American older adults in COVID-19 Times: Vulnerability types, aging attitudes and emotional responses (preprint)

Background: The coronavirus disease aroused challenges to the emotional well-being of vulnerable older adults in hard-hit areas. This study investigates different vulnerability types among American older adults and how modes of vulnerability are associated with aging attitudes and emotional responses. Methods: Using Latent Class Analysis, we investigated 2003 respondents aged over 50 from HRS. Hierarchical linear regressions with the affective profile as cluster identity were used to examine the relationship between vulnerability type and positive aging attitudes with positive and negative emotional responses. Results: We detected three vulnerability types among American older adults: the slight vulnerability (72%), the healthcare use vulnerability (19%), and the dual vulnerabilities (9%). No significant difference in positive emotions was found between vulnerability types. However, more negative emotions were found among older adults with healthcare use vulnerability (B=0.746, SE=0.759) and dual vulnerabilities (B=1.186, SE=0.274) than those with slight vulnerability. Positive aging attitudes associate with more positive emotions (B=0.266, SE=0.017) but less negative emotions (B=-0.183, SE=0.016) and had significant moderation effects on the relationship between vulnerability types and negative emotional responses (B=-0.118, SE=0.045). Conclusion: Older adults' emotional well-being should not be neglected as they deserve the support of prevention and intervention strategies, in particular when they have vulnerabilities in healthcare use and financial sustainment. Female, non-white races, and those aged below 65, been uncoupled, less educated, and with ADL difficulties should prioritize.

Tributação de Lucros Extraordinários no Brasil: Da Guerra à Pandemia e Além (Excess Profits Taxation in Brazil: From the War to the Pandemic and Beyond) (preprint)

English Abstract: The new coronavirus has reinforced problems that states have been facing in recent years with regard to the tax challenges arising from the digitalization of the economy, especially with regard to large technology multinationals that earn extraordinary profits across the globe, while avoiding the payment of taxes corresponding to their significant ability to pay. In the midst of the current global health-economic crisis, it became evident that, although the lives of the inhabitants of the planet are inevitably intertwined, not everyone is affected in a negative way or in the same way. While most taxpayers suffer from the consequences of COVID-19, a few companies see their profits increase exponentially for reasons beyond their entrepreneurial skills, which has led many to recommend that they be taxed at a higher rate. In light of this reality, this chapter assesses the possibility of Brazilian law to tax extraordinary profits more strongly as a measure to make the digital economy more sustainable and to face the fiscal crisis brought about by the pandemic.Portuguese Abstract: O novo coronavírus reforçou problemas que os Estados vinham enfrentando nos últimos anos quanto aos desafios tributários decorrentes da digitalização da economia, sobretudo no que tange a grandes multinacionais de tecnologia que auferem lucros extraordinários em todo o globo, ao mesmo tempo em que evitam o pagamento de impostos correspondentes à sua expressiva capacidade contributiva. Em meio à atual crise sanitário-econômica global, ficou evidenciado que, apesar de as vidas dos habitantes do planeta estarem inevitavelmente interligadas, nem todos são afetados de forma negativa ou da mesma maneira. Enquanto a maioria dos contribuintes sofrem com as consequências do Covid-19, algumas poucas empresas veem seus lucros aumentarem exponencialmente por razões alheias a suas capacidades empreendedorísticas, o que tem levado muitos a recomendar que sejam tributadas a uma alíquota superior. Diante dessa realidade, o presente capítulo avalia a possibilidade de o Direito Brasileiro tributar mais fortemente lucros extraordinários como medida para tornar a economia digital mais sustentável e para o enfrentamento da crise fiscal trazida pela pandemia.

Patients With Hereditary Angioedema Do Not Develop More Severe COVID-19 but SARS-CoV-2 Infection May Trigger Attacks: 66 Cases (preprint)

Purpose: Hereditary angioedema (HAE) is a rare genetic disease with hyperactivated contact and kallikrein-kinin systems leading to bradykinin (BK) release and edema. SARS-CoV-2 infection results in inflammatory exacerbation. C1 inhibitor (C1-INH) deficiency could aggravate clinical outcomes, with HAE patients at a greater risk of adverse outcomes of COVID-19, however, data are still limited. Our aim was to characterize the course and severity of COVID-19 in patients with HAE.MethodsLatin American HAE reference centers evaluated SARS-CoV-2 infection in this population. Patients with confirmed diagnosis of HAE with (HAE-C1-INH) or without C1-INH deficiency (HAE-nC1-INH) were included. HAE symptomatology and the course of COVID-19 were characterized with the application of a questionnaire. Results66 patients from 10 countries (HAE-C1-INH 80,3%; HAE-nC1-INH 19.6%) were reported with SARS-CoV-2 infection. Comorbidities were absent in 69.7% of the patients and obesity present in 12.1%. Attacks occurred in 45.5% of patients with HAE during SARS-CoV-2 infection. Long term prophylaxis was reported in 52% (34/66) of HAE patients. Complete cure was observed in 61 patients (92.4%), pulmonary sequelae in 4 and death in one HAE-C1-INH patient. The cause of death was septic shock secondary to bacterial pulmonary coinfection. Disease progression was not impacted by sex, therapy or type of HAE (p = 0.803). ConclusionAttacks occurred in almost half of HAE patients suggesting that SARS-CoV-2 infection is a trigger. HAE did not represent a risk factor for a worse outcome of COVID-19, even in use of androgens.

Development and internal verification of the hospitalization risk score to triage COVID-19 patients upon admission: a multicenter nested case-control study. (preprint)

Background: Novel coronavirus disease 2019(COVID-19)has a large population base of infection, and only worsening cases required hospitalization. A hospitalization risk score of COVID-19(HRS-COVID-19) to identify and treat worsening patients early thus seems crucial.Method: We conducted a multicenter nested case-control study with 200 cases enrolling confirmed symptomatic COVID-19 patients from four designated hospitals before worsened. Least Absolute Shrinkage and Selection Operator(LASSO), Directed Acyclic Graph(DAG)and Change-in-Estimate(CIE) screened out independent risk factors for HRS-COVID-19 from demographic, clinical and imaging data of the cases. The HRS-COVID-19 was evaluated by the area under curve(AUC), calibration curve, decision curve and clinical impact curve; internal validation by the bootstrap-resampling(boot=1000); and through a nomogram and a network calculator to show.Results: In the nested case cohort, 50 patients reached the compound endpoint(requiring hospitalization) and 150 patients were able to avoid hospitalization. Dyspnea, incubation period, age, lymphocyte count, C-reactive protein and semi-quantitative CT scores were included in HRS-COVID-19. The HRS-COVID-19 has good fitting(Hosmer-Lemeshow goodness,P=0.45); high discrimination(AUC 0.980,95%CI, 0.965-0.996); with excellent calibration and clinical benefits. We make a free online risk calculator (https://hospitalization-risk-score-of-covid-19.shinyapps.io/DynNomapp/).Conclusion: In the study, the HRS-COVID-19 based on the clinical characteristics at admission is helpful for early identification and active treatment of aggravated high-risk COVID-19 patients.

Recent Drops in Market Liquidity May Foreshadow Major Drops in US Commercial Real Estate Markets (preprint)

The study quantifies liquidity impacts measured by the Demand-Supply Gap in terms of asset pricing implications for US private commercial real estate markets of the COVID-19 crisis. So far (using data up to April 2020), New York is hardest hit among the eight metros examined, with a predicted average price drop between 19 and 30 percent, reflecting a drop in liquidity already three-quarters of the total liquidity drop that occurred in the entire Global Financial Crisis of 2008-09. Among property sectors nationwide, retail is hit hardest with 14 to 19 percent predicted price drop and liquidity down already almost 60 percent as much as it dropped in the entire GFC.