier.Research limitations/implications>This study does not address why dissatisfied SMEs might remain with their current suppliers. Further research might replicate this study using additional pricing data from suppliers.Practical implications>Suppliers in business-to-business (B2B) sectors can leverage these findings to allocate their marketing budgets optimally and establish service strategies that will enable them to retain buyers and reduce their switching risk.Originality/value>As an extension of extant literature, this study specifies switching drivers for SMEs in the B2B beauty sector. The findings should apply throughout this worldwide service sector, as well as to similar markets such as health, beauty and personal care and well-being services.

Vat Revenues In 2008–2020: Trends And Challenges Of Covid-19

Motivation: VAT revenues are particularly vulnerable to economic turbulence, especially if the crisis directly affects private consumption or changes its structure. Even when consumption levels are relatively high, VAT revenues may be lower due to a shift in consumer spending to the most essential goods or services or an increase in public sector consumption. Because of the reduction in operation and the closure of many businesses, the Covid-19 crisis is likely to have an even greater impact on consumption than the previous financial crisis of 2008. Aim: The purpose of this article is to analyse VAT revenues in OECD countries over the period 2008–2020, identify general trends, and highlight similarities and differences in this regard between the 2008 financial crisis and the Covid-19 crisis. Results: Consumption taxes account for about 33% of all taxes collected in OECD countries, of which 20% is VAT. Covid-19 could change that in an important manner. After the 2008 global financial crisis, tax revenues, including VAT, returned to pre-crisis levels after an average of eight years. VAT revenues in relation to GDP peaked in 2016, and have been stable since then. Due to reduced operation and closure of businesses, the Covid-19 epidemic not only changed the structure of private consumption, but also significantly affected its level. In addition, government actions reducing certain rates have contributed to the decline in VAT revenues. As the survey results indicate, standard VAT rates between 2017 and 2020 were at record high levels, averaging 19.3%. With such high rates, in order to re-store VAT revenues after the crisis, governments may have to think about how to broaden the tax base (e.g., temporarily lower rates and stimulate consumption).

The Overall Cumulative Impact of Covid-19 and Brexit on European Supply Chains

Supply chains are usually perceived as a stable environment where only local or regionalised disruptions may happen, thus this paper focuses on the unpreceded situation where cumulative impact of Brexit, Covid-19, and Suez Canal blockage on supply chains. Each event has been analysed from different angles to provide a wider view and depiction of complexity of modern supply chains as well as their vulnerability when it comes to cumulative impacts of major disruptions. © 2021 IEEE.

Widening inequities in clean cooking fuel use and food security: compounding effects of COVID-19 restrictions and VAT on LPG in a Kenyan informal urban settlement

Universal access to cleaner cooking fuels (including liquefied petroleum gas (LPG)) is a key target of Sustainable Development Goal 7. Currently, approximately 40 million Kenyans rely on polluting cooking fuels (e.g. charcoal, wood). While the Kenyan government aims to rapidly scale up use of LPG for cooking by 2030, COVID-19 restrictions and a 16% value added tax (VAT) re-introduced on LPG in 2021 have likely hampered progress in LPG uptake. We aimed to quantify the effect of these economic shocks on food and energy security in Langas informal urban settlement in western Kenya. We further evaluated whether households most adversely affected by COVID-19 restrictions were more likely to be socioeconomically impacted by the VAT re-imposition. A cross-sectional survey (n = 1542) assessed changes in cooking fuel patterns, food security and livelihoods of primary cooks due to these two economic shocks. While under COVID-19 restrictions, 75% (n = 1147) of participants reported income declines and 18% (n = 164) of participants using LPG (n = 922) switched their primary cooking fuel to charcoal, wood or kerosene. Households reporting lower income while under COVID-19 restrictions had 5.3 times (95% CI:[3.8,7.4]) the odds of experiencing food insecurity as those with no change in income. Unemployment and food insecurity under COVID-19 restrictions were substantially higher among informal sector workers (70% and 60%, respectively) compared with business/government employees (45% and 37%, respectively). Following the VAT re-introduction, 44% (n = 356) of households using LPG consumed less, and 34% (n = 276) cooked more frequently with polluting fuels. Individuals switching away from LPG under COVID-19 restrictions had 3.0 times (95% CI:[2.1,4.3]) the odds of reducing their LPG consumption due to the VAT re-introduction as those maintaining use of LPG. COVID-19 restrictions and the VAT re-introduction disproportionately negatively affected informal sector workers’ livelihoods. A zero-rating of VAT on LPG can help alleviate deepened inequities in LPG access in Kenya.

The Economic Impact of the Pandemic in Rwanda: An Analysis of Firm-Level VAT Data

There are substantial differences in the spread of the covid-19 pandemic and policy responses to it between high- and low-income countries. While evidence on the former is growing, there remain more unanswered questions on the latter. This paper addresses this gap by providing insights on the impact of the pandemic in Rwanda, based on firm-level administrative data from Value Added Tax (VAT) returns. We find that VAT sales in 2020 declined by 11.4 % compared to 2019. These losses are particularly associated with a lockdown imposed around April 2020, after which sales quickly rebounded to pre-crisis levels once restrictions were lifted. In absolute terms, the economic cost is concentrated among the largest firms. However, small firms have been most affected in proportional terms. Disaggregating our results further, we show that firms in accommodation and food, transport services, wholesale and retail trade, as well as those registered in the capital, have been particularly affected by the crisis. Overall, the decline in sales translated to a similarly large percentage loss in VAT revenue for the government.

Portuguese social solidarity cooperatives between recovery and resilience in the context of covid-19: preliminary results of the COOPVID Project

La covid-19 planteó varios retos a todas las organizaciones en general y, especialmente, a las cooperativas de solidaridad social. Sin embargo, los desafíos que enfrentan estas cooperativas tienen características únicas que provienen de las características especiales en comparación con el otro tipo de cooperativas. Por lo tanto, es vital estudiar estos desafíos y los impactos de covid-19. Este estudio tiene como objetivo principal entender esos retos e impactos. Se realizó un estudio exploratorio realizando 11 entrevistas a 11 cooperativas de solidaridad social. Las cooperativas fueron elegidas por ser heterogéneas entre las cooperativas existentes en Portugal. Este estudio corresponde a la primera fase de un proyecto que aún está en marcha. Este artículo presenta los principales resultados del análisis de contenido de los datos recogidos con las entrevistas. Los datos muestran que las cooperativas pudieron adaptarse rápidamente y continuar con su misión bajo la presión de la pandemia, a pesar de las primeras dificultades presentadas en una situación nueva y desconocida, mostrando una capacidad de adaptación y de servicio a sus socios. Sin embargo, estos socios también se vieron sometidos a varios retos nuevos y crecientes. Las adaptaciones fueron posibles gracias a los cambios legales en la ley de organización del trabajo, desde el despido hasta el teletrabajo, al apoyo gubernamental que implica programas financieros, al IVA y a la flexibilización de otros impuestos, así como a la reorganización de los recursos humanos y a la actitud positiva del personal de las cooperativas ante las dificultades (tanto de los dirigentes como de los trabajadores en general). Las diferencias entre las cooperativas de solidaridad social estudiadas en relación con las tecnologías digitales mostraron que las que ya contaban con alguna infraestructura tuvieron pequeñas dificultades para adaptarse.Alternate :Covid-19 posed several challenges to all organisations in general and to social solidarity cooperatives in particular. However, the challenges faced by these cooperatives have unique features arising from their special characteristics compared to other types of cooperatives. Therefore it is vital to study these challenges and the impacts of covid-19. This study has as main goal to understand those challenges and their impact. An exploratory study was undertaken by applying 11 interviews to 11 social solidarity cooperatives. The cooperatives were chosen to be heterogeneous among the existent cooperatives in Portugal. This study corresponds to the first phase of a project that is still underway. This article presents the main results of the content analysis of the data collected from the interviews. Data show cooperatives could promptly adapt and continue their mission under pressure from the pandemic despite the first difficulties encountered in a new and unknown situation, showing a capacity to adapt and serve their members. However, these members were also submitted to several increasing and new challenges. The adaptations were possible due to legal changes in the work organisa- tion law, from layoff to telework, government support involving financial programs, VAT, and other tax relaxation, as well as due to human resources reorganisation and the cooperatives' staff positive attitude towards the difficulties (both leaders and general workers). Differences between the social solidarity cooperatives under study concerning digital technologies showed that those already having some infrastructure had minor adapting difficulties.

EXEMPTIONS FROM PAYING VALUE ADDED TAX FOR MEDICAL SERVICES RELATED TO COVID–19

In the period of the COVID-19 pandemic, citizens' health is among the key goals of every government and as a public good must be ensured through an accessible, functional, and effective public health system. Taxation policy measures give taxation benefits for health services provided related to the COVID-19 pandemic. Consequently, Council Directive (EU) 2021/1159 of 13 July 2021 amending Directive 2006/112/EC as regards temporary exemptions on importations and on certain supplies was brought in in response to the COVID-19 pandemic (OJ L 250, 15. 7. 2021.). In this paper, the stated Directive (which is being applied in the Republic of Croatia) will be analysed from a legal perspective, as well as other legislative taxation measures undertaken at European Union related to the COVID-19 disease. Also, cases of the illegal use of VAT taxation exemptions (fraud) related to providing medical services for COVID-19 because the fact should not be overlooked that, according to European Commission Reports, member states have recorded losses in VAT taxation revenue estimated at 140 042 billions of Euros representing a total revenue loss of 11% at European Union level.

Some Implications of the Development of E-Commerce on EU Tax Regulations

E-commerce has progressed within Europe before, on the basis of the pre-pandemic raise, with COVID-19 determining an explosion of its evolution. The European e-commerce market is very important, linking together more than 500 million consumers. This paper presents the results of assessing the guidelines and trends observed in the European regulatory process in the current period, when e-commerce is developing appreciably, studying the applicable legal norms and their effects on facilitating the control of remote payments. Compliance with the VAT (value-added tax) regime is addressed in the context described by the two important categories of active legal rules: the rules for consumer protection and the rules related to ensuring data protection. The investigation of the legal framework in this regard started from the presupposition that the necessary changes in regulation for facilitating e-commerce are capable to determine indirect changes in many aspects of financial rules and taxation. While analyzing the regulation of online trade, the various measures undertaken recently in respect to European sources of law and their implications for national legal framework opened additional directions of investigation. This paper points out the indirect effect of e-commerce development on the regulatory framework, both in the area of consumer protection and in line with the difficult balance between the right to information and protection of data. The fiscal effects of e-commerce payments and the challenges for the value-added tax regime are also addressed, both from a theoretical point of view and with input from the Court of Justice of the European Union’s jurisprudence. The analyzed documents show that, in this respect, the legal reform will go deeper and will continue with the rhythm of the development of the online activities.

Association of body composition parameters measured on CT with risk of hospitalization in patients with Covid-19.

PURPOSE: To assess prognostic value of body composition parameters measured at CT to predict risk of hospitalization in patients with COVID-19 infection. METHODS: 177 patients with SARS-CoV-2 infection and with abdominopelvic CT were included in this retrospective IRB approved two-institution study. Patients were stratified based on disease severity as outpatients (no hospital admission) and patients who were hospitalized (inpatients). Two readers blinded to the clinical outcome segmented axial CT images at the L3 vertebral body level for visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), muscle adipose tissue (MAT), muscle mass (MM). VAT to total adipose tissue ratio (VAT/TAT), MAT/MM ratio, and muscle index (MI) at L3 were computed. These measures, along with detailed clinical risk factors, were compared in patients stratified by severity. Various logistic regression clinical and clinical + imaging models were compared to discriminate inpatients from outpatients. RESULTS: There were 76 outpatients (43%) and 101 inpatients. Male gender (p = 0.013), age (p = 0.0003), hypertension (p = 0.0003), diabetes (p = 0.0001), history of cardiac disease (p = 0.007), VAT/TAT (p < 0.0001), and MAT/MM (p < 0.0001), but not BMI, were associated with hospitalization. A clinical model (age, gender, BMI) had AUC of 0.70. Addition of VAT/TAT to the clinical model improved the AUC to 0.73. Optimal model that included gender, BMI, race (Black), MI, VAT/TAT, as well as interaction between gender and VAT/TAT and gender and MAT/MM demonstrated the highest AUC of 0.83. CONCLUSION: MAT/MM and VAT/TAT provides important prognostic information in predicting patients with COVID-19 who are likely to require hospitalization.

Visceral Adipose Tissue: A New Target Organ in Virus-Induced Type 1 Diabetes.

Type 1 diabetes (T1D) is a proinflammatory pathology that leads to the specific destruction of insulin producing ß-cells and hyperglycaemia. Much of the knowledge about type 1 diabetes (T1D) has focused on mechanisms of disease progression such as adaptive immune cells and the cytokines that control their function, whereas mechanisms linked with the initiation of the disease remain unknown. It has been hypothesized that in addition to genetics, environmental factors play a pivotal role in triggering ß-cell autoimmunity. The BioBreeding Diabetes Resistant (BBDR) and LEW1.WR1 rats have been used to decipher the mechanisms that lead to virus-induced T1D. Both animals develop ß-cell inflammation and hyperglycemia upon infection with the parvovirus Kilham Rat Virus (KRV). Our earlier in vitro and in vivo studies indicated that KRV-induced innate immune upregulation early in the disease course plays a causal role in triggering ß-cell inflammation and destruction. Furthermore, we recently found for the first time that infection with KRV induces inflammation in visceral adipose tissue (VAT) detectable as early as day 1 post-infection prior to insulitis and hyperglycemia. The proinflammatory response in VAT is associated with macrophage recruitment, proinflammatory cytokine and chemokine upregulation, endoplasmic reticulum (ER) and oxidative stress responses, apoptosis, and downregulation of adipokines and molecules that mediate insulin signaling. Downregulation of inflammation suppresses VAT inflammation and T1D development. These observations are strikingly reminiscent of data from obesity and type 2 diabetes (T2D) in which VAT inflammation is believed to play a causal role in disease mechanisms. We propose that VAT inflammation and dysfunction may be linked with the mechanism of T1D progression.