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1.
Networks and Heterogeneous Media ; 0(0):24, 2022.
Article in English | Web of Science | ID: covidwho-1798842

ABSTRACT

During the Covid-19 pandemic a key role is played by vaccination to combat the virus. There are many possible policies for prioritizing vaccines, and different criteria for optimization: minimize death, time to herd immunity, functioning of the health system. Using an age-structured population compartmental finite-dimensional optimal control model, our results suggest that the eldest to youngest vaccination policy is optimal to minimize deaths. Our model includes the possible infection of vaccinated populations. We apply our model to real-life data from the US Census for New Jersey and Florida, which have a significantly different population structure. We also provide various estimates of the number of lives saved by optimizing the vaccine schedule and compared to no vaccination.

2.
Intern Emerg Med ; 2022 Feb 04.
Article in English | MEDLINE | ID: covidwho-1797521

ABSTRACT

The global pandemic caused by SARS-CoV-2 (COVID-19) has led to significant morbidity and mortality, and unprecedented economic and health system disruption. Non-pharmacologic interventions (NPIs) such as masking and physical distancing have formed the underpinnings of COVID-19 infection control strategies. Concomitantly, numerous jurisdictions have seen a decrease in hospitalizations for non-COVID-19 respiratory illnesses (NCRIs) such as asthma, community-acquired pneumonia, influenza, and chronic obstructive pulmonary disease relative to pre-pandemic levels. These associations give rise to a number of testable hypotheses regarding the efficacy of NPIs in reducing the substantial burden of NCRIs. Here, we review emerging perspectives on the role of NPIs in NCRI prevention with the ultimate goal of informing future research and public policy development as we move into what may be the endemic phase of the COVID-19 pandemic.

3.
Open Forum Infect Dis ; 9(5):ofac116, 2022.
Article in English | PubMed | ID: covidwho-1795131

ABSTRACT

BACKGROUND: Characterizations of coronavirus disease 2019 (COVID-19) vaccine breakthrough infections are limited. We aim to characterize breakthrough infections and identify risk factors associated with outcomes. METHODS: This was a retrospective case series of consecutive fully vaccinated patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a multicenter academic center in Southeast Michigan, between December 30, 2020, and September 15, 2021. RESULTS: A total of 982 patients were identified;the mean age was 57.9 years, 565 (59%) were female, 774 (79%) were White, and 255 (26%) were health care workers (HCWs). The median number of comorbidities was 2;225 (23%) were immunocompromised. BNT162b2 was administered to 737 (75%) individuals. The mean time to SARS-CoV-2 detection was 135 days. The majority were asymptomatic or exhibited mild to moderate disease, 154 (16%) required hospitalization, 127 (13%) had severe-critical illness, and 19 (2%) died. Age (odds ratio [OR], 1.14;95% CI, 1.04-1.07;P < .001), cardiovascular disease (OR, 3.02;95% CI, 1.55-5.89;P = .001), and immunocompromised status (OR, 2.57;95% CI, 1.70-3.90;P < .001) were independent risk factors for hospitalization. Additionally, age (OR, 1.06;95% CI, 1.02-1.11;P = .006) was significantly associated with mortality. HCWs (OR, 0.15;95% CI, 0.05-0.50;P = .002) were less likely to be hospitalized, and prior receipt of BNT162b2 was associated with lower odds of hospitalization (OR, 0.436;95% CI, 0.303-0.626;P < .001) and/or death (OR, 0.360;95% CI, 0.145-0.898;P = .029). CONCLUSIONS: COVID-19 vaccines remain effective at attenuating disease severity. However, patients with breakthrough infections necessitating hospitalization may benefit from early treatment modalities and COVID-19-mitigating strategies, especially in areas with substantial or high transmission rates.

4.
J Gen Intern Med ; 2022 Apr 08.
Article in English | MEDLINE | ID: covidwho-1782930

ABSTRACT

BACKGROUND: Hospitalizations fell precipitously among the general population during the COVID-19 pandemic. It remains unclear whether individuals experiencing homelessness experienced similar reductions. OBJECTIVE: To examine how overall and cause-specific hospitalizations changed among individuals with a recent history of homelessness (IRHH) and their housed counterparts during the first wave of the COVID-19 pandemic, using corresponding weeks in 2019 as a historical control. DESIGN: Population-based cohort study conducted in Ontario, Canada, between September 30, 2018, and September 26, 2020. PARTICIPANTS: In total, 38,617 IRHH, 15,022,368 housed individuals, and 186,858 low-income housed individuals matched on age, sex, rurality, and comorbidity burden. MAIN MEASURES: Primary outcomes included medical-surgical, non-elective (overall and cause-specific), elective surgical, and psychiatric hospital admissions. KEY RESULTS: Average rates of medical-surgical (rate ratio: 3.8, 95% CI: 3.7-3.8), non-elective (10.3, 95% CI: 10.1-10.4), and psychiatric admissions (128.1, 95% CI: 126.1-130.1) between January and September 2020 were substantially higher among IRHH compared to housed individuals. During the peak period (March 17 to June 16, 2020), rates of medical-surgical (0.47, 95% CI: 0.47-0.47), non-elective (0.80, 95% CI: 0.79-0.80), and psychiatric admissions (0.86, 95% CI: 0.84-0.88) were significantly lower among housed individuals relative to equivalent weeks in 2019. No significant changes were observed among IRHH. During the re-opening period (June 17-September 26, 2020), rates of non-elective hospitalizations for liver disease (1.41, 95% CI: 1.23-1.69), kidney disease (1.29, 95% CI: 1.14-1.47), and trauma (1.19, 95% CI: 1.07-1.32) increased substantially among IRHH but not housed individuals. Distinct hospitalization patterns were observed among IRHH even in comparison with more medically and socially vulnerable matched housed individuals. CONCLUSIONS: Persistence in overall hospital admissions and increases in non-elective hospitalizations for liver disease, kidney disease, and trauma indicate that the COVID-19 pandemic presented unique challenges for recently homeless individuals. Health systems must better address the needs of this population during public health crises.

5.
SSRN; 2022.
Preprint in English | SSRN | ID: ppcovidwho-332511

ABSTRACT

Background: mRNA-based COVID-19 booster vaccinations have been administered in Germany since mid-September 2021. We utilized Germany’s national COVID-19 surveillance data to assess effectiveness of three vaccination doses among adolescents and adults during Delta- and Omicron-predominance. Methods: We applied a quasi-Poisson regression model to estimate incidence rate ratios and 95% confidence intervals for symptomatic SARS-CoV-2 infection and COVID-19 associated hospitalization and severe illness by age group (12-17, 18-59, and ≥60 years). We further investigated waning of vaccine effectiveness (VE) over time during Omicron-predominance. Findings: VE against symptomatic infection was considerably lower during Omicron- versus Delta-predominance (70% vs. 95% among ≥18 year-olds). During Omicron-predominance, estimated 3-dose VE at <4 weeks post-vaccination was highest in 12-17 year-olds (89·7%), followed by ≥60 year-olds (87·8%) and 18-59 year-olds (77·4%), and declined to 84·4% at 4 to <8 weeks post-vaccination and 51·1% and 76·4% at 8 to <12 weeks post-vaccination, respectively. VE against hospitalization was high in all age groups and remained >90% among ≥60 year-olds and >75% among 18-59 year-olds at 8 to <12 weeks post-vaccination, while VE against severe illness among ≥60 year-olds was >95% at 8 to <12 weeks. Interpretation: First estimates for effectiveness of mRNA booster vaccinations against Omicron-infections in adolescents are encouragingly high. Waning of protection against mild illness over the first 15 weeks post-vaccination was marked among 18-59 year-olds;however, boosting offered excellent protection against hospitalization and severe illness. Utilizing routine surveillance data to monitor COVID-19 VE in real time can be a valid and resource-saving approach upon surge of novel SARS-CoV-2 variants.

6.
Cureus Journal of Medical Science ; 14(3):11, 2022.
Article in English | Web of Science | ID: covidwho-1776626

ABSTRACT

Background The incidence of acute coronary syndromes (ACS) decreased during the coronavirus disease 2019 (COVID-19) pandemic. Few studies have investigated gender differences in ACS admissions and outcomes during pandemics and have presented divergent results. This study aimed to investigate the effect of the COVID-19 pandemic on male and female hospitalizations and in-hospital outcomes in patients presenting with ACS. Methodology We designed a retrograde, single-center trial gathering data for ACS hospitalizations during the lockdown (March 9, 2020, to April 30, 2020) compared with the same timeframe of 2019. ACS hospitalizations were subgrouped as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA). We calculated the incidence rate ratio (IRR) to compare all-ACS and subgroups for male and female hospitalizations and the risk ratio (RR) to compare overall male/female mortality. Results This study included 321 ACS patients (238 males, 83 females) during the COVID-19 lockdown and 550 patients (400 males, 150 females) during 2019. The IRRs of all-ACS/males/females were significantly lower during the COVID-19 period at 0.58 (95% confidence interval (CI) = 0.44-0.76), 0.59 (95% CI = 0.43-0.75), and 0.55 (95% CI = 0.37-0.74), respectively. The IRR for STEMI was significantly lower among females (0.59 (95% CI = 0.39-0.89)), but not among males (0.76 (95% CI = 0.55-1.08)) The IRR for NSTEMI was not significantly lower, meanwhile it was significantly lower for UA among both males and females. The overall ACS mortality increased during the COVID-19 period (7.4% vs. 3.4%;RR = 2.16 (95% CI = 1.20-3.89)). Important increase was found in males (7.45% vs. 2.5%;RR = 3.02 (95% CI = 1.42-6.44)), hut not in females (7.2% vs. 6%;RR = 1.20 (95% CI = 0.44-3.27). Conclusions The admissions of ACS reduced similarly in males and females during the COVID-19 pandemic. The admissions of STEMI reduced predominantly in females. We identified a substantial increase in the overall ACS mortality, but predominantly in males, reducing the differences between males and females. Further studies are necessary to better understand the increase in male mortality during the pandemic.

7.
Lancet Reg Health Am ; 6: 100102, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1773595

ABSTRACT

Background: Brazil has faced two simultaneous problems related to respiratory health: forest fires and the high mortality rate due to COVID-19 pandemics. The Amazon rain forest is one of the Brazilian biomes that suffers the most with fires caused by droughts and illegal deforestation. These fires can bring respiratory diseases associated with air pollution, and the State of Pará in Brazil is the most affected. COVID-19 pandemics associated with air pollution can potentially increase hospitalizations and deaths related to respiratory diseases. Here, we aimed to evaluate the association of fire occurrences with the COVID-19 mortality rates and general respiratory diseases hospitalizations in the State of Pará, Brazil. Methods: We employed machine learning technique for clustering k-means accompanied with the elbow method used to identify the ideal quantity of clusters for the k-means algorithm, clustering 10 groups of cities in the State of Pará where we selected the clusters with the highest and lowest fires occurrence from the 2015 to 2019. Next, an Auto-regressive Integrated Moving Average Exogenous (ARIMAX) model was proposed to study the serial correlation of respiratory diseases hospitalizations and their associations with fire occurrences. Regarding the COVID-19 analysis, we computed the mortality risk and its confidence level considering the quarterly incidence rate ratio in clusters with high and low exposure to fires. Findings: Using the k-means algorithm we identified two clusters with similar DHI (Development Human Index) and GDP (Gross Domestic Product) from a group of ten clusters that divided the State of Pará but with diverse behavior considering the hospitalizations and forest fires in the Amazon biome. From the auto-regressive and moving average model (ARIMAX), it was possible to show that besides the serial correlation, the fires occurrences contribute to the respiratory diseases increase, with an observed lag of six months after the fires for the case with high exposure to fires. A highlight that deserves attention concerns the relationship between fire occurrences and deaths. Historically, the risk of mortality by respiratory diseases is higher (about the double) in regions and periods with high exposure to fires than the ones with low exposure to fires. The same pattern remains in the period of the COVID-19 pandemic, where the risk of mortality for COVID-19 was 80% higher in the region and period with high exposure to fires. Regarding the SARS-COV-2 analysis, the risk of mortality related to COVID-19 is higher in the period with high exposure to fires than in the period with low exposure to fires. Another highlight concerns the relationship between fire occurrences and COVID-19 deaths. The results show that regions with high fire occurrences are associated with more cases of COVID deaths. Interpretation: The decision-make process is a critical problem mainly when it involves environmental and health control policies. Environmental policies are often more cost-effective as health measures than the use of public health services. This highlight the importance of data analyses to support the decision making and to identify population in need of better infrastructure due to historical environmental factors and the knowledge of associated health risk. The results suggest that The fires occurrences contribute to the increase of the respiratory diseases hospitalization. The mortality rate related to COVID-19 was higher for the period with high exposure to fires than the period with low exposure to fires. The regions with high fire occurrences is associated with more COVID-19 deaths, mainly in the months with high number of fires. Funding: No additional funding source was required for this study.

8.
Diabetes Res Clin Pract ; 187: 109862, 2022 Apr 01.
Article in English | MEDLINE | ID: covidwho-1768028

ABSTRACT

AIMS: To report the national proportions and trends of adult hospitalizations with diabetes in the United States during 2000-2018. METHODS: We used the 2000-2018 National Inpatient Sample to identify hospital discharges with any listed and primary diagnoses for diabetes, based on International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) and ICD-10-CM codes. We calculated proportions and trends of adult hospitalizations with diabetes, overall and by subpopulations. We used the Nationwide Readmissions Database to assess calendar-year and 30-day readmission rates. RESULTS: From 2000 to 2018, the proportion of hospitalizations among adults ≥18 years increased from 17.1% to 27.3% (average annual percentage change [AAPC] 2.5%; P < 0.001) for any listed diabetes codes and from 1.5% to 2.1% (AAPC 2.2%; P < 0.001) for primary diagnosis of diabetes. Men, non-Hispanic Black patients, and those from poorer zip codes had higher proportions of hospitalizations with diabetes codes. CONCLUSION: In recent years, approximately one-quarter of adult hospitalizations in the United States had a listed diabetes code, increasing about 2.5% per year from 2000 to 2018. These data are important for benchmarking purposes, especially due to disruptions in health care utilization from the COVID-19 pandemic.

9.
J Trop Pediatr ; 68(3)2022 Apr 05.
Article in English | MEDLINE | ID: covidwho-1764660

ABSTRACT

BACKGROUND: The first case of coronavirus disease 2019 (COVID-19) in Cameroon was recorded in March 2020. In response to the pandemic, most countries like Cameroon instituted a number of control measures to curb its spread accross the country. These COVID-19 control measures added to the fear of this disease within the population may have led to other detrimental health effects like: the pattern of hospitalizations and hospital outcomes. METHODS: We did a cross-sectional study with data from in-patient admission records of children admitted to the pediatric ward of the Regional Hospital Bamenda over a 24 months period (1st of March 2019 to the 28th of February 2021). The pre-pandemic period in Cameroon (that is, the first 12 months, from March 2019 to February 2020) and the pandemic period (that is, the last 12 months, from March 2020 to February 2021) were compared. RESULTS: A total of 2282 hospitalization records were included in the study. Most of the hospitalized children were males (57.23%). There was a 19.03% decline in pediatric hospitalizations during the first 12 months of the pandemic, which was statistically significant (p = 0.00024). The causes of hospitalizations and mortality remained similar over both periods, with severe malaria, the leading cause of admissions. Hospital deaths before and during the pandemic were 1.6% and 1.9%, respectively. CONCLUSION: There was a statistically significant decline in pediatric hospitalizations during the first 12 months of the pandemic as compared to the same period before the pandemic. Hospital mortality and causes of hospitalizations remained similar over both the periods.


The coronavirus disease 2019 (COVID-19) pandemic is a public health emergency and a challenge to the health systems of most countries worldwide. The initial response of the Cameroon government to the COVID-19 pandemic was to put a number of measures in place to stop the spread of the virus across the country. These measures, though beneficial in the fight against COVID-19 could have led to other detrimental health effects on the population, through a change in the pattern of hospitalizations and hospital outcomes, and all these were made worse by the fear of COVID within the population. We carried out a descriptive and retrospective cross-sectional study using hospitalization and mortality data from the pediatric ward of the Regional Hospital Bamenda, in Cameroon. We compared the data for the last 12 months before the pandemic (March 2019­February 2020) to that of the first 12 months during the pandemic in Cameroon (March 2020­February 2021). The comparison of the two periods showed that there was a statistically significant decline in pediatric hospitalizations during the first 12 months of the pandemic, by 19.03% (p = 0.00024). The hospital mortality rates before and during the pandemic were 1.6% and 1.9%, respectively, and the causes of these hospitalizations and mortality remained similar over both the periods.


Subject(s)
COVID-19 , COVID-19/epidemiology , Cameroon/epidemiology , Child , Cross-Sectional Studies , Hospitalization , Humans , Male , Pandemics , Retrospective Studies
10.
J Popul Econ ; : 1-26, 2022 Mar 24.
Article in English | MEDLINE | ID: covidwho-1756781

ABSTRACT

Soon after the onset of the COVID-19 pandemic, the French government decided to still hold the first round of the 2020 municipal elections as scheduled on March 15. What was the impact of these elections on the spread of COVID-19 in France? Answering this question leads to intricate econometric issues as omitted variables may drive both epidemiological dynamics and electoral turnout, and as a national lockdown was imposed at almost the same time as the elections. In order to disentangle the effect of the elections from that of confounding factors, we first predict each department's epidemiological dynamics using information up to the election. We then take advantage of differences in electoral turnout across departments to identify the impact of the election on prediction errors in hospitalizations. We report a detrimental effect of the first round of the election on hospitalizations in locations that were already at relatively advanced stages of the epidemic. Estimates suggest that the elections accounted for at least 3,000 hospitalizations, or 11% of all hospitalizations by the end of March. Given the sizable health cost of holding elections during an epidemic, promoting ways of voting that reduce exposure to COVID-19 is key until the pandemic shows signs of abating.

11.
Cureus ; 14(2): e22152, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1753935

ABSTRACT

Background and objective Coronavirus disease 2019 (COVID-19) was first reported in China two years ago as primarily a lung infection associated with cough and fever. It spread rapidly across the world and was declared a pandemic in early 2020, with 131 million people infected and 2.85 million deaths worldwide. To date, approximately 550,000 deaths have occurred due to COVID-19 in the United States and the numbers continue to rise. The extrapulmonary manifestations of this disease such as acute kidney injury (AKI), cardiovascular events, and gastrointestinal (GI) indications were not emphasized initially. However, subsequent studies from the United States and Canada have noted GI involvement in this disease in a large number of cases. Our group, taking care of these patients during the early phase of the pandemic in 2020, observed the frequent presentations of GI symptoms such as diarrhea and hepatic dysfunction and this study examines the same. Methods We undertook a retrospective study of 184 consecutive adult patients who were hospitalized at our center with confirmed COVID-19 infection, with a view to further elucidate the GI and hepatic involvement during the early breakout (March 17-May 17, 2020) of this illness. Results Major comorbidities associated with this illness in our cohort of patients included hypertension (HTN, 66%), diabetes mellitus (DM, 44%), obesity (41%), and chronic kidney disease (CKD, 17%). The most common GI manifestation was diarrhea (25%) and, interestingly, more than two-thirds of the patients had at least one liver function abnormality. The most common liver function abnormality was elevated serum aspartate aminotransferase (AST). Elevated AST was significantly correlated (p<0.05) with inflammatory markers such as D-dimer, lactate dehydrogenase (LDH), and ferritin, as well as AKI by bi-variate analysis. Salient observations from our study include higher mortality, frequent AKI, and cardiovascular events in male patients (p<0.05).  The liver injury in our cohort was suspected to be multifactorial, involving excessive cytokine release, viral infiltration of the hepatocytes, and cholangiocytes playing a role in transaminitis. The mean (±SD) duration of hospital stay was 13.5 ±15 days with 33% admissions to the ICU. The overall mortality was around 27%, with no significant difference between African Americans and Caucasians. However, patients admitted to the ICU had a very high mortality rate (54%) compared to those admitted to intermediate care (IMC)/acute care who had less severity of illness and associated pulmonary complications. Conclusions This study evaluates the presence of comorbidities such as DM, HTN, and obesity in patients hospitalized with COVID-19 at a community hospital in the Mid-Atlantic region of the United States. Statistical analysis of the data obtained for this cohort revealed a high frequency of GI symptoms, with diarrhea as the predominant common initial manifestation of the disease. Serum AST elevations were common and correlated with inflammatory markers and AKI. Male gender was also significantly associated with the development of AKI, higher frequency of cardiovascular events, and increased mortality. Overall mortality was noted to be 27%, with higher mortality in patients admitted to the ICU (54%) as compared to the IMC/floor (13%). These observations should spur future investigations into the role of these comorbidities, development of diarrhea, and hepatic dysfunction in COVID-19.

12.
J Clin Med ; 11(6)2022 Mar 13.
Article in English | MEDLINE | ID: covidwho-1742506

ABSTRACT

BACKGROUND: A decline in cardiovascular hospitalizations was observed during the initial phases of the COVID-19 pandemic. We examine the continuous effect of the COVID-19 pandemic in reducing cardiovascular hospitalization and associated mortality rates during the first year of the pandemic in Israel. METHODS: We conduct a retrospective cohort study using the data of Clalit Health Services, the largest healthcare organization in Israel. We divide the Corona year into six periods (three lockdowns and three post-lockdowns) and compare the incidence rates of cardiovascular hospitalizations and 30-day all-cause mortality during each period to the previous three years. RESULTS: The number of non-STEMI hospitalizations during the first year of the pandemic was 13.7% lower than the average of the previous three years (95% CI 11-17%); STEMI hospitalizations were 15.7% lower (95% CI 13-19%); CHF (Congestive heart failure) hospitalizations were 23.9% lower (95%, CI 21-27%). No significant differences in 30-day all-cause mortality rates were observed among AMI (acute myocardial infarction) patients during most of the periods, whereas the annual 30-day all-cause mortality rate among CHF patients was 23% higher. CONCLUSIONS: AMI and CHF hospitalizations were significantly lower during the first year of the pandemic relative to 2017-9. Mortality rates were higher in the case of CHF patients but not in the case of AMI patients, possibly due to a change in the clinical acuity of patients arriving at the hospitals. We conclude that targeted public health messaging should be implemented together with proactive monitoring, in order to identify residual disability in patients who may have received non-optimal treatment during the pandemic.

14.
Medica Jadertina ; 51(4):301-310, 2021.
Article in Croatian | Scopus | ID: covidwho-1710444

ABSTRACT

The Covid-19 pandemic in 2020 significantly affected all segments of society. The health care system had to adapt quickly to the new situation. Patients canceled and delayed a significant number of examinations and diagnostic procedures, which resulted in a reduction in the number of hospitalizations. The aim of this paper is to present the hospitalizations in the inpatient health care and in the hospital day care in Zadar General Hospital in 2020, in the year of the COVID-19 pandemic, and to compare the obtained data with the hospitalizations in 2019. Materials and methods: We used data from National Public Health Information System of the Croatian Institute of Public Health, which registers on a monthly basis of all reports of hospitalizations according to the individual health-statistical reports type "JZ-BSO" Public Health – Patient Statistical Form. Data were processed and presented by descriptive statistical methods. Results: In 2020, 51,152 hospitalizations were recorded at Zadar General Hospital which is 10% less than in the previous year 2019. In 2020, 16,814 hospitalizations were recorded in the inpatient health care, which is 13.6% less than in 2019 (p < 0.05), while 34,338 hospitalizations were recorded in the hospital day care and the decrease was 8.1% (p < 0.05). The number of deaths in Zadar GH in 2020 increased by 5%. In 2020, a total of 885 patients died, and in 2019, 843 patients (p > 0.05). The largest decrease in the number of hospitalizations was recorded in April;in the inpatient health care by 43.8%, and in the hospital day care by 33.5%. In 2020, 6,882 persons positive for SARS-CoV-2 virus were recorded in Zadar County. 327 hospitalizations of SAR-CoV-2 positive persons were recorded in the hospital day care, of which 171 were transferred to inpatient health care and the rest were discharge. In the inpatient health care, 529 hospitalizations of SARS-CoV-2 positive persons were recorded, of which 77.3% were discharged, 5.5% were transferred to another inpatient health care units, and 16.8% died. Conclusion: The Covid-19 pandemic affected the reduction in the number of hospitalizations in 2020, which was expected. Work in the health care system was adapted to the conditions of the pandemic, and for patients the pandemic had the effect of reducing the number and delaying going to medical examinations. © 2021, Opca Bolnica Zadar. All rights reserved.

16.
Emerg Infect Dis ; 28(3): 564-571, 2022 03.
Article in English | MEDLINE | ID: covidwho-1700805

ABSTRACT

We report on local nowcasting (short-term forecasting) of coronavirus disease (COVID-19) hospitalizations based on syndromic (symptom) data recorded in regular healthcare routines in Östergötland County (population ≈465,000), Sweden, early in the pandemic, when broad laboratory testing was unavailable. Daily nowcasts were supplied to the local healthcare management based on analyses of the time lag between telenursing calls with the chief complaints (cough by adult or fever by adult) and COVID-19 hospitalization. The complaint cough by adult showed satisfactory performance (Pearson correlation coefficient r>0.80; mean absolute percentage error <20%) in nowcasting the incidence of daily COVID-19 hospitalizations 14 days in advance until the incidence decreased to <1.5/100,000 population, whereas the corresponding performance for fever by adult was unsatisfactory. Our results support local nowcasting of hospitalizations on the basis of symptom data recorded in routine healthcare during the initial stage of a pandemic.


Subject(s)
COVID-19 , Adult , COVID-19/epidemiology , Delivery of Health Care , Forecasting , Hospitalization , Humans , SARS-CoV-2 , Sweden/epidemiology
17.
J Infect Dis ; 225(4): 567-577, 2022 02 15.
Article in English | MEDLINE | ID: covidwho-1684702

ABSTRACT

BACKGROUND: We evaluated prevaccine pandemic period COVID-19 death risk factors among nursing home (NH) residents. METHODS: In a retrospective cohort study covering Medicare fee-for-service beneficiaries aged ≥65 years residing in US NHs, we estimated adjusted hazard ratios (HRs) using multivariate Cox proportional hazards regressions. RESULTS: Among 608251 elderly NH residents, 57398 (9.4%) died of COVID-19-related illness 1 April to 22 December 2020; 46.9% (26893) of these deaths occurred without prior COVID-19 hospitalizations. We observed a consistently increasing age trend for COVID-19 deaths. Racial/ethnic minorities shared similarly high risk of NH COVID-19 deaths with whites. NH facility characteristics for-profit ownership and low health inspection ratings were associated with higher death risk. Resident characteristics (male [HR, 1.69], end-stage renal disease [HR, 1.42], cognitive impairment [HR, 1.34], and immunocompromised status [HR, 1.20]) were death risk factors. Other individual-level characteristics were less predictive of death than in community-dwelling population. CONCLUSIONS: Low NH health inspection ratings and private ownership contributed to COVID-19 death risks. Nearly half of NH COVID-19 deaths occurred without prior COVID-19 hospitalization and older residents were less likely to get hospitalized with COVID-19. No substantial differences were observed by race/ethnicity and socioeconomic status for NH COVID-19 deaths.


Subject(s)
COVID-19 , Nursing Homes , Aged , COVID-19/mortality , Hospitalization , Humans , Male , Medicare , Proportional Hazards Models , Retrospective Studies , Risk Factors , United States/epidemiology
18.
Int J Infect Dis ; 112: 81-88, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1654537

ABSTRACT

BACKGROUND: The advent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines has been associated with a significant decline in coronavirus disease 2019 (COVID-19) hospitalizations and deaths. However, little is known about the benefits experienced by different population groups and/or using distinct vaccines. METHODS: The Spanish public registry was analyzed to examine associations between weekly vaccination scale-up and the incidence of COVID-19 hospitalizations by age, sex, and vaccine modality. The study period extended from January 2020 to June 2021. RESULTS: A total of 363 960 COVID-19 hospitalizations were recorded in Spain during the study period, with three peaks in March 2020, November 2020, and January 2021. The incidence of COVID-19 hospitalizations per 100 000 population increased exponentially with age, on average 71.5% for each decade older. Overall, individuals older than 60 years of age accounted for 65% of all COVID-19 hospitalizations. The speedy vaccination rollout since the end of 2020, with prioritization of the elderly groups, resulted in a rapid fall in COVID-19 hospitalizations starting in February 2021. The benefit was already noticed 3-4 weeks after the first dose, regardless of the vaccine modality. CONCLUSIONS: COVID-19 hospitalizations increased exponentially with age in all three peaks of SARS-CoV-2 infection in Spain. Early mass vaccination of people over 60 years of age prevented a fourth wave of COVID-19 hospitalizations during the spring of 2021.


Subject(s)
COVID-19 , Aged , COVID-19 Vaccines , Hospitalization , Humans , Middle Aged , SARS-CoV-2 , Spain/epidemiology , Vaccination
19.
Microorganisms ; 10(1)2022 Jan 14.
Article in English | MEDLINE | ID: covidwho-1632844

ABSTRACT

Since the SARS-CoV-2 outbreak, many countries have introduced measures to limit the transmission. The data based on ICD-10 codes of lower respiratory tract infections and microbiological analysis of respiratory and gastrointestinal infections were collected. The retrospective five-year analysis of the medical records revealed a substantial decrease in respiratory tract infections during the pandemic year (from April 2020 to March 2021). We noted an 81% decline in the LRTI-associated hospital admissions based on the ICD-10 analysis (from a mean of 1170 admissions per year in the previous four years to 225 admissions between April 2020 through March 2021). According to microbiological analysis, there were 100%, 99%, 87%, and 47% drops in influenza virus, respiratory syncytial virus, rotavirus, and norovirus cases reported respectively during the pandemic season until April 2021 in comparison to pre-pandemic years. However, the prevalence of gastrointestinal bacterial infections was stable. Moreover, in August 2021, an unexpected rise in RSV-positive cases was observed. The measures applied during the COVID-19 pandemic turned out to be effective but also had a substantial contribution to the so-far stable epidemiological situation of seasonal infections.

20.
Epidemiol Prev ; 45(6): 568-579, 2021.
Article in English | MEDLINE | ID: covidwho-1607585

ABSTRACT

OBJECTIVES: to present an evaluation of the campaign for vaccination against COVID-19 in the territory covered by the Agency for Health Protection of the Metropolitan Area of Milan from 01.01.2021 to 30.09.2021. DESIGN: descriptive study of vaccine adherence; predictive study of the factors associated with vaccine adherence, efficacy of vaccination in terms of hospitalization and mortality, and factors that increase the risk of hospital admission following full vaccination. SETTING AND PARTICIPANTS: population-based study with subjects aged >18 years eligible for vaccination (N. 2,981,997). An information system obtained by integrating various administrative healthcare sources made it possible to analyse socioeconomic characteristics, COVID-19 related hospitalizations, and general mortality in subjects eligible for vaccination. MAIN OUTCOME MEASURES: full vaccination (2 doses); COVID-19-related hospitalizations, COVID-19-related hospitalizations occurring more than 15 days after the second dose, general mortality. RESULTS: in the first nine months of the vaccination campaign, 74.7% of the subjects (N. 2,228,915) was fully vaccinated, whereas 15.6% (N. 465,829) did not even receive one dose. Women have a lower probability of getting vaccinated than men; the 50-59 years and 70+ years age groups emerge as the most problematic to reach, while the younger one (<40) is the most adherent. A social gradient emerged, with residents of more disadvantaged areas progressively less incline to get vaccinated than those living in more affluent areas. Adherence is greater in Italian citizenship and is likely to increase with an increase in the number of chronic conditions. Hospitalizations amounted to 1.22% (N. 5,672) in the unvaccinated population compared to 0.05% (N. 1,013) in the vaccinated population; general mortality was 4.51% (N. 15,198) in the unvaccinated population against 0.32% (N. 8.733) in the vaccinated population. Sociodemographic factors and the presence of previous health conditions are important predictors of hospitalization outcomes even within the fully vaccinated population. Specifically, the highest hazard ratios are found in subjects with heart failure (HR 2.15; 95%CI 1.83-2.53), in immunocompromised patients (HR 2.02; 95%CI 1.52-2.69), and in transplant recipients (HR 1.92; 95%CI 1.10-3.33). CONCLUSIONS: vaccination campaign adherence is affected by the sociodemographic characteristics of the population and is a determining factor in preventing hospitalizations for COVID-19 and death. The persistent higher risk of hospitalization in chronic subjects following the second dose emphasizes the need to direct booster doses to the more vulnerable. Information systems proved to be effective monitoring tools in the absence of specific trials.


Subject(s)
COVID-19 , Female , Humans , Immunization Programs , Italy/epidemiology , Male , SARS-CoV-2 , Vaccination
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