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1.
In Vivo ; 36(6): 2823-2827, 2022.
Article in English | MEDLINE | ID: covidwho-2100683

ABSTRACT

BACKGROUND/AIM: COVID-19 is a concerning issue among in-center hemodialysis (HD) patients. To prevent COVID-19 diffusion in our HD facility, weekly rapid nasal antigen test screening was performed for all asymptomatic patients on chronic HD. This study aimed to assess the performance of weekly rapid antigen test in detecting SARS-CoV-2 infection among asymptomatic patients receiving HD. PATIENTS AND METHODS: A retrospective analysis was conducted in HD patients who underwent rapid antigen test screening from December 2021 to March 2022. The diagnosis of COVID-19 with rapid antigen test was always confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: During the observational period, 1,748 rapid antigen tests were performed in 220 HD patients. Mean age was 68.4±14.6 years. Fifteen (8.5%) patients resulted positive for SARS-CoV-2 infection using rapid antigen tests. The diagnosis was subsequently confirmed in 14 (93.3%) patients by RT-PCR. During the same period, 12 (5.4%) symptomatic patients, regularly screened with weekly rapid antigen test, resulted positive for SARS-CoV-2 infection using RT-PCR. Overall, weekly rapid antigen test screening identified 14 out of 26 (53.8%) COVID-19 cases and showed a positive predictive value of 93%. CONCLUSION: Weekly antigen test screening of asymptomatic patients on chronic HD detected around half of the COVID-19 cases in our population.


Subject(s)
COVID-19 , Humans , Middle Aged , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/epidemiology , SARS-CoV-2 , Retrospective Studies , COVID-19 Testing , Renal Dialysis , Sensitivity and Specificity
2.
Am J Case Rep ; 23: e937760, 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2100412

ABSTRACT

BACKGROUND On rare occasions, viral infections are known to also depress immune cell lines, further worsening clinical outcomes. We describe a patient who presented 3 weeks after recovery from mild COVID-19 disease with clinical features of an atypical pneumonia and was found to have a low CD4+ T-cell count. CASE REPORT An 82-year-old man with a past medical history of coronary artery disease, rheumatoid arthritis, gout, hypertension, and atrial fibrillation presented with a 1-week history of progressively worsening shortness of breath and cough. He was noted to have recovered from mild SARS-CoV-2 infection 3 weeks prior to his current presentation and had been at his baseline level of health following infection. A T cell subset panel was obtained, which revealed an absolute CD3 count of 92 (reference range 840-3060), absolute CD4 count of 52 (reference range 500-1400), absolute CD8 count of 37 (reference range 180-1170), and a normal CD4: CD8 ratio. He was subsequently started on atovaquone for pneumocystis jiroveci pneumonia prophylaxis. CONCLUSIONS This case highlights the need for a high index of suspicion for lymphocyte depletion in older patients with multiple comorbidities who present during or after SARS-CoV-2 infection with atypical symptoms that are suggestive of immunosuppression. In such instances, there should be a low threshold to start prophylactic therapy for possible opportunistic infections.


Subject(s)
COVID-19 , Pneumonia, Pneumocystis , Male , Humans , Aged , Aged, 80 and over , SARS-CoV-2 , T-Lymphocyte Subsets , Cough
3.
Scand J Trauma Resusc Emerg Med ; 28(1): 107, 2020 Oct 28.
Article in English | MEDLINE | ID: covidwho-2098376

ABSTRACT

OBJECTIVES: COVID-19 presents challenges to the emergency care system that could lead to emergency department (ED) crowding. The Huddinge site at the Karolinska university hospital (KH) responded through a rapid transformation of inpatient care capacity together with changing working methods in the ED. The aim is to describe the KH response to the COVID-19 crisis, and how ED crowding, and important input, throughput and output factors for ED crowding developed at KH during a 30-day baseline period followed by the first 60 days of the COVID-19 outbreak in Stockholm Region. METHODS: Different phases in the development of the crisis were described and identified retrospectively based on major events that changed the conditions for the ED. Results were presented for each phase separately. The outcome ED length of stay (ED LOS) was calculated with mean and 95% confidence intervals. Input, throughput, output and demographic factors were described using distributions, proportions and means. Pearson correlation between ED LOS and emergency ward occupancy by phase was estimated with 95% confidence interval. RESULTS: As new working methods were introduced between phase 2 and 3, ED LOS declined from mean (95% CI) 386 (373-399) minutes to 307 (297-317). Imaging proportion was reduced from 29 to 18% and admission rate increased from 34 to 43%. Correlation (95% CI) between emergency ward occupancy and ED LOS by phase was 0.94 (0.55-0.99). CONCLUSIONS: It is possible to avoid ED crowding, even during extreme and quickly changing conditions by leveraging previously known input, throughput and output factors. One key factor was the change in working methods in the ED with higher competence, less diagnostics and increased focus on rapid clinical admission decisions. Another important factor was the reduction in bed occupancy in emergency wards that enabled a timely admission to inpatient care. A key limitation was the retrospective study design.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Crowding , Emergency Service, Hospital , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Adult , Aged , Aged, 80 and over , Bed Occupancy , COVID-19 , Female , Hospitalization , Hospitals, University , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Sweden
4.
Scand J Trauma Resusc Emerg Med ; 28(1): 66, 2020 Jul 13.
Article in English | MEDLINE | ID: covidwho-2098371

ABSTRACT

BACKGROUND: There is a need for validated clinical risk scores to identify patients at risk of severe disease and to guide decision-making during the covid-19 pandemic. The National Early Warning Score 2 (NEWS2) is widely used in emergency medicine, but so far, no studies have evaluated its use in patients with covid-19. We aimed to study the performance of NEWS2 and compare commonly used clinical risk stratification tools at admission to predict risk of severe disease and in-hospital mortality in patients with covid-19. METHODS: This was a prospective cohort study in a public non-university general hospital in the Oslo area, Norway, including a cohort of all 66 patients hospitalised with confirmed SARS-CoV-2 infection from the start of the pandemic; 13 who died during hospital stay and 53 who were discharged alive. Data were collected consecutively from March 9th to April 27th 2020. The main outcome was the ability of the NEWS2 score and other clinical risk scores at emergency department admission to predict severe disease and in-hospital mortality in covid-19 patients. We calculated sensitivity and specificity with 95% confidence intervals (CIs) for NEWS2 scores ≥5 and ≥ 6, quick Sequential Organ Failure Assessment (qSOFA) score ≥ 2, ≥2 Systemic Inflammatory Response Syndrome (SIRS) criteria, and CRB-65 score ≥ 2. Areas under the curve (AUCs) for the clinical risk scores were compared using DeLong's test. RESULTS: In total, 66 patients (mean age 67.9 years) were included. Of these, 23% developed severe disease. In-hospital mortality was 20%. Tachypnoea, hypoxemia and confusion at admission were more common in patients developing severe disease. A NEWS2 score ≥ 6 at admission predicted severe disease with 80.0% sensitivity and 84.3% specificity (Area Under the Curve (AUC) 0.822, 95% CI 0.690-0.953). NEWS2 was superior to qSOFA score ≥ 2 (AUC 0.624, 95% CI 0.446-0.810, p < 0.05) and other clinical risk scores for this purpose. CONCLUSION: NEWS2 score at hospital admission predicted severe disease and in-hospital mortality, and was superior to other widely used clinical risk scores in patients with covid-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Early Warning Score , Hospital Mortality , Patient Admission , Pneumonia, Viral/epidemiology , Adult , Aged , Aged, 80 and over , COVID-19 , Cohort Studies , Female , Humans , Male , Middle Aged , Norway/epidemiology , Pandemics , Risk Assessment , SARS-CoV-2 , Sensitivity and Specificity , Severity of Illness Index
5.
Infect Control Hosp Epidemiol ; 42(2): 228-229, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-2096442

ABSTRACT

Coronavirus disease 2019 (COVID-19) has migrated to regions that were initially spared, and it is likely that different populations are currently at risk for illness. Herein, we present our observations of the change in characteristics and resource use of COVID-19 patients over time in a national system of community hospitals to help inform those managing surge planning, operational management, and future policy decisions.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Hospitalization/statistics & numerical data , Adult , Age Factors , Aged , Aged, 80 and over , COVID-19/ethnology , COVID-19/mortality , Female , Hospitals, Community , Humans , Male , Middle Aged , SARS-CoV-2/isolation & purification , Virginia/epidemiology , Young Adult
7.
Ultrasound Med Biol ; 47(2): 214-221, 2021 02.
Article in English | MEDLINE | ID: covidwho-2096090

ABSTRACT

In this study, the utility of point-of-care lung ultrasound for clinical classification of coronavirus disease (COVID-19) was prospectively assessed. Twenty-seven adult patients with COVID-19 underwent bedside lung ultrasonography (LUS) examinations three times each within the first 2 wk of admission to the isolation ward. We divided the 81 exams into three groups (moderate, severe and critically ill). Lung scores were calculated as the sum of points. A rank sum test and bivariate correlation analysis were carried out to determine the correlation between LUS on admission and clinical classification of COVID-19. There were dramatic differences in LUS (p < 0.001) among the three groups, and LUS scores (r = 0.754) correlated positively with clinical severity (p < 0.01). In addition, moderate, severe and critically ill patients were more likely to have low (≤9), medium (9-15) and high scores (≥15), respectively. This study provides stratification criteria of LUS scores to assist in quantitatively evaluating COVID-19 patients.


Subject(s)
COVID-19/diagnostic imaging , Lung/diagnostic imaging , Point-of-Care Systems , Ultrasonography/instrumentation , Ultrasonography/methods , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Prospective Studies , Severity of Illness Index
9.
Infect Control Hosp Epidemiol ; 41(7): 820-825, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-2096308

ABSTRACT

OBJECTIVES: Patients with COVID-19 may present with respiratory syndromes indistinguishable from those caused by common viruses. Early isolation and containment is challenging. Although screening all patients with respiratory symptoms for COVID-19 has been recommended, the practicality of such an effort has yet to be assessed. METHODS: Over a 6-week period during a SARS-CoV-2 outbreak, our institution introduced a "respiratory surveillance ward" (RSW) to segregate all patients with respiratory symptoms in designated areas, where appropriate personal protective equipment (PPE) could be utilized until SARS-CoV-2 testing was done. Patients could be transferred when SARS-CoV-2 tests were negative on 2 consecutive occasions, 24 hours apart. RESULTS: Over the study period, 1,178 patients were admitted to the RSWs. The mean length-of-stay (LOS) was 1.89 days (SD, 1.23). Among confirmed cases of pneumonia admitted to the RSW, 5 of 310 patients (1.61%) tested positive for SARS-CoV-2. This finding was comparable to the pickup rate from our isolation ward. In total, 126 HCWs were potentially exposed to these cases; however, only 3 (2.38%) required quarantine because most used appropriate PPE. In addition, 13 inpatients overlapped with the index cases during their stay in the RSW; of these 13 exposed inpatients, 1 patient subsequently developed COVID-19 after exposure. No patient-HCW transmission was detected despite intensive surveillance. CONCLUSIONS: Our institution successfully utilized the strategy of an RSW over a 6-week period to contain a cluster of COVID-19 cases and to prevent patient-HCW transmission. However, this method was resource-intensive in terms of testing and bed capacity.


Subject(s)
Coronavirus Infections/transmission , Cross Infection/transmission , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Occupational Diseases/prevention & control , Patient Isolation , Pneumonia, Viral/transmission , Population Surveillance/methods , Adult , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Cross Infection/diagnosis , Cross Infection/prevention & control , Early Diagnosis , Female , Humans , Length of Stay , Male , Middle Aged , Pandemics/prevention & control , Patients' Rooms/organization & administration , Personal Protective Equipment , Pneumonia/virology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Singapore , Symptom Assessment , Tertiary Care Centers
14.
Croat Med J ; 63(5): 490-494, 2022 Oct 31.
Article in English | MEDLINE | ID: covidwho-2092263

ABSTRACT

Acquired antibodies against factor II (prothrombin) are rare and most commonly associated with severe liver disease or vitamin K antagonist treatment. In very rare cases, these antibodies and associated hypoprothrombinemia are found in patients with lupus anticoagulant (LAC), an antiphospholipid antibody that inhibits phospholipid-dependent coagulation tests. This uncommon entity, called lupus anticoagulant-hypoprothrombinemia syndrome (LAHPS), may cause both severe, life-threatening bleeding and a predisposition to thrombosis. Coronavirus disease 2019 (COVID-19) is associated with a variety of coagulation abnormalities and an increased risk of thrombosis. Bleeding may occur, but it is less common than thromboembolism and has mostly been described in association with the severity of the disease and anticoagulation treatment in hospitalized patients, rarely in the post-acute phase of the disease. We report on a case of an 80-year-old man who developed LAHPS with prothrombin antibodies and severe bleeding after COVID-19.


Subject(s)
Antiphospholipid Syndrome , COVID-19 , Hypoprothrombinemias , Male , Humans , Aged, 80 and over , Hypoprothrombinemias/complications , Lupus Coagulation Inhibitor , COVID-19/complications , Prothrombin , Disease Susceptibility/complications , Antiphospholipid Syndrome/complications , Hemorrhage/etiology
15.
Acta Biomed ; 93(5): e2022256, 2022 Oct 26.
Article in English | MEDLINE | ID: covidwho-2091392

ABSTRACT

BACKGROUND AND AIM: Respiratory failure in SARS-CoV-2 patients is characterized by the presence of hypoxemia and hypocapnia without relevant dyspnea. To date, the use of respiratory parameters other than PaO2/FiO2 ratio to stratify the risk of worsening of these patients has not been sufficiently studied.  Aim of this work was to evaluate whether the ratio between partial pressure levels of carbon dioxide (PaCO2) and the fraction of inspired oxygen (FiO2) measured at emergency department (ED) admission is predictive of the clinical course of patients suffering from SARS-CoV-2 pneumonia. METHODS: We retrospectively studied 236 patients with SARS-CoV-2 pneumonia evaluated at the ED of the Perugia Hospital. The end-points were: in-hospital mortality, need for invasive mechanical ventilation (IMV) and length of in-hospital stay (LOS). Clinical, blood gas and laboratory data were collected at ED admission. RESULTS: Of the 236 patients 157 were male, the mean age was 64 ± 16. Thirtythree patients (14%) needed IMV, 49 died (21%). In the univariate analysis, the PaCO2/FiO2 ratio was inversely associated with the need for IMV (p <0.001), mortality (p <0.001) and LOS (p = 0.005). At the multivariate analysis the PaCO2/FiO2 ratio was found to be predictive of the need for IMV, independently from age, gender, number of comorbidities, neutrophils, lymphocytes, glomerular filtrate, d-dimer, LDH and CRP. CONCLUSIONS: the PaCO2/FiO2 ratio is predictive of the risk of respiratory failure worsening in patients with SARS-CoV-2 pneumonia, independently from other several confounding factors.


Subject(s)
COVID-19 , Pneumonia , Respiratory Insufficiency , Humans , Male , Middle Aged , Aged , Aged, 80 and over , Female , SARS-CoV-2 , Retrospective Studies , Carbon Dioxide , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Oxygen
16.
Gerontology ; 68(11): 1285-1290, 2022.
Article in English | MEDLINE | ID: covidwho-2088997

ABSTRACT

BACKGROUND: Older adults denoted one of the populations that mostly suffered from the consequences of the COVID-19 pandemic. The cost of confinement was paid in terms of social isolation, distance from relatives and friends, lack of social support, and limited access to the healthcare system, which had a negative impact on health of older adults with comorbidities and frailty. OBJECTIVES: The purpose of the present study was to report the consequences of the COVID-19 pandemic on cognitive performances, functional status, and health-related quality of life among frail outpatients, compared to pre-pandemic status. METHOD: The current sample was part of a larger sample of frail and pre-frail outpatients, who were first evaluated at the clinic between April and May 2019 and who underwent a first follow-up evaluation between April and May 2020. Those outpatients who have undergone the first follow-up evaluation were contacted between April and May 2021 and were asked to voluntarily participate in a second telephone-based evaluation. Cognitive performances (through Mini Mental State Examination - MMSE), functional independency in basic and instrumental daily activities, physical and mental components of health-related quality of life (SF-12 PCS and SF-12 MCS, respectively) were evaluated and compared to previous evaluations. RESULTS: Seventy one outpatients (mean age of 80.69 years) completed the present follow-up evaluation. Patients reported significantly lower cognitive performances (mean MMSE 19.37; p < 0.001), lower physical quality of life (mean score 31.69; p < 0.001), and lower mental quality of life (mean score 38.79; p < 0.001) compared to both pre-pandemic baseline and the first follow-up. Moreover, patients showed a significantly reduced independency in basic daily activities (mean score 3.8; p = 0.004), and a significantly reduced independency in managing telephone (p = 0.012) and medications (p = 0.035), compared to baseline. CONCLUSIONS: The COVID-19 pandemic has been a prolonged stressor over time, which has markedly affected health-related quality of life of outpatients, and it can be considered a stressor that might have contributed to the patients' greater cognitive and functional vulnerability.


Subject(s)
COVID-19 , Quality of Life , Humans , Aged , Aged, 80 and over , Frail Elderly/psychology , Geriatric Assessment , Pandemics , Activities of Daily Living , COVID-19/epidemiology , Outpatients , Functional Status , Cognition
17.
West Afr J Med ; 39(9): 889-895, 2022 Sep 16.
Article in English | MEDLINE | ID: covidwho-2083721

ABSTRACT

BACKGROUND: COVID-19 vaccine hesitancy is a global public health problem. It is a complex and context-specific phenomenon that varies within and across nations. Despite COVID-19 vaccine programmes in Nigeria, there are possibilities that vaccine uptake and coverage among adult citizens will suffer setbacks amidst various interventions by the Federal Government of Nigeria. AIM: The study aimed to determine the drivers, dangers, and corrective measures for COVID-19 vaccine hesitancy and potential penalties for declining vaccination among adults in South-eastern Nigeria. METHODS: A descriptive study was carried out from March to April, 2021 on a cross section of 400 adults in South-eastern Nigeria. Data collection was done using a structured, pretested, and interviewer administered questionnaire. The questionnaire elicited information on drivers, dangers and corrective measures for COVID-19 vaccine hesitancy and potential penalties for declining vaccination. RESULTS: The study participants were aged 18-86 (51±14.2) years. There were 227(56.8%) females. The most common driver of refusal of COVID-19 vaccination was the safety of COVID-19 vaccines(100.0%). The most perceived dangers of refusing the COVID-19 vaccine were the risks of contracting COVID-19 infection(100.0%) and dying from its complications(100.0%). The most common corrective measure for refusal of the COVID-19 vaccine was public health information and education on vaccine safety(100.0%). The predominant potential penalty for declining the COVID-19 vaccine was restricting access to air travel (100.0%). CONCLUSION: This study has shown that the most common driver of vaccine hesitancy was vaccine safety while the most commonly perceived dangers were risks of contracting COVID-19 infection and dying from its complications. The most common corrective measure for refusal of the COVID-19 vaccine was public health information and education on vaccine safety. The most preeminent penalty for declining the COVID-19 vaccine was restricting access to air travel. There is a need to address these context-specific drivers and dangers that promote vaccine hesitancy. Public health information and education strategies to reduce vaccine hesitancy should be the focus of intervention to improve uptake of COVID-19 vaccination and safeguard the health of Nigerians.


CONTEXTE: L'hésitation à se faire vacciner contre le COVID-19 est un problème de santé publique mondial. Il s'agit d'un phénomène complexe et spécifique au contexte qui varie au sein d'une même nation et d'une nation à l'autre. Malgré les programmes de vaccination contre le COVID-19 au Nigeria, il est possible que l'adoption et la couverture vaccinale chez les adultes subissent des revers malgré les diverses interventions du gouvernement fédéral du Nigeria. OBJECTIF: L'étude visait à déterminer les moteurs, les dangers et les mesures correctives de l'hésitation à se faire vacciner contre le COVID- 19 et les sanctions potentielles en cas de refus de vaccination chez les adultes du sud-est du Nigeria. MÉTHODES: Une étude descriptive a été menée de mars à avril 2021 sur un échantillon de 400 adultes du sud-est du Nigeria. La collecte des données a été effectuée à l'aide d'un questionnaire structuré, testé au préalable et administré par un enquêteur. Le questionnaire a permis d'obtenir des informations sur les facteurs, les dangers et les mesures correctives de l'hésitation à se faire vacciner par le COVID-19 et les sanctions potentielles en cas de refus de la vaccination. RÉSULTATS: Les participants à l'étude étaient âgés de 18 à 86 ans (51±14,2). Il y avait 227 (56,8 %) femmes. Le motif le plus courant de refus de la vaccination par le COVID-19 était l'innocuité des vaccins COVID-19 (100,0 %). Les dangers les plus perçus du refus du vaccin COVID-19 étaient les risques de contracter une infection au COVID-19 (100,0%) et de mourir de ses complications (100,0%). La mesure corrective la plus courante pour le refus du vaccin COVID-19 était l'information et l'éducation en matière de santé publique sur la sécurité du vaccin (100,0%). La pénalité potentielle prédominante pour le refus du vaccin COVID-19 était la restriction de l'accès aux voyages aériens (100,0 %). CONCLUSION: Cette étude a montré que le facteur le plus courant de l'hésitation à se faire vacciner était la sécurité du vaccin, tandis que les dangers les plus couramment perçus étaient les risques de contracter l'infection au COVID-19 et de mourir de ses complications. La mesure corrective la plus courante pour le refus du vaccin COVID-19 était l'information et l'éducation de la santé publique sur la sécurité du vaccin. La sanction la plus prééminente pour le refus du vaccin COVID-19 était la restriction de l'accès aux voyages aériens. Il est nécessaire de s'attaquer à ces facteurs et dangers spécifiques au contexte qui favorisent l'hésitation à se faire vacciner. Les stratégies d'information et d'éducation en matière de santé publique visant à réduire l'hésitation à se faire vacciner devraient être au centre de l'intervention afin d'améliorer l'adoption de la vaccination par le COVID-19 et de préserver la santé des Nigérians. Mots clés: Vaccin COVID-19, Dangers, Facteurs d'incitation, Hésitation, Nigeria, Pénalités.


Subject(s)
COVID-19 Vaccines , COVID-19 , Patient Acceptance of Health Care , Vaccination Hesitancy , Adult , Female , Humans , Male , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Cross-Sectional Studies , Nigeria , Vaccination/adverse effects , Surveys and Questionnaires , Adolescent , Young Adult , Middle Aged , Aged , Aged, 80 and over
18.
Saudi Med J ; 43(9): 1013-1019, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2081101

ABSTRACT

OBJECTIVES: To describe the clinical characteristics and the contributing factors potentially associated with the poorer outcome in Libyan COVID-19 ICU patients. METHODS: The present work is a retrospective, single-center study, which included 94 COVID-19 patients admitted to the Isolation Department at Marj Hospital from August 21st, 2020 till April 30th, 2021. The patients' data, including their medical history, clinical manifestations, radiological imaging, and laboratory findings, were obtained from the hospital records. RESULTS: A higher proportion of the admitted patients were males. The patients' mean age was 68.29 ± 13.64. The patients came with varying symptoms, but most commonly they were affected by dyspnea, fever, cough, and fatigue. Diabetes was the most common underlying comorbidity; nonetheless, other chronic diseases like hypertension, cardiovascular disease, renal disease, and lung diseases individually affected a significant proportion of patients. Although there was no effect of gender on patients' outcomes, age had a significant influence on the disease consequences. CONCLUSION: There was a strong effect of age on ICU admission and patients' surviving the illness. Diabetes was the most common underlying comorbid disease in COVID-19 patients. On admission time, inflammatory markers such as CRP, D-dimer, serum ferritin, and LDH, in common, were the most important indicators of poorer prognosis. Male gender, comorbidity, and symptomology adversely affected the rate of admission but not the patient survival.


Subject(s)
COVID-19 , Diabetes Mellitus , Aged , Aged, 80 and over , COVID-19/epidemiology , Diabetes Mellitus/epidemiology , Female , Hospitalization , Humans , Libya/epidemiology , Male , Middle Aged , Retrospective Studies
19.
Front Public Health ; 10: 898787, 2022.
Article in English | MEDLINE | ID: covidwho-2080282

ABSTRACT

Background: The continued emergence of new COVID-19 variants highlights the importance of vaccination in the effort to reduce disease transmission and burden. The objective of this study is to evaluate the processes and outcomes associated with a novel in-home COVID-19 vaccination program aimed at vaccinating high-risk populations in New York, USA. Methods: To evaluate program processes, we described the program itself and reflected on some key lessons learned. To evaluate program outcomes, we analyzed data reported by vaccine recipients. These outcomes included the percentage of vaccine recipients that successfully received the full course of vaccinations, and the demographic and health characteristics of vaccine recipients. We additionally assessed demographic differences in motivations for receiving in-home care, using chi-squared tests to assess statistical significance. Data were collected and reported via dynamic online intake forms. Results: The median age of vaccine recipients was 79 ± SD 9.0 years. The oldest vaccine recipient was 107 years old. Of those with non-missing data, more than half of vaccine recipients were female (63%), identified as part of a racial/ethnic minority (66%), reported an annual income of < $25,000 (58%), and received a high school degree or less (68%). Most vaccine recipients reported having one or more health conditions associated with increased risk of severe COVID-19 disease (72%). Vaccine recipients were most likely to report receiving in-home vaccination because they were home-bound due to disability. Motivations for receiving in-home vaccination differed by demographic subgroup. Conclusion: The population receiving vaccinations from this in-home care delivery program comprised seniors who were mostly female and non-white, indicated socioeconomic vulnerability, and reported one or more COVID-related health conditions; this signified that the program met its goal of vaccinating those most at risk for severe COVID-19 disease.


Subject(s)
COVID-19 , Vaccines , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Ethnicity , Female , Humans , Male , Minority Groups , SARS-CoV-2 , Vaccination , Vulnerable Populations
20.
PLoS One ; 17(10): e0275486, 2022.
Article in English | MEDLINE | ID: covidwho-2079744

ABSTRACT

BACKGROUND: Older adults have been especially vulnerable to adverse effects from the COVID-19 pandemic including higher mortality and more severe disease complications. At the same time, social isolation, malnutrition and physical inactivity are serious concerns among older adults. The pandemic and associated restrictions may serve to exacerbate these issues, presenting increased risks to physical and mental health. The aims of this qualitative study were: i) to explore how community-living older people in the UK experienced the first wave of the COVID-19 pandemic, specifically how it impacted their well-being and associated health behaviours; ii) to explore how older people's experiences and behaviours changed over time throughout the first wave. METHODS: Qualitative data were collected by conducting serial telephone interviews, with an interval of approximately three months. Participants were from the Hertfordshire Cohort Study, all aged over 80 years. Discussions were audio-recorded, information related to the COVID-19 pandemic was transcribed verbatim and transcripts analysed thematically. Interviews were conducted from March to October 2020. RESULTS: Data for twelve participants (7 men and 5 women) from a total of 35 interviews were used, comprising two or three timepoints per participant. Analysis identified five overarching themes: 1) shopping strategies and food accessibility, 2) limitations on activities and going out, 3) disruption to healthcare, 4) social and psychological repercussions, and 5) coping strategies. Findings highlight challenges associated with accessing shops, healthcare, and usual activities due to pandemic-related restrictions. Longitudinal findings showed that for some, the ongoing pandemic and related restrictions appeared to aggravate mental health issues (low mood, anxiety) over time, as well as greater feelings of isolation or loneliness, reduced activity and functional limitations; this was despite some relaxation of restrictions later on. Coping strategies used by participants included finding ways to keep busy and to do physical activity safely, maintaining social contact remotely, and having an optimistic or positive outlook, a 'do what you can' attitude. CONCLUSIONS: Interventions are likely to be needed in the wake of the COVID-19 pandemic to support health behaviours, such as increasing physical activity, social engagement and improving mental health among community-living older adults.


Subject(s)
COVID-19 , Independent Living , Aged , Aged, 80 and over , COVID-19/epidemiology , Cohort Studies , Female , Humans , Independent Living/psychology , Male , Pandemics , Qualitative Research
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