Progress and treatment of "long COVID" in non-hospitalized patients: A single-center retrospective cohort study

Background: "Long COVID" or "post-COVID conditions" describes prolonged symptoms after the acute phase of coronavirus disease 2019 (COVID-19). However, there is a paucity of published reports on its treatment. Method(s): This retrospective cohort study included adult, non-hospitalized patients with COVID-19 symptoms at least one month after the onset who had been examined at the isolation facility in Miyagi prefecture between October 2020 and September 2021. Result(s): In total, 70 patients with a median age of 46 (21-69) years were included, and 37 were women (52.9%). The median time from onset to the end of treatment was 46 (28-396) days. Thirty-eight patients (53.5%) showed improvement in all symptoms, while four (5.7%) did not recover within the study period. The symptoms at six months with high residual rates were dizziness (33.3%), fatigue (14.3%), myalgia (14.3%), abdominal discomfort (14.3%), and taste dysfunction (11.8%). For treatment of prolonged symptoms, formulae of Kampo medicine (Japanese traditional medicine) were used alone or in combination with Western medications in 76%, 66%, 53%, and 66% of patients at 1-2 months, 2-3 months, 3-6 months, and over 6 months respectively. Kampo formulae with anti-inflammatory effects were used in the early period;however, tonifying formulae and blood stasis-resolving formulae were used in the late period. Conclusion(s): Non-hospitalized patients with COVID-19 may suffer from persistent symptoms after the acute phase of infection. For the management of long COVID, a comprehensive and holistic approach is needed. Kampo medicine should be considered as a treatment option for long COVID.Copyright © 2023 The Authors. Traditional & Kampo Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Society for Oriental Medicine and Japan Society of Medical and Pharmaceutical Sciences for Traditional Medicine.

Impact of (long) COVID on athletes' performance: a prospective study in elite football players.

OBJECTIVES: To investigate possible persistent performance deficits after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in elite athletes. METHODS: A prospective cohort study in three Belgian professional male football teams was performed during the 2020 - 2021 season. Participants were submitted to strength, jump, and sprint tests and an aerobic performance test (the Yo-Yo Intermittent Recovery test (YYIR)). These tests were repeated at fixed time intervals throughout the season. Assessment of SARS-CoV-2 infection was performed by a polymerase chain reaction (PCR) test before each official game. RESULTS: Of the 84 included participants, 22 were infected with SARS-CoV-2 during follow-up. At the first testing after infection (52.0 ± 11.2 days after positive PCR testing) significantly higher percentages of maximal heart rate (%HRmax) were seen - within the isolated group of infected players- during (p = .006) and after the YYIR (2 min after, p = .013), compared to pre-infection data. This increase in %HRmax was resolved at the second YYIR testing after infection (127.6 ± 33.1 days after positive PCR testing). Additionally, when comparing the first test after infection in formerly infected to non-infected athletes, significantly higher %HRmax were found during (p < .001) and after the YYIR test (p < .001),No significant deficits were found for the jump, muscular strength or sprint tests.Aerobic performance seems compromised even weeks after infection. Simultaneously, anaerobic performance seemed to be spared. Because of the potential detrimental effects on the immune system, caution might be advised with high-intensity exposure until aerobic performance is restored.KEY MESSAGESElite football players' aerobic performance seems to be affected for weeks after they return to sports after a SARS-CoV-2 infection.Similarly, anaerobic performance tests showed no discernible changes between both before and after SARS-CoV-2 infections.Regular YYIR testing is recommended to monitor aerobic performance after SARS-CoV-2 infection.

Impact of corticosteroids use on midterm sequelae in survivors of COVID-19 admitted to hospital: A prospective cohort study.

An understanding of the midterm sequelae in COVID-19 and their association with corticosteroids use are needed. Between March and July 2020, we evaluated 1227 survivors of COVID-19, 3 months posthospitalization, of whom 213 had received corticosteroids within 7 days of admission. Main outcome was any midterm sequelae (oxygen therapy, shortness of breath, one major clinical sign, two minor clinical signs or three minor symptoms). Association between corticosteroids use and midterm sequelae was assessed using inverse propensity-score weighting models. Our sample included 753 (61%) male patients, and 512 (42%) were older than 65 years. We found a higher rate of sequelae among users than nonusers of corticosteroids (42% vs. 35%, odds ratio [OR] 1.40 [1.16-1.69]). Midterm sequelae were more frequent in users of low-dose corticosteroids than nonusers (64% vs. 51%, OR 1.60 [1.10-2.32]), whereas no association between higher doses (≥20 mg/day equivalent of dexamethasone) and sequelae was evidenced (OR 0.95 [0.56-1.61]). Higher risk of sequelae with corticosteroids use was observed among subjects with propensity score below the 90th percentile. Our study suggest that corticosteroids use during hospitalization for COVID-19 is associated with higher risk of midterm sequelae.

The impact of the COVID-19 pandemic on depression in community-dwelling older adults: a prospective cohort study.

BACKGROUND: There are growing concerns about the impact of the COVID-19 pandemic on the mental health of older adults. We examined the effect of the pandemic on the risk of depression in older adults. METHODS: We analyzed data from the prospective cohort study of Korean older adults, which has been followed every 2 years. Among the 2308 participants who completed both the third and the fourth follow-up assessments, 58.4% completed their fourth follow-up before the outbreak of COVID-19 and the rest completed it during the pandemic. We conducted face-to-face diagnostic interviews using Mini International Neuropsychiatric Interview and used Geriatric Depression Scale. We performed generalized estimating equations and logistic regression analyses. RESULTS: The COVID-19 pandemic was associated with increased depressive symptoms in older adults [b (standard error) = 0.42 (0.20), p = 0.040] and a doubling of the risk for incident depressive disorder even in euthymic older adults without a history of depression (odds ratio = 2.44, 95% confidence interval 1.18-5.02, p = 0.016). Less social activities, which was associated with the risk of depressive disorder before the pandemic, was not associated with the risk of depressive disorder during the pandemic. However, less family gatherings, which was not associated with the risk of depressive disorder before the pandemic, was associated with the doubled risk of depressive disorder during the pandemic. CONCLUSIONS: The COVID-19 pandemic significantly influences the risk of late-life depression in the community. Older adults with a lack of family gatherings may be particularly vulnerable.

Menstrual abnormalities after COVID-19 vaccination in the Netherlands: A description of spontaneous and longitudinal patient-reported data.

AIMS: During the COVID-19 vaccination campaigns, the number of reports of menstrual abnormalities increased rapidly. Here, we describe the nature and potential risk factors associated with menstrual abnormalities based on spontaneously reporting data as well as data from a prospective cohort event monitoring (CEM) study as these are poorly studied. METHODS: Reports of menstrual abnormalities received by the Netherlands Pharmacovigilance Centre Lareb in the spontaneous reporting system between February 2021 and April 2022 were summarized. In addition, logistic regression analysis was performed on the reported menstrual abnormalities in the CEM study to assess the association between person characteristics, prior SARS-CoV-2 infection and use of hormonal contraceptives and the occurrence of menstrual abnormalities after vaccination. RESULTS: We analysed over 24 000 spontaneous reports of menstrual abnormalities and over 500 episodes (among 16 929 included women) of menstrual abnormalities in the CEM study. The CEM study showed an incidence of 41.4 per 1000 women aged ≤54 years. Amenorrhoea/oligomenorrhoea and heavy menstrual bleeding collectively accounted for about half of all abnormalities reported. Significant associations were observed for the age group 25-34 years (odds ratio 2.18; 95% confidence interval 1.45-3.41) and the Pfizer vaccine (odds ratio 3.04; 95% confidence interval 2.36-3.93). No association was observed for body mass index and presence of most comorbidities assessed. CONCLUSION: The cohort study showed a high incidence of menstrual disorders among women aged ≤54 years, and this observation was supported by the analysis of spontaneous reports. This suggests that a relation between COVID-19 vaccination and menstrual abnormalities is plausible and should be further investigated.

High screen time and internalizing and externalizing behaviours among children aged 3 to 14 years during the COVID-19 pandemic in France.

Children's screen time increased as a result of the COVID-19 pandemic. In the summer of 2021, we explored the association between high screen time over a period of one year since May 2020 and behavioural problems among children and adolescents. The data were derived from the French EpiCov cohort study, collected in spring 2020, autumn 2020, and spring 2021. Participants (N = 1089) responded to online or telephone interviews about one of their children aged 3 to 14 years. Screen time was categorized as high if the daily mean screen time exceeded recommendations at each collection time. The Strengths and Difficulties Questionnaire (SDQ) was completed by parents to identify internalizing (emotional or peer problems) and externalizing (conduct problems or hyperactivity/inattention) behaviours in their children. Among the 1,089 children, 561 (51.5%) were girls, the average age was 8.6 years (SD 3.7). Internalizing behaviours: High screen time was not associated with internalizing behaviours (OR [95% CI] 1.20 [0.90-1.59]) or emotional symptoms (1.00 [0.71-1.41]) while it was associated with peer problems (1.42 [1.04-1.95]). Externalizing behaviours: High screen time was associated with externalizing problems (1.63 [1.01-2.63]) and conduct problems (1.91 [1.15-3.22]) only among older children aged 11 to 14 years. No association with hyperactivity/inattention was found. In a French cohort, exploration of persistent high screen time in the first year of the pandemic and behaviour difficulties in Summer 2021 resulted in mixed findings according to behaviour's type and children's age. These mixed findings warrant further investigation into screen type and leisure/school screen use to enhance future pandemic responses appropriate for children.

Association of fat-soluble vitamins (A, D, and E) status with humoral immune response to COVID-19 inactivated vaccination.

Background: Fat-soluble vitamins (A, D, and E) are essential for the proper functioning of the immune system and are of central importance for infection risk in humans. Vitamins A, D, and E have been reported to be associated with the immune response following vaccination; however, their effects on the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination remain unknown. Methods: We measured the neutralizing antibody titers against wild type and omicron within 98 days after the third homologous boosting shot of inactivated SARS-CoV-2 vaccine (BBIBP-CorV or CoronaVac) in 141 healthy adults in a prospective, open-label study. High-performance liquid chromatography-tandem mass spectroscopy was used to determine the concentrations of plasma vitamins A, D, and E. Results: We found that the anti-wide-type virus and anti-omicron variant antibody levels significantly increased compared with baseline antibody levels (P < 0.001) after the third vaccination. 25(OH)D3 was significantly negatively associated with the baseline anti-wide-type virus antibody concentrations [beta (95% CI) = -0.331 (-0.659 ~ -0.003)] after adjusting for covariates. A potentially similar association was also observed on day 98 after the third vaccination [beta (95% CI) = -0.317 (-0.641 ~ 0.007)]. After adjusting for covariates, we also found that 25(OH)D3 was significantly negatively associated with the seropositivity of the anti-omicron variant antibody at day 98 after the third vaccination [OR (95% CI) = 0.940 (0.883 ~ 0.996)]. The association between plasma 25(OH)D3 with anti-wild-type virus antibody levels and seropositivity of anti-omicron variant antibodies were persistent in subgroup analyses. We observed no association between retinol/α-tocopherol and anti-wide-type virus antibody levels or anti-omicron variant antibody seropositive in our study. Conclusion: The third inactivated SARS-CoV-2 vaccination significantly improved the ability of anti-SARS-CoV-2 infection in the human body. Higher vitamin D concentrations could significantly decrease the anti-wide-type virus-neutralizing antibody titers and anti-omicron variant antibody seropositive rate after the inactivated SARS-CoV-2 vaccination in people with adequate levels of vitamin D, better immune status, and stronger immune response; further studies comprising large cohorts of patients with different nutritional status are warranted to verify our results.

Incidence, characteristics, risk factors and outcomes of diabetic ketoacidosis in COVID-19 patients: Comparison with influenza and pre-pandemic data.

AIMS: This study characterized incidence, patient profiles, risk factors and outcomes of in-hospital diabetic ketoacidosis (DKA) in patients with COVID-19 compared with influenza and pre-pandemic data. METHODS: This study consisted of 13 383 hospitalized patients with COVID-19 (March 2020-July 2022), 19 165 hospitalized patients with influenza (January 2018-July 2022) and 35 000 randomly sampled hospitalized pre-pandemic patients (January 2017-December 2019) in Montefiore Health System, Bronx, NY, USA. Primary outcomes were incidence of in-hospital DKA, in-hospital mortality, and insulin use at 3 and 6 months post-infection. Risk factors for developing DKA were identified. RESULTS: The overall incidence of DKA in patients with COVID-19 and influenza, and pre-pandemic were 2.1%, 1.4% and 0.5%, respectively (p < .05 pairwise). Patients with COVID-19 with DKA had worse acute outcomes (p < .05) and higher incidence of new insulin treatment 3 and 6 months post-infection compared with patients with influenza with DKA (p < .05). The incidence of DKA in patients with COVID-19 was highest among patients with type 1 diabetes (12.8%), followed by patients with insulin-dependent type 2 diabetes (T2D; 5.2%), non-insulin dependent T2D (2.3%) and, lastly, patients without T2D (1.3%). Patients with COVID-19 with DKA had worse disease severity and higher mortality [odds ratio = 6.178 (4.428-8.590), p < .0001] compared with those without DKA. Type 1 diabetes, steroid therapy for COVID-19, COVID-19 status, black race and male gender were associated with increased risk of DKA. CONCLUSIONS: The incidence of DKA was higher in COVID-19 cohort compared to the influenza and pre-pandemic cohort. Patients with COVID-19 with DKA had worse outcomes compared with those without. Many COVID-19 survivors who developed DKA during hospitalization became insulin dependent. Identification of risk factors for DKA and new insulin-dependency could enable careful monitoring and timely intervention.

Cognitive impairment in long-COVID and its association with persistent dysregulation in inflammatory markers.

Objective: To analyze the potential impact of sociodemographic, clinical and biological factors on the long-term cognitive outcome of patients who survived moderate and severe forms of COVID-19. Methods: We assessed 710 adult participants (Mean age = 55 ± 14; 48.3% were female) 6 to 11 months after hospital discharge with a complete cognitive battery, as well as a psychiatric, clinical and laboratory evaluation. A large set of inferential statistical methods was used to predict potential variables associated with any long-term cognitive impairment, with a focus on a panel of 28 cytokines and other blood inflammatory and disease severity markers. Results: Concerning the subjective assessment of cognitive performance, 36.1% reported a slightly poorer overall cognitive performance, and 14.6% reported being severely impacted, compared to their pre-COVID-19 status. Multivariate analysis found sex, age, ethnicity, education, comorbidity, frailty and physical activity associated with general cognition. A bivariate analysis found that G-CSF, IFN-alfa2, IL13, IL15, IL1.RA, EL1.alfa, IL45, IL5, IL6, IL7, TNF-Beta, VEGF, Follow-up C-Reactive Protein, and Follow-up D-Dimer were significantly (p<.05) associated with general cognition. However, a LASSO regression that included all follow-up variables, inflammatory markers and cytokines did not support these findings. Conclusion: Though we identified several sociodemographic characteristics that might protect against cognitive impairment following SARS-CoV-2 infection, our data do not support a prominent role for clinical status (both during acute and long-stage of COVID-19) or inflammatory background (also during acute and long-stage of COVID-19) to explain the cognitive deficits that can follow COVID-19 infection.

Surrogate Marker Assessment Using Mediation and Instrumental Variable Analyses in a Case-Cohort Design

The identification of surrogate markers for gold standard outcomes in clinical trials enables future cost-effective trials that target the identified markers. Due to resource limitations, these surrogate markers may be collected only for cases and for a subset of the trial cohort, giving rise to what is termed the case-cohort design. Motivated by a COVID-19 vaccine trial, we propose methods of assessing the surrogate markers for a time-to-event outcome in a case-cohort design by using mediation and instrumental variable (IV) analyses. In the mediation analysis we decomposed the vaccine effect on COVID-19 risk into an indirect effect (the effect mediated through the surrogate marker such as neutralizing antibodies) and a direct effect (the effect not mediated by the marker), and we propose that the mediation proportions are surrogacy indices. In the IV analysis we aimed to quantify the causal effect of the surrogate marker on disease risk in the presence of surrogatedisease confounding which is unavoidable even in randomized trials. We employed weighted estimating equations derived from nonparametric maximum likelihood estimators (NPMLEs) under semiparametric probit models for the time-to-disease outcome. We plugged in the weighted NPMLEs to construct estimators for the aforementioned causal effects and surrogacy indices, and we determined the asymptotic properties of the proposed estimators. Finite sample performance was evaluated in numerical simulations. Applying the proposed mediation and IV analyses to a mock COVID-19 vaccine trial data, we found that 84.2% of the vaccine efficacy was mediated by 50% pseudovirus neutralizing antibody and that neutralizing antibodies had significant protective effects for COVID-19 risk.

Prevalence of Post-COVID-19 Syndrome and Related Factors among University Employees: A Prospective Cohort Study

Objective: The term post-COVID (coronavirus disease) is used to refer to the presence of prolonged symptoms 12 weeks or more after the disease treatment. This study aimed to evaluate the presence of symptoms and anxiety in patients with COVID-19 who did not require inpatient care at the third and sixth months following symptom onset. Materials and Methods: The study is a prospective cohort study involving 471 university employees who contracted COVID-19 between October 2020 and October 2021. Data were obtained through the disease contact follow-up program implemented at the university and phone interviews conducted at the third and sixth months from symptom onset. Results: The study group comprised 361 individuals at three months and 109 at six months from symptom onset. The study found that symptoms persisted in 116 (32.1%) people in the third month and in 47 (13.0%) people in the sixth month. The most common symptoms at three months were shortness of breath, fatigue, and fatigue, while fatigue, fatigue, and shortness of breath were the most common symptoms at six months. Conclusion: Understanding the long-term effects of coronavirus will enhance the management of the disease. As a result, the follow-up of symptomatic COVID-19 and post-COVID-19 patients will become more systematic and effective.

The Importance of Being FAIR and FAST - The Clinical Epidemiology and Study Platform of the German Network University Medicine (NUKLEUS).

The COVID-19 pandemic has urged the need to set up, conduct and analyze high-quality epidemiological studies within a very short time-scale to provide timely evidence on influential factors on the pandemic, e.g. COVID-19 severity and disease course. The comprehensive research infrastructure developed to run the German National Pandemic Cohort Network within the Network University Medicine is now maintained within a generic clinical epidemiology and study platform NUKLEUS. It is operated and subsequently extended to allow efficient joint planning, execution and evaluation of clinical and clinical-epidemiological studies. We aim to provide high-quality biomedical data and biospecimens and make its results widely available to the scientific community by implementing findability, accessibility, interoperability and reusability - i.e. following the FAIR guiding principles. Thus, NUKLEUS might serve as role model for FAIR and fast implementation of clinical epidemiological studies within the setting of University Medical Centers and beyond.

'Forgotten issue': Living and caring for people with chronic breathlessness

Introduction: Breathlessness is a common symptom in clinical practice and in many prevalent diseases including chronic obstructive lung disease (COPD), asthma, heart failure, lung cancers and post COVID-19 syndrome. Understanding patients' experience of living with breathlessness, their expectations of care and self-management needs is essential to support development of health services and resources that meet their needs. Aim(s): To explore the perspectives of patients and their careers, on living with chronic breathlessness, provision and quality of medical care, and accessing information and resources to assist self-management. The study also explored their views on three evidence-based breathlessness patient education materials (PEMs). Method(s): Qualitative study involving in-depth semi-structured interviews with 16 patients living with chronic breathlessness (>=2 weeks) and their careers. Topics explored included: (1) experience living with breathlessness;(2) current medical care experience and their expectations;and (3) self-management resources, needs and views on some current publicly available PEMs. Result(s): Fourteen patients (cardiac, respiratory, and non-cardiorespiratory) and two carers (50% female) were interviewed (mean age 57 years). Twelve main themes were identified - (1) Breathlessness controls their lives, (2) Breathlessness avoidance and the vicious cycle, (3) Coping vs Fatalism, (4) Feeling misunderstood by their surroundings and health providers, (5) Diagnostic delays, misdiagnosis, and knowledge gaps, (6) Discontinuity of care, (7) Focus on pharmacologic management of breathlessness, (8) Demand for choice, non-pharmacologic options and support, (9) Beyond curing disease: symptom relief and improving quality of life as a goal, (10) Being more aware and in control of their disease, (11) Self-management and limited support for it, and (12) Resources they would value. Conclusion(s): Breathlessness remains a neglected condition in Australia. Patients suffer from lack of clinician and community awareness, discontinuity of care, and too few clinical and self-management options.

Pulmonary embolism at the emergency department during the COVID-19 pandemic. A comparative cohort study from a tertiary level hospital in southern Spain

Several studies have been published showing a significant increase in thrombotic complications in coronavirus disease 2019 (COVID-19) patients, including acute pulmonary embolism (PE). However, there is significant variability regarding published data on the number of computed tomography pulmonary angiography (CTPA) orders to rule out PE, frequency and characteristics of PE, and other factors that could have magnified the actual incidence of PE. The aim of this work is to analyze these factors during the first year of the pandemic. A longitudinal retrospective observational study was designed comparing two cohorts (preCOVID and COVID) of patients for whom an emergency CTPA was requested to rule out PE at the emergency department of our institution. Information was collected regarding the number of CTPAs requested, patient demographics, presence and extension of PE, and radiological signs of right ventricle strain/pulmonary hypertension (RVS/PH). Univariate and bivariate analyses were performed, with stratification by time intervals according to different pandemic waves in the COVID cohort. A total of 1905 patients (530 in the pre-COVID cohort and 1375 in the COVID cohort), with a mean age of 68.3 years (standard deviation, 16.5) and 981 (51.5%) women were included. No significant differences were observed regarding the incidence of PE between both cohorts. In patients with PE, no significant differences regarding age or sex were found, but a significantly higher frequency of peripheral PE was observed in the COVID cohort (42.0% vs. 6.5%, p < 0.001). Regarding signs of RVS/PH, a lower degree of septal deviation and contrast reflux to the inferior vena cava was observed in the COVID cohort, but no significant differences were observed in the right-to-left ventricular ratio. For the COVID cohort, the distribution of central vs. peripheral PE was similar in patients without laboratory-confirmed COVID-19 infection. Finally, the analysis of signs of RVS/PH stratifying by pandemic waves showed a lower frequency of RVS/PH signs in the 2nd and 3rd pandemic waves. In conclusion, despite a significantly higher number of CTPAs were performed during the pandemic, the incidence of PE was similar to that of the pre-pandemic period. A higher number of peripheral PE and less radiological signs of RVS/PH were observed during the pandemic. These findings could be explained by an increased incidental detection of PE during the pandemic. Our study has some limitations, mainly derived from its retrospective and single-center nature, which should be overcome in future research. [ FROM AUTHOR] Copyright of Signa Vitae is the property of Pharmamed Mado Ltd. 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.)

Acute Myocardial Infarction and Myocarditis following COVID-19 Vaccination.

BACKGROUND: Emerging reports raise concerns on the potential association between the COVID-19 vaccines and cardiac manifestations. We sought to evaluate cardiac complications associated with COVID-19 vaccination in a pooled analysis from our institution's cohort study and systematic review. METHODS: Consecutive patients admitted in a tertiary hospital in Singapore between 1 January 2021 and 31 March 2021, with onset of cardiac manifestations within 14 days following COVID-19 vaccination were studied. Furthermore, a systematic review was performed, with PubMed, Embase, Research Square, MedRxiv, and LitCovid databases accessed from inception up to 29 June 2021. Relevant manuscripts reporting individual patient data on cardiac complications following COVID-19 vaccination were included. RESULTS: Thirty patients were included in the study cohort, with 29 diagnosed with acute myocardial infarction (AMI) and 1 with myocarditis. Five patients developed heart failure, two had cardiogenic shock, three intubated, and one had cardiovascular-related mortality. In the systematic review, 16 studies were included with 41 myocarditis and six AMI cases. In the pooled analysis of the study cohort and the systematic review, 35 patients had AMI and 42 had myocarditis. Majority were men, and myocarditis patients were younger than AMI patients. Myocarditis patients tended to present 72 hours post-vaccination, while AMI patients were older and typically presented 24 hours post-vaccination. Majority with AMI or myocarditis developed symptoms after the first and second vaccination dose respectively. CONCLUSIONS: This pooled analysis of patients presenting with cardiac manifestations following COVID-19 vaccination highlights the differences between myocarditis and AMI presentations in temporal association with the vaccination.

Impact of COVID-19 state-wide lockdown on older adult presentations to Queensland emergency departments.

OBJECTIVE: To determine the impact of the COVID-19 state-wide lockdown on ED presentations for older adults in Queensland, Australia. METHODS: A retrospective cohort study pertaining to adults aged 70+ years who presented to Queensland public hospital EDs across three separate time periods; 11 March to 30 June 2018 and 2019 (pre-pandemic average), 2020 (COVID-19 state-wide lockdown) and 2021 (post-state-wide lockdown). The primary outcome was change in presentation rates to ED. Secondary outcomes included change in triage category rates, length of stay (LOS), diagnosis and disposition. RESULTS: There was 380 854 older adult presentations. During the COVID-19 state-wide lockdown, ED presentation rates decreased by 12.5% (incidence rate ratio 0.875 [95% confidence interval 0.867-0.883]). All triage category presentation rates decreased, as did ED LOS and reasons for presentation, except sepsis and disorders of the nervous system. In the post-state-wide lockdown period a 22% (incidence rate ratio 1.22 [95% confidence interval 1.21-1.23]) increase in the presentation rate was observed and presentations in all triage categories increased. ED LOS increased to longer than pre-pandemic (P < 0.001). Respiratory presentations increased by 346%. Patients who 'did not wait' increased by 212% and ED mortality rose by 42% compared to during the lockdown. CONCLUSION: There was a significant decrease in presentation rates to EDs during the COVID-19 state-wide lockdown for the older population, followed by an increase in presentation rates, longer ED LOS, and an increased ED mortality rate, in the post-state-wide lockdown period. It is important to ensure older adults continue to seek appropriate, timely medical care, during a pandemic.

Impact of the COVID-19 pandemic on the quality of diabetes care: Insights from longitudinal data in Switzerland.

In this population-based cohort study on diabetes care, self-reported quality indicators measured just before (2019) and during (2021) the COVID-19 pandemic were comparable, apart from a modest increase in seasonal influenza immunization and a small decline in patient-centeredness of care in 2021.

Current tobacco use and SARS-CoV-2 infection in two Norwegian population-based cohorts.

BACKGROUND: Clear evidence of an increased risk for SARS-CoV-2 infection among smokers has not been established. We aimed to investigate associations between cigarette smoking or use of snus (snuff) and other nicotine-containing products and a positive SARS-CoV-2 test, taking test behavior into account. METHODS: Current tobacco use and testing behavior during the pandemic were recorded by adult participants from the Norwegian Mother, Father and Child Cohort Study and The Norwegian Influenza Pregnancy Cohort. SARS-CoV-2 infection status was obtained from The Norwegian Surveillance System for Communicable Diseases (MSIS) in May 2021 (n = 78,860) and antibody measurements (n = 5581). We used logistic regression models stratified by gender and adjusted for age, education, region, number of household members, and work situation. RESULTS: Snus use was more common among men (26%) than women (9%) and more prevalent than cigarette smoking. We found no clear associations between cigarette smoking or snus and a COVID-19 diagnosis among men. Associations among women were conflicting, indicating that cigarette smoke was negatively associated with a diagnosis (OR 0.51, 95% CI 0.35, 0.75), while no association was found for snus use (OR 1.07, 95% CI 0.86, 1.34). Compared with non-users of tobacco, both cigarette smokers and snus users had increased odds of being tested for SARS-CoV-2. CONCLUSIONS: Cigarette smoking, but not snus use, was negatively associated with SARS-CoV-2 infection in women. The lack of an association between snus use and SARS-CoV-2 infection in this population with prevalent snus use does not support the hypothesis of a protective effect of nicotine.

All-cause and COVID-19 mortality in Qatar during the COVID-19 pandemic.

OBJECTIVE: To investigate all-cause mortality, COVID-19 mortality and all-cause non-COVID-19 mortality in Qatar during the COVID-19 pandemic. METHODS: A national, retrospective cohort analysis and national, matched, retrospective cohort studies were conducted between 5 February 2020 and 19 September 2022. RESULTS: There were 5025 deaths during a follow-up time of 5 247 220 person-years, of which 675 were COVID-19 related. Incidence rates were 0.96 (95% CI 0.93 to 0.98) per 1000 person-years for all-cause mortality, 0.13 (95% CI 0.12 to 0.14) per 1000 person-years for COVID-19 mortality and 0.83 (95% CI 0.80 to 0.85) per 1000 person-years for all-cause non-COVID-19 mortality. Adjusted HR, comparing all-cause non-COVID-19 mortality relative to Qataris, was lowest for Indians at 0.38 (95% CI 0.32 to 0.44), highest for Filipinos at 0.56 (95% CI 0.45 to 0.69) and was 0.51 (95% CI 0.45 to 0.58) for craft and manual workers (CMWs). Adjusted HR, comparing COVID-19 mortality relative to Qataris, was lowest for Indians at 1.54 (95% CI 0.97 to 2.44), highest for Nepalese at 5.34 (95% CI 1.56 to 18.34) and was 1.86 (95% CI 1.32 to 2.60) for CMWs. Incidence rate of all-cause mortality for each nationality group was lower than the crude death rate in the country of origin. CONCLUSIONS: Risk of non-COVID-19 death was low and was lowest among CMWs, perhaps reflecting the healthy worker effect. Risk of COVID-19 death was also low, but was highest among CMWs, largely reflecting higher exposure during first epidemic wave, before advent of effective COVID-19 treatments and vaccines.