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2.
Ann Intern Med ; 174(10): 1409-1419, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1515633

ABSTRACT

BACKGROUND: The COVID-19 pandemic has caused substantial morbidity and mortality. OBJECTIVE: To describe monthly clinical trends among adults hospitalized with COVID-19. DESIGN: Pooled cross-sectional study. SETTING: 99 counties in 14 states participating in the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET). PATIENTS: U.S. adults (aged ≥18 years) hospitalized with laboratory-confirmed COVID-19 during 1 March to 31 December 2020. MEASUREMENTS: Monthly hospitalizations, intensive care unit (ICU) admissions, and in-hospital death rates per 100 000 persons in the population; monthly trends in weighted percentages of interventions, including ICU admission, mechanical ventilation, and vasopressor use, among an age- and site-stratified random sample of hospitalized case patients. RESULTS: Among 116 743 hospitalized adults with COVID-19, the median age was 62 years, 50.7% were male, and 40.8% were non-Hispanic White. Monthly rates of hospitalization (105.3 per 100 000 persons), ICU admission (20.2 per 100 000 persons), and death (11.7 per 100 000 persons) peaked during December 2020. Rates of all 3 outcomes were highest among adults aged 65 years or older, males, and Hispanic or non-Hispanic Black persons. Among 18 508 sampled hospitalized adults, use of remdesivir and systemic corticosteroids increased from 1.7% and 18.9%, respectively, in March to 53.8% and 74.2%, respectively, in December. Frequency of ICU admission, mechanical ventilation, and vasopressor use decreased from March (37.8%, 27.8%, and 22.7%, respectively) to December (20.5%, 12.3%, and 12.8%, respectively); use of noninvasive respiratory support increased from March to December. LIMITATION: COVID-NET covers approximately 10% of the U.S. population; findings may not be generalizable to the entire country. CONCLUSION: Rates of COVID-19-associated hospitalization, ICU admission, and death were highest in December 2020, corresponding with the third peak of the U.S. pandemic. The frequency of intensive interventions for management of hospitalized patients decreased over time. These data provide a longitudinal assessment of clinical trends among adults hospitalized with COVID-19 before widespread implementation of COVID-19 vaccines. PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention.


Subject(s)
COVID-19/therapy , Hospitalization/trends , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Adolescent , Adrenal Cortex Hormones/therapeutic use , Adult , Age Distribution , Aged , Alanine/analogs & derivatives , Alanine/therapeutic use , Antiviral Agents/therapeutic use , COVID-19/ethnology , COVID-19/mortality , Critical Care/trends , Cross-Sectional Studies , Female , Humans , Intensive Care Units/trends , Length of Stay/trends , Male , Middle Aged , Pandemics , Respiration, Artificial/trends , SARS-CoV-2 , United States/epidemiology , Vasoconstrictor Agents/therapeutic use , Young Adult
3.
Lancet ; 398(10311): 1593-1618, 2021 10 30.
Article in English | MEDLINE | ID: covidwho-1510425

ABSTRACT

BACKGROUND: Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10-24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. METHODS: We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10-24 years by age group (10-14 years, 15-19 years, and 20-24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10-24 years with that in children aged 0-9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10-24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017). FINDINGS: In 2019 there were 1·49 million deaths (95% uncertainty interval 1·39-1·59) worldwide in people aged 10-24 years, of which 61% occurred in males. 32·7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32·1% were due to communicable, nutritional, or maternal causes; 27·0% were due to non-communicable diseases; and 8·2% were due to self-harm. Since 1950, deaths in this age group decreased by 30·0% in females and 15·3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10-14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15-19 years was 1·3% in males and 1·6% in females, almost half that of males aged 1-4 years (2·4%), and around a third less than in females aged 1-4 years (2·5%). The proportion of global deaths in people aged 0-24 years that occurred in people aged 10-24 years more than doubled between 1950 and 2019, from 9·5% to 21·6%. INTERPRETATION: Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10-24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group. FUNDING: Bill & Melinda Gates Foundation.


Subject(s)
Cause of Death/trends , Global Burden of Disease , Mortality/trends , Adolescent , Age Distribution , Child , Female , Humans , Male , Sex Distribution , Socioeconomic Factors , Young Adult
4.
JAMA ; 326(16): 1606-1613, 2021 10 26.
Article in English | MEDLINE | ID: covidwho-1505020

ABSTRACT

Importance: As part of postauthorization safety surveillance, the US Food and Drug Administration (FDA) has identified a potential safety concern for Guillain-Barré syndrome (GBS) following receipt of the Ad26.COV2.S (Janssen/Johnson & Johnson) COVID-19 vaccine. Objective: To assess reports of GBS received in the Vaccine Adverse Event Reporting System (VAERS) following Ad26.COV2.S vaccination. Design, Setting, and Participants: Reports of presumptive GBS were identified in a US passive reporting system (VAERS) February-July 2021 and characterized, including demographics, clinical characteristics, and relevant medical history. Exposures: Receipt of the Ad26.COV2.S vaccine; the comparator was the background rate of GBS in the general (unvaccinated) population that had been estimated and published based on a standardized case definition. Main Outcomes and Measures: Presumptive GBS; the reporting rate was analyzed, including calculation of the observed to expected ratio based on background rates and vaccine administration data. Because of limited availability of medical records, cases were not assessed according to the Brighton Collaboration criteria for GBS. Results: As of July 24, 2021, 130 reports of presumptive GBS were identified in VAERS following Ad26.COV2.S vaccination (median age, 56 years; IQR, 45-62 years; 111 individuals [86.0%] were < 65 years; 77 men [59.7%]). The median time to onset of GBS following vaccination was 13 days (IQR, 10-18 days), with 105 cases (81.4%) beginning within 21 days and 123 (95.3%) within 42 days. One hundred twenty-one reports (93.1%) were serious, including 1 death. With approximately 13 209 858 doses of vaccine administered to adults in the US, the estimated crude reporting rate was 1 case of GBS per 100 000 doses administered. The overall estimated observed to expected rate ratio was 4.18 (95% CI, 3.47-4.98) for the 42-day window, and in the worst-case scenario analysis for adults 18 years or older, corresponded to an estimated absolute rate increase of 6.36 per 100 000 person-years (based on a rate of approximately 8.36 cases per 100 000 person-years [123 cases per 1 472 162 person-years] compared with a background rate of approximately 2 cases per 100 000 person-years). For both risk windows, the observed to expected rate ratio was elevated in all age groups except individuals aged 18 through 29 years. Conclusions and Relevance: These findings suggest a potential small but statistically significant safety concern for Guillain-Barré syndrome following receipt of the Ad26.COV2.S vaccine. However, the findings are subject to the limitations of passive reporting systems and presumptive case definition, and they must be considered preliminary pending analysis of medical records to establish a definitive diagnosis.


Subject(s)
COVID-19 Vaccines/adverse effects , Guillain-Barre Syndrome/epidemiology , Adult , Age Distribution , Aged , COVID-19 Vaccines/administration & dosage , Female , Guillain-Barre Syndrome/etiology , Humans , Male , Middle Aged , Preliminary Data , Product Surveillance, Postmarketing , United States/epidemiology , Vaccination/statistics & numerical data , Young Adult
5.
Eur J Clin Invest ; 51(11): e13678, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1501400

ABSTRACT

Strategies for the use of COVID-19 vaccines in children and young adults (in particular university students) are hotly debated and important to optimize. As of late August 2021, recommendations on the use of these vaccines in children vary across different countries. Recommendations are more uniform for vaccines in young adults, but vaccination uptake in this age group shows a large range across countries. Mandates for vaccination of university students are a particularly debated topic with many campuses endorsing mandates in the USA in contrast to European countries, at least as of August 2021. The commentary discusses the potential indirect impact of vaccination of youth on the COVID-19 burden of disease for other age groups and societal functioning at large, estimates of direct impact on reducing fatalities and nonlethal COVID-19-related events in youth, estimates of potential lethal and nonlethal adverse events from vaccines and differential considerations that may exist in the USA, European countries and nonhigh-income countries. Decision-making for deploying COVID-19 vaccines in young people is subject to residual uncertainty on the future course of the pandemic and potential evolution towards endemicity. Rational recommendations would also benefit from better understanding of the clinical and sociodemographic features of COVID-19 risk in young populations and from dissecting the role of re-infections and durability of natural vs. vaccine-induced immunity.


Subject(s)
COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , Organizational Policy , Practice Guidelines as Topic , Students , Universities , Adolescent , Age Distribution , COVID-19/epidemiology , Child , Humans , Risk Assessment , SARS-CoV-2 , Young Adult
6.
CMAJ ; 193(42): E1619-E1625, 2021 10 25.
Article in English | MEDLINE | ID: covidwho-1496561

ABSTRACT

BACKGROUND: Between February and June 2021, the initial wild-type strains of SARS-CoV-2 were supplanted in Ontario, Canada, by new variants of concern (VOCs), first those with the N501Y mutation (i.e., Alpha/B1.1.17, Beta/B.1.351 and Gamma/P.1 variants) and then the Delta/B.1.617 variant. The increased transmissibility of these VOCs has been documented, but knowledge about their virulence is limited. We used Ontario's COVID-19 case data to evaluate the virulence of these VOCs compared with non-VOC SARS-CoV-2 strains, as measured by risk of hospitalization, intensive care unit (ICU) admission and death. METHODS: We created a retrospective cohort of people in Ontario who tested positive for SARS-CoV-2 and were screened for VOCs, with dates of test report between Feb. 7 and June 27, 2021. We constructed mixed-effect logistic regression models with hospitalization, ICU admission and death as outcome variables. We adjusted models for age, sex, time, vaccination status, comorbidities and pregnancy status. We included health units as random intercepts. RESULTS: Our cohort included 212 326 people. Compared with non-VOC SARS-CoV-2 strains, the adjusted elevation in risk associated with N501Y-positive variants was 52% (95% confidence interval [CI] 42%-63%) for hospitalization, 89% (95% CI 67%-117%) for ICU admission and 51% (95% CI 30%-78%) for death. Increased risk with the Delta variant was more pronounced at 108% (95% CI 78%-140%) for hospitalization, 235% (95% CI 160%-331%) for ICU admission and 133% (95% CI 54%-231%) for death. INTERPRETATION: The increasing virulence of SARS-CoV-2 VOCs will lead to a considerably larger, and more deadly, pandemic than would have occurred in the absence of the emergence of VOCs.


Subject(s)
COVID-19/mortality , SARS-CoV-2/pathogenicity , Age Distribution , COVID-19/transmission , Comorbidity , Female , Hospitalization/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Male , Ontario/epidemiology , Pandemics , Pregnancy , Retrospective Studies , Risk Assessment , Vaccination Coverage/statistics & numerical data
7.
Virol J ; 18(1): 159, 2021 08 03.
Article in English | MEDLINE | ID: covidwho-1496199

ABSTRACT

BACKGROUND: The multifaceted non-pharmaceutical interventions (NPIs) taken during the COVID-19 pandemic not only decrease the spreading of the SARS-CoV-2, but have impact on the prevalence of other viruses. This study aimed to explore the prevalence of common respiratory viruses among hospitalized children with lower respiratory tract infections (LRTI) in China during the COVID-19 pandemic. METHODS: Respiratory specimens were obtained from children with LRTI at Children's Hospital of Fudan University for detection of respiratory syncytial virus (RSV), adenovirus (ADV), parainfluenza virus (PIV) 1 to 3, influenza virus A (FluA), influenza virus B (FluB), human metapneumovirus (MPV) and rhinovirus (RV). The data were analyzed and compared between the year of 2020 (COVID-19 pandemic) and 2019 (before COVID-19 pandemic). RESULTS: A total of 7107 patients were enrolled, including 4600 patients in 2019 and 2507 patients in 2020. Compared with 2019, we observed an unprecedented reduction of RSV, ADV, FluA, FluB, and MPV infections in 2020, despite of reopening of schools in June, 2020. However, the RV infection was significantly increased in 2020 and a sharp increase was observed especially after reopening of schools. Besides, the PIV infection showed resurgent characteristic after September of 2020. The mixed infections were significantly less frequent in 2020 compared with the year of 2019. CONCLUSIONS: The NPIs during the COVID-19 pandemic have great impact on the prevalence of common respiratory viruses in China. Meanwhile, we do need to be cautious of a possible resurgence of some respiratory viruses as the COVID-19 restrictions are relaxed.


Subject(s)
COVID-19/epidemiology , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/virology , Age Distribution , COVID-19/prevention & control , Child , Child, Preschool , China/epidemiology , Coinfection/epidemiology , Coinfection/virology , Female , Hospitalization , Hospitals, Pediatric , Humans , Infant , Male , Prevalence , SARS-CoV-2 , Seasons , Viruses/classification , Viruses/isolation & purification
8.
J Infect Dis ; 221(2): 183-190, 2020 01 02.
Article in English | MEDLINE | ID: covidwho-1452713

ABSTRACT

BACKGROUND: Severe influenza illness is presumed more common in adults with chronic medical conditions (CMCs), but evidence is sparse and often combined into broad CMC categories. METHODS: Residents (aged 18-80 years) of Central and South Auckland hospitalized for World Health Organization-defined severe acute respiratory illness (SARI) (2012-2015) underwent influenza virus polymerase chain reaction testing. The CMC statuses for Auckland residents were modeled using hospitalization International Classification of Diseases, Tenth Revision codes, pharmaceutical claims, and laboratory results. Population-level influenza rates in adults with congestive heart failure (CHF), coronary artery disease (CAD), cerebrovascular accidents (CVA), chronic obstructive pulmonary disease (COPD), asthma, diabetes mellitus (DM), and end-stage renal disease (ESRD) were calculated by Poisson regression stratified by age and adjusted for ethnicity. RESULTS: Among 891 276 adults, 2435 influenza-associated SARI hospitalizations occurred. Rates were significantly higher in those with CMCs compared with those without the respective CMC, except for older adults with DM or those aged <65 years with CVA. The largest effects occurred with CHF (incidence rate ratio [IRR] range, 4.84-13.4 across age strata), ESRD (IRR range, 3.30-9.02), CAD (IRR range, 2.77-10.7), and COPD (IRR range, 5.89-8.78) and tapered with age. CONCLUSIONS: Our findings support the increased risk of severe, laboratory-confirmed influenza disease among adults with specific CMCs compared with those without these conditions.


Subject(s)
Chronic Disease/epidemiology , Influenza, Human/epidemiology , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Case-Control Studies , Cross-Sectional Studies , Female , Hospitalization/statistics & numerical data , Humans , Incidence , Influenza, Human/virology , Male , Middle Aged , New Zealand/epidemiology , Prospective Studies , Risk Assessment , Young Adult
9.
Medicine (Baltimore) ; 100(43): e27634, 2021 Oct 29.
Article in English | MEDLINE | ID: covidwho-1494092

ABSTRACT

ABSTRACT: Acute sstroke is the most common time-dependent disease attended in the emergency medical service (EMS) of Madrid (SUMMA 112). Community of Madrid has been one of the most affected regions in Spain by the coronavirus disease 2019 (COVID-19) pandemic. A significant reduction in acute sstroke hospital admissions has been reported during the COVID-19 pandemic compared to the same period 1 year before. As international clinical practice guidelines support those patients with suspected acute stroke should be accessed via EMS, it is important to know whether the pandemic has jeopardized urgent pre-hospital stroke care, the first medical contact for most patients. We aimed to examine the impact of the COVID-19 in stroke codes (SC) in our EMS among 3 periods of time: the COVID-19 period, the same period the year before, and the 2019-2020 seasonal influenza period.We compared the SC frequency among the periods with high cumulative infection rate (above the median of the series) of the first wave of COVID-19, seasonal influenza, and also with the same period of the year before.One thousand one hundred thirty SC were attended during the 3 periods. No significant reduction in SC was found during the COVID-19 pandemic. The reduction of hospital admissions might be attributable to patients attending the hospital by their means. The maximum SC workload seen during seasonal influenza has not been reached during the pandemic. We detected a nonsignificant deviation from the SC protocol, with a slight increase in hospitals' transfers to hospitals without stroke units.


Subject(s)
COVID-19/epidemiology , Emergency Service, Hospital/statistics & numerical data , Stroke/epidemiology , Age Distribution , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Sex Distribution , Spain/epidemiology
10.
JAMA Netw Open ; 4(10): e2130479, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1482074

ABSTRACT

Importance: Racial and ethnic minority groups are disproportionately affected by COVID-19. Objectives: To evaluate whether rates of severe COVID-19, defined as hospitalization, intensive care unit (ICU) admission, or in-hospital death, are higher among racial and ethnic minority groups compared with non-Hispanic White persons. Design, Setting, and Participants: This cross-sectional study included 99 counties within 14 US states participating in the COVID-19-Associated Hospitalization Surveillance Network. Participants were persons of all ages hospitalized with COVID-19 from March 1, 2020, to February 28, 2021. Exposures: Laboratory-confirmed COVID-19-associated hospitalization, defined as a positive SARS-CoV-2 test within 14 days prior to or during hospitalization. Main Outcomes and Measures: Cumulative age-adjusted rates (per 100 000 population) of hospitalization, ICU admission, and death by race and ethnicity. Rate ratios (RR) were calculated for each racial and ethnic group compared with White persons. Results: Among 153 692 patients with COVID-19-associated hospitalizations, 143 342 (93.3%) with information on race and ethnicity were included in the analysis. Of these, 105 421 (73.5%) were 50 years or older, 72 159 (50.3%) were male, 28 762 (20.1%) were Hispanic or Latino, 2056 (1.4%) were non-Hispanic American Indian or Alaska Native, 7737 (5.4%) were non-Hispanic Asian or Pacific Islander, 40 806 (28.5%) were non-Hispanic Black, and 63 981 (44.6%) were White. Compared with White persons, American Indian or Alaska Native, Latino, Black, and Asian or Pacific Islander persons were more likely to have higher cumulative age-adjusted rates of hospitalization, ICU admission, and death as follows: American Indian or Alaska Native (hospitalization: RR, 3.70; 95% CI, 3.54-3.87; ICU admission: RR, 6.49; 95% CI, 6.01-7.01; death: RR, 7.19; 95% CI, 6.47-7.99); Latino (hospitalization: RR, 3.06; 95% CI, 3.01-3.10; ICU admission: RR, 4.20; 95% CI, 4.08-4.33; death: RR, 3.85; 95% CI, 3.68-4.01); Black (hospitalization: RR, 2.85; 95% CI, 2.81-2.89; ICU admission: RR, 3.17; 95% CI, 3.09-3.26; death: RR, 2.58; 95% CI, 2.48-2.69); and Asian or Pacific Islander (hospitalization: RR, 1.03; 95% CI, 1.01-1.06; ICU admission: RR, 1.91; 95% CI, 1.83-1.98; death: RR, 1.64; 95% CI, 1.55-1.74). Conclusions and Relevance: In this cross-sectional analysis, American Indian or Alaska Native, Latino, Black, and Asian or Pacific Islander persons were more likely than White persons to have a COVID-19-associated hospitalization, ICU admission, or in-hospital death during the first year of the US COVID-19 pandemic. Equitable access to COVID-19 preventive measures, including vaccination, is needed to minimize the gap in racial and ethnic disparities of severe COVID-19.


Subject(s)
COVID-19/ethnology , Health Status Disparities , Hospital Mortality , Hospitalization/statistics & numerical data , Intensive Care Units/statistics & numerical data , Adult , Age Distribution , Aged , Cross-Sectional Studies , Ethnic Groups/statistics & numerical data , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2 , United States/epidemiology
11.
Tohoku J Exp Med ; 255(2): 127-134, 2021 10.
Article in English | MEDLINE | ID: covidwho-1468220

ABSTRACT

Vitamin D attenuates inflammatory responses to viral respiratory infections. Hence, vitamin D deficiency may be a highly significant prognostic factor for severity and mortality in COVID-19 patients. To evaluate the complications and mortality in different vitamin D status groups in COVID-19 hospitalized patients, we conducted this retrospective study on 646 laboratory-confirmed COVID-19 patients who were hospitalized in Shahid Modarres Hospital, Tehran, Iran from 16th March 2020 until 25th February 2021. Overall, patients with vitamin D deficiency, insufficiency and sufficiency were 16.9%, 43.6% and 39.5%, respectively. The presence of comorbidity, length of hospitalization, ICU admission, and invasive mechanical ventilation requirement and overall complications were significantly more in patients with vitamin D deficiency (p-value < 0.001). 46.8% (51/109) of vitamin D deficient patients died due to the disease, whilst the mortality rate among insufficient and sufficient vitamin D groups was 29.4% (83/282) and 5.5% (14/255), respectively. In univariate analysis, age > 60 years (odds ratio (OR) = 6.1), presence of comorbidity (OR = 10.7), insufficient vitamin D status (OR = 7.2), and deficient vitamin D status (OR = 15.1) were associated with increase in COVID-19 mortality (p-value < 0.001). Finally, the multivariate analysis adjusted for age, sex, and comorbidities indicated vitamin D deficiency as an independent risk factor for mortality (OR = 3.3, p-value = 0.002). Vitamin D deficiency is a strong risk factor for mortality and severity of SARS-CoV-2 infection. Vitamin D supplementation may be able to prevent or improve the prognosis of COVID-19 during this pandemic.


Subject(s)
COVID-19/complications , Hospitalization , Vitamin D Deficiency/complications , Vitamin D Deficiency/epidemiology , Adult , Age Distribution , Aged , Aged, 80 and over , COVID-19/blood , COVID-19/mortality , COVID-19/virology , Female , Humans , Male , Middle Aged , Prevalence , Retrospective Studies , SARS-CoV-2/physiology , Treatment Outcome , Vitamin D/blood , Vitamin D Deficiency/blood , Vitamin D Deficiency/virology
13.
JAMA ; 323(16): 1574-1581, 2020 04 28.
Article in English | MEDLINE | ID: covidwho-1453471

ABSTRACT

Importance: In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited. Objective: To characterize patients with coronavirus disease 2019 (COVID-19) requiring treatment in an intensive care unit (ICU) in the Lombardy region of Italy. Design, Setting, and Participants: Retrospective case series of 1591 consecutive patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinator center (Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network and treated at one of the ICUs of the 72 hospitals in this network between February 20 and March 18, 2020. Date of final follow-up was March 25, 2020. Exposures: SARS-CoV-2 infection confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swabs. Main Outcomes and Measures: Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Data were recorded by the coordinator center on an electronic worksheet during telephone calls by the staff of the COVID-19 Lombardy ICU Network. Results: Of the 1591 patients included in the study, the median (IQR) age was 63 (56-70) years and 1304 (82%) were male. Of the 1043 patients with available data, 709 (68%) had at least 1 comorbidity and 509 (49%) had hypertension. Among 1300 patients with available respiratory support data, 1287 (99% [95% CI, 98%-99%]) needed respiratory support, including 1150 (88% [95% CI, 87%-90%]) who received mechanical ventilation and 137 (11% [95% CI, 9%-12%]) who received noninvasive ventilation. The median positive end-expiratory pressure (PEEP) was 14 (IQR, 12-16) cm H2O, and Fio2 was greater than 50% in 89% of patients. The median Pao2/Fio2 was 160 (IQR, 114-220). The median PEEP level was not different between younger patients (n = 503 aged ≤63 years) and older patients (n = 514 aged ≥64 years) (14 [IQR, 12-15] vs 14 [IQR, 12-16] cm H2O, respectively; median difference, 0 [95% CI, 0-0]; P = .94). Median Fio2 was lower in younger patients: 60% (IQR, 50%-80%) vs 70% (IQR, 50%-80%) (median difference, -10% [95% CI, -14% to 6%]; P = .006), and median Pao2/Fio2 was higher in younger patients: 163.5 (IQR, 120-230) vs 156 (IQR, 110-205) (median difference, 7 [95% CI, -8 to 22]; P = .02). Patients with hypertension (n = 509) were older than those without hypertension (n = 526) (median [IQR] age, 66 years [60-72] vs 62 years [54-68]; P < .001) and had lower Pao2/Fio2 (median [IQR], 146 [105-214] vs 173 [120-222]; median difference, -27 [95% CI, -42 to -12]; P = .005). Among the 1581 patients with ICU disposition data available as of March 25, 2020, 920 patients (58% [95% CI, 56%-61%]) were still in the ICU, 256 (16% [95% CI, 14%-18%]) were discharged from the ICU, and 405 (26% [95% CI, 23%-28%]) had died in the ICU. Older patients (n = 786; age ≥64 years) had higher mortality than younger patients (n = 795; age ≤63 years) (36% vs 15%; difference, 21% [95% CI, 17%-26%]; P < .001). Conclusions and Relevance: In this case series of critically ill patients with laboratory-confirmed COVID-19 admitted to ICUs in Lombardy, Italy, the majority were older men, a large proportion required mechanical ventilation and high levels of PEEP, and ICU mortality was 26%.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Critical Care/statistics & numerical data , Hospital Mortality , Intensive Care Units/statistics & numerical data , Pneumonia, Viral/epidemiology , Positive-Pressure Respiration/statistics & numerical data , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , COVID-19 , Comorbidity , Coronavirus Infections/mortality , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Critical Illness/therapy , Female , Hospitalization , Humans , Italy/epidemiology , Male , Middle Aged , Pandemics , Pneumonia, Viral/mortality , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Respiration, Artificial , Retrospective Studies , SARS-CoV-2 , Sex Distribution , Young Adult
14.
Ghana Med J ; 54(4 Suppl): 16-22, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1436190

ABSTRACT

Introduction: COVID-19 is a new disease, knowledge on the mode of transmission and clinical features are still evolving, new tests are being developed with inherent challenges regarding interpretation of tests results. There is generally, a gap in knowledge on the virus globally as the pandemic evolves and in Ghana, there is dearth of information and documentation on the clinical characteristics of the virus. With these in mind, we set out to profile the initial cohort of COVID-19 patients who recovered in Ghana. Methods: We reviewed clinical records of all confirmed cases of COVID-19 who had recovered from the two main treatment centres in Accra, Ghana. Descriptive data analysis was employed and presented in simple and relational tables. Independent t-test and ANOVA were used to determine differences in the mean age of the sexes and the number of days taken for the first and second retesting to be done per selected patient characteristics. Results: Of the 146 records reviewed, 54% were male; mean age of patients was 41.9 ± 17.5 years, nearly half were asymptomatic, with 9% being severely ill. The commonest presenting symptoms were cough (22.6%), headache (13%) and sore throat (11%) while the commonest co-morbidities were hypertension (25.3%), diabetes mellitus (14%) and heart disease (3.4%). Conclusion: COVID-19 affected more males than females; nearly half of those infected were asymptomatic. Cough, headache and sore throat were the commonest symptoms and mean duration from case confirmation to full recovery was 19 days. Further research is required as pandemic evolves. Funding: None declared.


Subject(s)
Asymptomatic Infections/epidemiology , COVID-19/epidemiology , SARS-CoV-2 , Adult , Age Distribution , Analysis of Variance , COVID-19/virology , Cohort Studies , Cough/epidemiology , Cough/virology , Female , Ghana/epidemiology , Headache/epidemiology , Headache/virology , Humans , Male , Middle Aged , Pharyngitis/epidemiology , Pharyngitis/virology , Sex Distribution
15.
Am J Public Health ; 111(10): 1839-1846, 2021 10.
Article in English | MEDLINE | ID: covidwho-1435678

ABSTRACT

Objectives. To describe excess mortality during the COVID-19 pandemic in Guatemala during 2020 by week, age, sex, and place of death. Methods. We used mortality data from 2015 to 2020, gathered through the vital registration system of Guatemala. We calculated weekly mortality rates, overall and stratified by age, sex, and place of death. We fitted a generalized additive model to calculate excess deaths, adjusting for seasonality and secular trends and compared excess deaths to the official COVID-19 mortality count. Results. We found an initial decline of 26% in mortality rates during the first weeks of the pandemic in 2020, compared with 2015 to 2019. These declines were sustained through October 2020 for the population younger than 20 years and for deaths in public spaces and returned to normal from July onward in the population aged 20 to 39 years. We found a peak of 73% excess mortality in mid-July, especially in the population aged 40 years or older. We estimated a total of 8036 excess deaths (95% confidence interval = 7935, 8137) in 2020, 46% higher than the official COVID-19 mortality count. Conclusions. The extent of this health crisis is underestimated when COVID-19 confirmed death counts are used. (Am J Public Health. 2021;111(10): 1839-1846. https://doi.org/10.2105/AJPH.2021.306452).


Subject(s)
COVID-19/mortality , Pandemics , Adolescent , Adult , Age Distribution , Aged , Child , Child, Preschool , Death Certificates , Female , Guatemala/epidemiology , Humans , Infant , Male , Middle Aged , Public Health , SARS-CoV-2 , Sex Distribution , Young Adult
16.
J Med Virol ; 93(10): 5977-5987, 2021 10.
Article in English | MEDLINE | ID: covidwho-1432436

ABSTRACT

Accurate and comprehensive testing is crucial for practitioners to portray the pandemic. Without testing there is no data; yet, the exact number of infected people cannot be determined due to the lack of comprehensive testing. The number of seropositive for SARS-CoV-2 infection is obviously relative to the extent of testing. However, the true number of infections might be still far higher than the reported values. To compare the countries based on the number of seropositive for SARS-CoV-2 infection is misleading, as there may not be enough tests being carried out to properly monitor the outbreak. In this paper, we closely look through the COVID-19 testing results. Herein, we try to draw conclusions based on the reported data: first, the presence of a possible relationship between COVID-19 transition and patients' age will be assessed. Then, the COVID-19 case fatality rate (CFR) is compared with the age-demographic data for different countries. Based on the results, a method for estimating a lower bound (minimum) for the number of actual positive cases will be developed and validated. Results of this study have shown that CFR is a metric reflecting the spread of the virus, but is a factor of the extent of testing and does not necessarily show the real size of the outbreak. Moreover, no large difference in susceptibility by age has been found. The results suggest the similarity between the age distribution of COVID-19 and the population age-demographic is improving over the course of the pandemic. In addition, countries with lower CFRs have a more similar COVID-19 age distribution, which is a result of more comprehensive testing. Finally, a method for estimation of the real number of infected people based on the age distributions, reported CFRs, and the extent of testing will be developed and validated.


Subject(s)
COVID-19 Testing/statistics & numerical data , COVID-19/diagnosis , COVID-19/mortality , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Middle Aged , Mortality , Pandemics/statistics & numerical data , SARS-CoV-2 , Young Adult
17.
Parasit Vectors ; 14(1): 483, 2021 Sep 19.
Article in English | MEDLINE | ID: covidwho-1430472

ABSTRACT

BACKGROUND: During the period of the coronavirus disease 2019 (COVID-19) outbreak, strong intervention measures, such as lockdown, travel restriction, and suspension of work and production, may have curbed the spread of other infectious diseases, including natural focal diseases. In this study, we aimed to study the impact of COVID-19 prevention and control measures on the reported incidence of natural focal diseases (brucellosis, malaria, hemorrhagic fever with renal syndrome [HFRS], dengue, severe fever with thrombocytopenia syndrome [SFTS], rabies, tsutsugamushi and Japanese encephalitis [JE]). METHODS: The data on daily COVID-19 confirmed cases and natural focal disease cases were collected from Jiangsu Provincial Center for Disease Control and Prevention (Jiangsu Provincial CDC). We described and compared the difference between the incidence in 2020 and the incidence in 2015-2019 in four aspects: trend in reported incidence, age, sex, and urban and rural distribution. An autoregressive integrated moving average (ARIMA) (p, d, q) × (P, D, Q)s model was adopted for natural focal diseases, malaria and severe fever with thrombocytopenia syndrome (SFTS), and an ARIMA (p, d, q) model was adopted for dengue. Nonparametric tests were used to compare the reported and the predicted incidence in 2020, the incidence in 2020 and the previous 4 years, and the difference between the duration from illness onset date to diagnosed date (DID) in 2020 and in the previous 4 years. The determination coefficient (R2) was used to evaluate the goodness of fit of the model simulation. RESULTS: Natural focal diseases in Jiangsu Province showed a long-term seasonal trend. The reported incidence of natural focal diseases, malaria and dengue in 2020 was lower than the predicted incidence, and the difference was statistically significant (P < 0.05). The reported incidence of brucellosis in July, August, October and November 2020, and SFTS in May to November 2020 was higher than that in the same period in the previous 4 years (P < 0.05). The reported incidence of malaria in April to December 2020, HFRS in March, May and December 2020, and dengue in July to November 2020 was lower than that in the same period in the previous 4 years (P < 0.05). In males, the reported incidence of malaria in 2020 was lower than that in the previous 4 years, and the reported incidence of dengue in 2020 was lower than that in 2017-2019. The reported incidence of malaria in the 20-60-year age group was lower than that in the previous 4 years; the reported incidence of dengue in the 40-60-year age group was lower than that in 2016-2018. The reported cases of malaria in both urban and rural areas were lower than in the previous 4 years. The DID of brucellosis and SFTS in 2020 was shorter than that in 2015-2018; the DID of tsutsugamushi in 2020 was shorter than that in the previous 4 years. CONCLUSIONS: Interventions for COVID-19 may help control the epidemics of natural focal diseases in Jiangsu Province. The reported incidence of natural focal diseases, especially malaria and dengue, decreased during the outbreak of COVID-19 in 2020. COVID-19 prevention and control measures had the greatest impact on the reported incidence of natural focal diseases in males and people in the 20-60-year age group.


Subject(s)
Brucellosis/epidemiology , COVID-19/prevention & control , Dengue/epidemiology , Malaria/epidemiology , Adult , Age Distribution , Aged , COVID-19/epidemiology , China/epidemiology , Disease Outbreaks , Female , Humans , Incidence , Male , Middle Aged , Physical Distancing , Severe Fever with Thrombocytopenia Syndrome/epidemiology , Travel/statistics & numerical data , Young Adult
18.
J Bone Joint Surg Am ; 102(12): 1022-1028, 2020 06 17.
Article in English | MEDLINE | ID: covidwho-1409848

ABSTRACT

BACKGROUND: Although elective surgical procedures in the United States have been suspended because of the coronavirus disease 2019 (COVID-19) pandemic, orthopaedic surgeons are being recruited to serve patients with COVID-19 in addition to providing orthopaedic acute care. Older individuals are deemed to be at higher risk for poor outcomes with COVID-19. Although previous studies have shown a high proportion of older providers nationwide across medical specialties, we are not aware of any previous study that has analyzed the age distribution among the orthopaedic workforce. Therefore, the purposes of the present study were (1) to determine the geographic distribution of U.S. orthopaedic surgeons by age, (2) to compare the distribution with other surgical specialties, and (3) to compare this distribution with the spread of COVID-19. METHODS: Demographic statistics from the most recent State Physician Workforce Data Reports published by the Association of American Medical Colleges were extracted to identify the 2018 statewide proportion of practicing orthopaedic surgeons ≥60 years of age as well as age-related demographic data for all surgical specialties. Geospatial data on the distribution of COVID-19 cases were obtained from the Environmental Systems Research Institute. State boundary files were taken from the U.S. Census Bureau. Orthopaedic workforce age data were utilized to group states into quintiles. RESULTS: States with the highest quintile of orthopaedic surgeons ≥60 years of age included states most severely affected by COVID-19: New York, New Jersey, California, and Florida. For all states, the median number of providers ≥60 years of age was 105.5 (interquartile range [IQR], 45.5 to 182.5). The median proportion of orthopaedic surgeons ≥60 years of age was higher than that of all other surgical subspecialties, apart from thoracic surgery. CONCLUSIONS: To our knowledge, the present report provides the first age-focused view of the orthopaedic workforce during the COVID-19 pandemic. States in the highest quintile of orthopaedic surgeons ≥60 years old are also among the most overwhelmed by COVID-19. As important orthopaedic acute care continues in addition to COVID-19 frontline service, special considerations may be needed for at-risk staff. Appropriate health system measures and workforce-management strategies should protect the subset of those who are most potentially vulnerable. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Orthopedic Surgeons/supply & distribution , Pneumonia, Viral/epidemiology , Age Distribution , Age Factors , COVID-19 , Geographic Mapping , Health Workforce/organization & administration , Humans , Middle Aged , Pandemics , SARS-CoV-2 , United States/epidemiology
19.
Am J Public Health ; 111(10): 1847-1850, 2021 10.
Article in English | MEDLINE | ID: covidwho-1403352

ABSTRACT

Objectives. To estimate all-cause excess deaths in Mexico City (MXC) and New York City (NYC) during the COVID-19 pandemic. Methods. We estimated expected deaths among residents of both cities between March 1 and August 29, 2020, using log-linked negative binomial regression and compared these deaths with observed deaths during the same period. We calculated total and age-specific excess deaths and 95% prediction intervals (PIs). Results. There were 259 excess deaths per 100 000 (95% PI = 249, 269) in MXC and 311 (95% PI = 305, 318) in NYC during the study period. The number of excess deaths among individuals 25 to 44 years old was much higher in MXC (77 per 100 000; 95% PI = 69, 80) than in NYC (34 per 100 000; 95% PI = 30, 38). Corresponding estimates among adults 65 years or older were 1263 (95% PI = 1199, 1317) per 100 000 in MXC and 1581 (95% PI = 1549, 1621) per 100 000 in NYC. Conclusions. Overall, excess mortality was higher in NYC than in MXC; however, the excess mortality rate among young adults was higher in MXC. Public Health Implications. Excess all-cause mortality comparisons across populations and age groups may represent a more complete measure of pandemic effects and provide information on mitigation strategies and susceptibility factors. (Am J Public Health. 2021;111(10): 1847-1850. https://doi.org/10.2105/AJPH.2021.306430).


Subject(s)
COVID-19/mortality , Cause of Death , Pandemics , Adolescent , Adult , Age Distribution , Aged , Child , Child, Preschool , Cities/statistics & numerical data , Humans , Infant , Infant, Newborn , Mexico/epidemiology , Middle Aged , New York City/epidemiology , Population Density , Risk Factors , SARS-CoV-2 , Young Adult
20.
Pediatrics ; 148(3)2021 09.
Article in English | MEDLINE | ID: covidwho-1394618

ABSTRACT

OBJECTIVES: To characterize the demographics, comorbidities, symptoms, in-hospital treatments, and health outcomes among children and adolescents diagnosed or hospitalized with coronavirus disease 2019 (COVID-19) and to compare them in secondary analyses with patients diagnosed with previous seasonal influenza in 2017-2018. METHODS: International network cohort using real-world data from European primary care records (France, Germany, and Spain), South Korean claims and US claims, and hospital databases. We included children and adolescents diagnosed and/or hospitalized with COVID-19 at age <18 between January and June 2020. We described baseline demographics, comorbidities, symptoms, 30-day in-hospital treatments, and outcomes including hospitalization, pneumonia, acute respiratory distress syndrome, multisystem inflammatory syndrome in children, and death. RESULTS: A total of 242 158 children and adolescents diagnosed and 9769 hospitalized with COVID-19 and 2 084 180 diagnosed with influenza were studied. Comorbidities including neurodevelopmental disorders, heart disease, and cancer were more common among those hospitalized with versus diagnosed with COVID-19. Dyspnea, bronchiolitis, anosmia, and gastrointestinal symptoms were more common in COVID-19 than influenza. In-hospital prevalent treatments for COVID-19 included repurposed medications (<10%) and adjunctive therapies: systemic corticosteroids (6.8%-7.6%), famotidine (9.0%-28.1%), and antithrombotics such as aspirin (2.0%-21.4%), heparin (2.2%-18.1%), and enoxaparin (2.8%-14.8%). Hospitalization was observed in 0.3% to 1.3% of the cohort diagnosed with COVID-19, with undetectable (n < 5 per database) 30-day fatality. Thirty-day outcomes including pneumonia and hypoxemia were more frequent in COVID-19 than influenza. CONCLUSIONS: Despite negligible fatality, complications including hospitalization, hypoxemia, and pneumonia were more frequent in children and adolescents with COVID-19 than with influenza. Dyspnea, anosmia, and gastrointestinal symptoms could help differentiate diagnoses. A wide range of medications was used for the inpatient management of pediatric COVID-19.


Subject(s)
COVID-19 , Adolescent , Age Distribution , COVID-19/complications , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/epidemiology , Child , Child, Preschool , Cohort Studies , Comorbidity , Databases, Factual , Diagnosis, Differential , Female , France/epidemiology , Germany/epidemiology , Hospitalization/statistics & numerical data , Humans , Infant , Infant, Newborn , Influenza, Human/complications , Influenza, Human/diagnosis , Influenza, Human/epidemiology , Male , Republic of Korea/epidemiology , Spain/epidemiology , Symptom Assessment , Time Factors , Treatment Outcome , United States/epidemiology
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