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1.
Int J Environ Res Public Health ; 18(4)2021 02 10.
Article in English | MEDLINE | ID: covidwho-1112719

ABSTRACT

The COVID-19 outbreak had a negative impact on psychological status among elderly subjects, negatively affecting their health-related quality of life (HRQoL). Psychological factors that promote resilience might beneficially contribute also to promoting a better HRQoL among elderly subjects. The main purpose of the present study was to investigate the contribution of dispositional optimism and expressive flexibility on the HRQoL of elderly outpatients during the COVID-19 outbreak. The outpatients were recruited from October 2018 to October 2019, and then followed-up during April 2020, by evaluating their HRQoL. The baseline sample consisted of 141 elderly outpatients (mean age 80.31 ± 6.84 years); the final number of outpatients included in the follow-up evaluation was 104 (mean age 80.26 ± 6.39). Univariate and multivariate linear regressions were developed to explore significant associations with the physical and mental component of HRQoL. Baseline dispositional optimism was a predictor of the mental component of HRQoL at follow-up; the flexible suppression of emotional expression was a predictor of the physical component of HRQoL at follow-up. From a psychogeriatric perspective, the accurate assessment of psychological factors, such as dispositional optimism and expressive flexibility, might help physicians and psychologists to recognize additional patients' vulnerabilities during the current emergency.


Subject(s)
/psychology , Mental Health , Pandemics , Quality of Life , Aged , Aged, 80 and over , Emotions , Health Status , Humans , Optimism
2.
Ann Intern Med ; 174(2): JC16, 2021 02.
Article in English | MEDLINE | ID: covidwho-1110694

ABSTRACT

SOURCE CITATION: Stone JH, Frigault MJ, Serling-Boyd NJ, et al. Efficacy of tocilizumab in patients hospitalized with Covid-19. N Engl J Med. 2020;383:2333-44. 33085857.


Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Respiratory Insufficiency/drug therapy , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Multicenter Studies as Topic , Randomized Controlled Trials as Topic , Respiratory Insufficiency/mortality , Respiratory Insufficiency/virology
3.
Rev. Nutr. (Online) ; 33: e200174, 2020. graf
Article in English | LILACS (Americas) | ID: covidwho-1105898

ABSTRACT

ABSTRACT It has been documented that the older adults of the population are at the greatest risk of mortality due to the coronavirus disease; consequently, they could be the population most affected by the measures of social isolation and reduction of virus contagion implemented worldwide. Social isolation can expose older adults to an increased nutritional risk due to factors such as socioeconomic insecurity, which could affect food acquisition and the need for support in daily tasks and meals. The institutionalized older adults often depend on food donations, which may have reduced due the economic crisis caused by the pandemic, and the aging process itself causes changes in nutritional necessitie and eating habits. In the coronavirus pandemic, nutritionists and dietitians can offer remote nutritional follow-up. Moreover, the government actions, such as the implementation of educational and social service programs, should be applied to support healthy aging and minimize exposure to nutritional risks and coronavirus disease.


RESUMO Tem sido documentado que os idosos são a população de maior risco para mortalidade por COVID-19. Consequentemente, pode ser a mais afetada pelas medidas de isolamento social e de redução de contágio pelo vírus implementadas em todo o mundo. O isolamento social pode expor os idosos ao risco nutricional aumentado devido a alguns fatores, como: a insegurança socioeconômica, a qual pode afetar a aquisição de alimentos; a necessidade de apoio nas tarefas e nas refeições diárias; a possível redução de doações de alimentos para idosos institucionalizados, em virtude da crise econômica ocasionada pela pandemia; e o próprio processo do envelhecimento, que causa alterações das necessidades nutricionais e do hábito de se alimentar. Contudo, no contexto da pandemia do novo coronavírus, nutricionistas podem oferecer acompanhamento nutricional remoto. Além disso, ações governamentais, como a implementação de programas educacionais e de serviço social, devem ser aplicadas para o envelhecimento saudável e para a minimização da exposição ao risco nutricional e à COVID-19.


Subject(s)
Humans , Middle Aged , Aged , Aged, 80 and over , Aged , Coronavirus , Pandemics , Nutritional Requirements
4.
Epidemiol Health ; 43: e2021007, 2021.
Article in English | MEDLINE | ID: covidwho-1094290

ABSTRACT

OBJECTIVES: This study explored socioeconomic disparities in Korea using health insurance type as a proxy during the ongoing coronavirus disease 2019 (COVID-19) pandemic. METHODS: We conducted a retrospective cohort study using Korea's nationwide healthcare database, which contained all individuals who received a diagnostic test for COVID-19 (n=232,390) as of May 15, 2020. We classified our cohort by health insurance type into beneficiaries of the National Health Insurance (NHI) or Medicaid programs. Our study outcomes were infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19-related outcomes, a composite of all-cause death, intensive care unit admission, and mechanical ventilation use. We estimated age-, sex-, and Charlson comorbidity index score-adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using a multivariable logistic regression analysis. RESULTS: Of the 218,070 NHI and 14,320 Medicaid beneficiaries who received COVID-19 tests, 7,777 and 738 tested positive, respectively. The Medicaid beneficiaries were older (mean age, 57.5 vs. 47.8 years), more likely to be males (47.2 vs. 40.2%), and had a higher comorbidity burden (mean CCI, 2.0 vs. 1.7) than NHI beneficiaries. Compared to NHI beneficiaries, Medicaid beneficiaries had a 22% increased risk of SARS-CoV-2 infection (aOR, 1.22; 95% CI, 1.09 to 1.38), but had no significantly elevated risk of COVID-19-related outcomes (aOR 1.10, 95% CI 0.77 to 1.57); the individual events of the composite outcome yielded similar findings. CONCLUSIONS: As socioeconomic factors, with health insurance as a proxy, could serve as determinants during the current pandemic, pre-emptive support is needed for high-risk groups to slow its spread.


Subject(s)
/statistics & numerical data , Healthcare Disparities/economics , Insurance, Health/statistics & numerical data , Pandemics , Adult , Aged , Aged, 80 and over , Databases, Factual , Female , Humans , Insurance Claim Review , Male , Middle Aged , Republic of Korea/epidemiology , Retrospective Studies , Socioeconomic Factors , Young Adult
5.
J Prim Care Community Health ; 12: 2150132721996278, 2021.
Article in English | MEDLINE | ID: covidwho-1094016

ABSTRACT

INTRODUCTION: Many of the potential barriers to providing telehealth services already disproportionately impact vulnerable populations. The purpose of this study was to assess the incorporation of synchronous ophthalmology telemedicine visits in a tertiary university-based ophthalmology clinic for low-income and uninsured patients in the COVID-19 era. METHODS: The records of 18 patients who were due for an in-person visit in the medically underserved patient clinic at our institute were reviewed. Patients considered high risk of ocular morbidity progression were approved to proceed with an in-person visit. Patients with non-urgent visit indications were attempted to be contacted by telephone to be offered a telemedicine telephone visit as an alternative to a postponed in-person office visit. RESULTS: Clinical triage by an attending ophthalmologist determined that 17 patients (94.4%, n = 18) had visit indications appropriate for evaluation by telemedicine. Six patients (35.3%, n = 17) were successfully contacted and offered a telemedicine visit as an alternative to a postponed in-person office visit. All 6 patients accepted, scheduled, and completed a telemedicine visit. Eleven patients (64.7%, n = 17) were not able to be successfully contacted to offer and schedule either a telemedicine visit or a postponed in-person office visit. Patients who were not able to be successfully contacted were on average younger in age and more likely to be female, Hispanic/Latino, from Latin America, with a preferred language of Spanish. CONCLUSIONS: Synchronous ophthalmology telemedicine visits can be successfully incorporated in a tertiary university-based setting for low-income and uninsured patients. The primary barrier to providing telemedicine visits in this population was the ability to successfully contact patients to offer and schedule these visits.


Subject(s)
Ambulatory Care Facilities/organization & administration , Medically Underserved Area , Ophthalmology , Telemedicine/organization & administration , Academic Medical Centers , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Ohio/epidemiology , Retrospective Studies , Tertiary Care Centers
6.
JAMA Netw Open ; 4(2): e2037640, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1092150

ABSTRACT

Importance: Medical research has not equitably included members of racial/ethnic minority groups or female and older individuals. There are limited data on participant demographic characteristics in vaccine trials despite the importance of these data to current trials aimed at preventing coronavirus disease 2019. Objective: To investigate whether racial/ethnic minority groups and female and older adults are underrepresented among participants in vaccine clinical trials. Design, Setting, and Participants: This cross-sectional study examined data from completed US-based vaccine trials registered on ClinicalTrials.gov from July 1, 2011, through June 30, 2020. The terms vaccine, vaccination, immunization, and inoculation were used to identify trials. Only those addressing vaccine immunogenicity or efficacy of preventative vaccines were included. Main Outcomes and Measures: The numbers and percentages of racial/ethnic minority, female, and older individuals compared with US census data from 2011 and 2018. Secondary outcome measures were inclusion by trial phase and year of completion. Results: A total of 230 US-based trials with 219 555 participants were included in the study. Most trials were randomized (180 [78.3%]), included viral vaccinations (159 [69.1%]), and represented all trial phases. Every trial reported age and sex; 134 (58.3%) reported race and 79 (34.3%) reported ethnicity. Overall, among adult study participants, White individuals were overrepresented (77.9%; 95% CI, 77.4%-78.4%), and Black or African American individuals (10.6%; 95% CI, 10.2%-11.0%) and American Indian or Alaska Native individuals (0.4%; 95% CI, 0.3%-0.5%) were underrepresented compared with US census data; enrollment of Asian individuals was similar (5.7%; 95% CI, 5.5%-6.0%). Enrollment of Hispanic or Latino individuals (11.6%; 95% CI, 11.1%-12.0%) was also low even among the limited number of adult trials reporting ethnicity. Adult trials were composed of more female participants (75 325 [56.0%]), but among those reporting age as a percentage, enrollment of participants who were aged 65 years or older was low (12.1%; 95% CI, 12.0%-12.3%). Black or African American participants (10.1%; 95% CI, 9.7%-10.6%) and Hispanic or Latino participants (22.5%; 95% CI, 21.6%-23.4%) were also underrepresented in pediatric trials. Among trials reporting race/ethnicity, 65 (48.5%) did not include American Indian or Alaska Native participants and 81 (60.4%) did not include Hawaiian or Pacific Islander participants. Conclusions and Relevance: This cross-sectional study found that among US-based vaccine clinical trials, members of racial/ethnic minority groups and older adults were underrepresented, whereas female adults were overrepresented. These findings suggest that diversity enrollment targets should be included for all vaccine trials targeting epidemiologically important infections.


Subject(s)
Clinical Trials as Topic/standards , Ethnic Groups/statistics & numerical data , Patient Selection , Sexism/statistics & numerical data , Vaccines , Adult , African Continental Ancestry Group/ethnology , African Continental Ancestry Group/statistics & numerical data , Aged , Aged, 80 and over , Asian Continental Ancestry Group/ethnology , Asian Continental Ancestry Group/statistics & numerical data , Clinical Trials as Topic/statistics & numerical data , Continental Population Groups/ethnology , Continental Population Groups/statistics & numerical data , Cross-Sectional Studies , European Continental Ancestry Group/ethnology , European Continental Ancestry Group/statistics & numerical data , Female , Humans , Male , Middle Aged , Oceanic Ancestry Group/ethnology , Oceanic Ancestry Group/statistics & numerical data , Sexism/ethnology
9.
BMJ Open ; 11(2): e044384, 2021 02 18.
Article in English | MEDLINE | ID: covidwho-1090929

ABSTRACT

OBJECTIVE: The aim of this paper is to describe evolution, epidemiology and clinical outcomes of COVID-19 in subjects tested at or admitted to hospitals in North West London. DESIGN: Observational cohort study. SETTING: London North West Healthcare NHS Trust (LNWH). PARTICIPANTS: Patients tested and/or admitted for COVID-19 at LNWH during March and April 2020 MAIN OUTCOME MEASURES: Descriptive and analytical epidemiology of demographic and clinical outcomes (intensive care unit (ICU) admission, mechanical ventilation and mortality) of those who tested positive for COVID-19. RESULTS: The outbreak began in the first week of March 2020 and reached a peak by the end of March and first week of April. In the study period, 6183 tests were performed in on 4981 people. Of the 2086 laboratory confirmed COVID-19 cases, 1901 were admitted to hospital. Older age group, men and those of black or Asian minority ethnic (BAME) group were predominantly affected (p<0.05). These groups also had more severe infection resulting in ICU admission and need for mechanical ventilation (p<0.05). However, in a multivariate analysis, only increasing age was independently associated with increased risk of death (p<0.05). Mortality rate was 26.9% in hospitalised patients. CONCLUSION: The findings confirm that men, BAME and older population were most commonly and severely affected groups. Only older age was independently associated with mortality.


Subject(s)
/epidemiology , Hospitalization , Adolescent , Adult , Aged , Aged, 80 and over , /mortality , Child , Child, Preschool , Cohort Studies , Cross-Sectional Studies , Female , Humans , Infant , Infant, Newborn , Intensive Care Units , London/epidemiology , Male , Middle Aged , Respiration, Artificial , Risk Factors , Young Adult
10.
Rev Bras Enferm ; 74Suppl 1(Suppl 1): e20200576, 2021.
Article in English, Portuguese | MEDLINE | ID: covidwho-1090510

ABSTRACT

OBJECTIVE: Reflect, in the light of the Health Belief Model, on the adoption of behavioral measures in the context of COVID-19. METHODS: Theoretical-reflective essay, based on the Health Belief Model, to reflect on adherence to preventive behaviors in the pandemic of COVID-19. RESULTS: Adherence to preventive behaviors is strongly influenced by socioeconomic, territorial, political and individual factors in the face of critical health situations. In addition, the spread of false news modulates the thinking and execution of behavioral actions in the population. FINAL CONSIDERATIONS: It is necessary to understand the importance of health communication processes and the use of tools aimed at responsible human behavior and engaged in the adoption of a preventive posture.


Subject(s)
Attitude to Health , /psychology , Guideline Adherence/statistics & numerical data , Health Behavior , Pandemics/prevention & control , Patient Participation/psychology , Adult , Aged , Aged, 80 and over , Brazil , Female , Humans , Male , Middle Aged , Surveys and Questionnaires
11.
Rev Bras Enferm ; 74Suppl 1(Suppl 1): e20200602, 2021.
Article in English, Portuguese | MEDLINE | ID: covidwho-1090509

ABSTRACT

OBJECTIVE: To report the experience of a Virtual Culture Circle with Brazilian families about coping with COVID-19, as a space that promotes health during the pandemic. METHOD: Experience resulting from an extension action, the Virtual Culture Circle was held based on Paulo Freire's Research Itinerary. It counted with the participation of seven families from different locations in Brazil. During the dialogues, a house was built: the foundation represented the thematic research; walls and roof, coding and decoding; doors and windows, the critical unveiling. RESULTS: The action-reflection-action process favored the approach and integration of the participants of the Culture Circle; despite the geographical distance, it is an innovative strategy for empowerment and health promotion. FINAL CONSIDERATIONS: The Virtual Culture Circle constituted a soft technology for health care and can be explored as a tool for promoting health, especially in scenarios where face-to-face meetings are an impossibility.


Subject(s)
Adaptation, Psychological , Health Promotion/methods , Patient Education as Topic/methods , Virtual Reality , Adult , Aged , Aged, 80 and over , Brazil , Female , Humans , Male , Middle Aged , Qualitative Research
12.
CMAJ Open ; 9(1): E107-E114, 2021.
Article in English | MEDLINE | ID: covidwho-1089183

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is thought to have increased use of virtual care, but population-based studies are lacking. We aimed to assess the uptake of virtual care during the COVID-19 pandemic using comprehensive population-based data from Ontario. METHODS: This was a repeated cross-sectional study design. We used administrative data to evaluate changes in in-person and virtual visits among all residents of Ontario before (2012-2019) and during (January-August 2020) the COVID-19 pandemic. We included all patients who had an ambulatory care visit in Ontario. We excluded claims for patients who were not Ontario residents or had an invalid or missing health card number. We compared monthly or quarterly virtual care use across age groups, neighbourhood income quintiles and chronic disease subgroups. We also examined physician characteristics that may have been associated with virtual care use. RESULTS: Among all residents of Ontario (population 14.6 million), virtual care increased from 1.6% of total ambulatory visits in the second quarter of 2019 to 70.6% in the second quarter of 2020. The proportion of physicians who provided 1 or more virtual visits per year increased from 7.0% in the second quarter of 2019 to 85.9% in the second quarter of 2020. The proportion of Ontarians who had a virtual visit increased from 1.3% in 2019 to 29.2% in 2020. Older patients were the highest users of virtual care. The proportion of total virtual visits that were provided to patients residing in rural areas (v. urban areas) declined significantly between 2012 and 2020, reflecting a shift in virtual care to a service increasingly used in urban centres. The rates of virtual care use increased similarly across all conditions and across all income quintiles. INTERPRETATION: Our findings show that Ontario's approach to virtual care led to broad adoption across all provider groups, patient age, types of chronic diseases and neighborhood income. These findings have policy implications, including use of virtual care billing codes, for the ongoing use of virtual care during the second wave of the pandemic and beyond.


Subject(s)
Ambulatory Care/trends , Telemedicine/trends , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Income , Male , Middle Aged , Ontario , Residence Characteristics , Rural Population , Urban Population , Young Adult
15.
J Transl Med ; 19(1): 79, 2021 02 17.
Article in English | MEDLINE | ID: covidwho-1088601

ABSTRACT

BACKGROUND: The Sars-CoV-2 can cause severe pneumonia with multiorgan disease; thus, the identification of clinical and laboratory predictors of the progression towards severe and fatal forms of this illness is needed. Here, we retrospectively evaluated and integrated laboratory parameters of 45 elderly subjects from a long-term care facility with Sars-CoV-2 outbreak and spread, to identify potential common patterns of systemic response able to better stratify patients' clinical course and outcome. METHODS: Baseline white blood cells, granulocytes', lymphocytes', and platelets' counts, hemoglobin, total iron, ferritin, D-dimer, and interleukin-6 concentration were used to generate a principal component analysis. Statistical analysis was performed by using R statistical package version 4.0. RESULTS: We identified 3 laboratory patterns of response, renamed as low-risk, intermediate-risk, and high-risk, strongly associated with patients' survival (p < 0.01). D-dimer, iron status, lymphocyte/monocyte count represented the main markers discriminating high- and low-risk groups. Patients belonging to the high-risk group presented a significantly longer time to ferritin decrease (p: 0.047). Iron-to-ferritin-ratio (IFR) significantly segregated recovered and dead patients in the intermediate-risk group (p: 0.012). CONCLUSIONS: Our data suggest that a combination of few laboratory parameters, i.e. iron status, D-dimer and lymphocyte/monocyte count at admission and during the hospital stay, can predict clinical progression in COVID-19.


Subject(s)
/diagnosis , Fibrin Fibrinogen Degradation Products/analysis , Iron/blood , Lymphocytes/pathology , Monocytes/pathology , Aged , Aged, 80 and over , Biomarkers/blood , /mortality , Female , Fibrin Fibrinogen Degradation Products/metabolism , Humans , Leukocyte Count , Long-Term Care , Male , Middle Aged , Platelet Count , Prognosis , Retrospective Studies , Treatment Outcome
16.
BMC Health Serv Res ; 21(1): 153, 2021 Feb 17.
Article in English | MEDLINE | ID: covidwho-1088592

ABSTRACT

BACKGROUND: The COVID-19 pandemic halted non-emergency surgery across Scotland. Measures to mitigate the risks of transmitting COVID-19 are creating significant challenges to restarting all surgical services safely. We describe the development of a risk stratification tool to prioritise patients for cataract surgery taking account both specific risk factors for poor outcome from COVID-19 infection as well as surgical 'need'. In addition we report the demographics and comorbidities of patients on our waiting list. METHODS: A prospective case review of electronic records was performed. A risk stratification tool was developed based on review of available literature on systemic risk factors for poor outcome from COVID-19 infection as well as a surgical 'need' score. Scores derived from the tool were used to generate 6 risk profile groups to allow prioritised allocation of surgery. RESULTS: There were 744 patients awaiting cataract surgery of which 66 (8.9 %) patients were 'shielding'. One hundred and thirty-two (19.5 %) patients had no systemic comorbidities, 218 (32.1 %) patients had 1 relevant systemic comorbidity and 316 (46.5 %) patients had 2 or more comorbidities. Five hundred and ninety patients (88.7 %) did not have significant ocular comorbidities. Using the risk stratification tool, 171 (23 %) patients were allocated in the highest 3 priority stages. Given an aging cohort with associated increase in number of systemic comorbidities, the majority of patients were in the lower priority stages 4 to 6. CONCLUSIONS: COVID-19 has created an urgent challenge to deal safely with cataract surgery waiting lists. This has driven the need for a prompt and pragmatic change to the way we assess risks and benefits of a previously regarded as low-risk intervention. This is further complicated by the majority of patients awaiting cataract surgery being elderly with comorbidities and at higher risk of mortality related to COVID-19. We present a pragmatic method of risk stratifying patients on waiting lists, blending an evidence-based objective assessment of risk and patient need combined with an element of shared decision-making. This has facilitated safe and successful restarting of our cataract service.


Subject(s)
/epidemiology , Cataract Extraction , Cataract/epidemiology , Pandemics , Waiting Lists , Aged , Aged, 80 and over , Comorbidity , Female , Humans , Male , Prospective Studies , Risk Assessment , Risk Factors , Scotland/epidemiology
17.
BMC Geriatr ; 21(1): 128, 2021 02 17.
Article in English | MEDLINE | ID: covidwho-1088582

ABSTRACT

BACKGROUND: Middle-aged and older adults are more vulnerable to hospitalization and mortality if they are infected with the COVID-19 virus. The present study investigates the longitudinal effects of subjective successful aging on middle-aged and older adults' emotional and coping responses to the COVID-19 pandemic, and explores an underlying mechanism through perceived time limitation during the pandemic. METHODS: A sample of 311 Hong Kong Chinese middle-aged and older adults (Mage = 64.58, SD = 10.14, Range = 45-90 years) were recruited from an Adult Development and Aging Project and participated in a questionnaire study via an online platform or phone interview. Their levels of subjective successful aging, perceived time limitation, and emotional and coping responses to the pandemic were measured. RESULTS: The respondents who perceived themselves as more successful in aging process reported more positive and fewer negative emotions compared with their counterparts with lower levels of subjective successful aging. The mediation analysis showed that perceived time limitation could partially account for the effects of subjective successful aging on emotional and coping responses. CONCLUSIONS: Findings of this study unveil the beneficial effects of subjective views of successful aging on emotional and coping responses to the pandemic through alleviating their perception of time limitation.


Subject(s)
Pandemics , Adaptation, Psychological , Aged , Aged, 80 and over , Aging , Emotions , Hong Kong/epidemiology , Humans , Middle Aged
18.
J Prim Care Community Health ; 12: 2150132721995451, 2021.
Article in English | MEDLINE | ID: covidwho-1088493

ABSTRACT

The purpose of this study was to describe knowledge and beliefs about SARS-CoV2 and COVID-19 and explore the gaps between current media coverage of health risks and what the general public knows about the virus and its outcome. A 37-question survey was developed and administered to a community collaborative group in a Midwestern state in the United States. Fifty-three participants completed the survey. When asked where participants found their information, a majority reported the internet (33.9%, n = 18/53) and radio and/or tv (28.3%, n = 15/53). Most participants showed a basic level of COVID-19 knowledge, but few could identify the 3 most frequent symptoms of COVID-19 (7.5%, n = 4/53). The results from this study highlight the continued need for increased public health communication. Educational efforts should focus on social media and internet outlets to address COVID-19 misinformation, strategies to address vaccine hesitancy, and the associated communication gap to help address related health disparities.


Subject(s)
Health Knowledge, Attitudes, Practice , Adolescent , Adult , Aged , Aged, 80 and over , Consumer Health Information , Female , Humans , Information Seeking Behavior , Kansas/epidemiology , Male , Mass Media , Middle Aged , Risk Assessment , Surveys and Questionnaires , Young Adult
19.
Am J Physiol Lung Cell Mol Physiol ; 320(2): L257-L265, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1088310

ABSTRACT

The novel SARS-CoV-2 coronavirus, which is responsible for COVID-19 disease, was first reported in Wuhan, China, in December of 2019. The virus rapidly spread, and the World Health Organization declared a pandemic by March 2020. With millions of confirmed cases worldwide, there is growing concern and considerable debate regarding the potential for coronavirus infection to contribute to an appreciable burden of chronic respiratory symptoms or fibrotic disease among recovered individuals. Because the first case of COVID-19 was documented less than one year ago, data regarding long-term clinical outcomes are not yet available, and predictions for long-term outcome are speculative at best. However, due to the staggering number of cases and the severity of disease in many individuals, there is a critical need to consider the potential long-term implications of COVID-19. This review examines current basic and clinical data regarding fibrogenic mechanisms of viral injury in the context of SARS-CoV-2. Several intersecting mechanisms between coronavirus infection and fibrotic pathways are discussed to highlight factors and processes that may be targetable to improve patient outcome. Reports of post-infection sequelae from previous coronavirus outbreaks are presented toward the goal of improved recognition of potential contributing risk factors for fibrotic disease.


Subject(s)
/complications , Pandemics , Pulmonary Fibrosis/etiology , Age Factors , Aged , Aged, 80 and over , /virology , Cytokines/physiology , Host Microbial Interactions/physiology , Humans , Inflammation/etiology , Inflammation/virology , Pulmonary Fibrosis/virology , Respiration, Artificial/adverse effects , /etiology , Risk Factors , /physiology , Signal Transduction , Survivors
20.
BMJ Open ; 11(2): e046556, 2021 02 17.
Article in English | MEDLINE | ID: covidwho-1088263

ABSTRACT

OBJECTIVES: The objective of this study was to describe variations in COVID-19 outcomes in relation to local risks within a well-defined but diverse single-city area. DESIGN: Observational study of COVID-19 outcomes using quality-assured integrated data from a single UK hospital contextualised to its feeder population and associated factors (comorbidities, ethnicity, age, deprivation). SETTING/PARTICIPANTS: Single-city hospital with a feeder population of 228 632 adults in Wolverhampton. MAIN OUTCOME MEASURES: Hospital admissions (defined as COVID-19 admissions (CA) or non-COVID-19 admissions (NCA)) and mortality (defined as COVID-19 deaths or non-COVID-19 deaths). RESULTS: Of the 5558 patients admitted, 686 died (556 in hospital); 930 were CA, of which 270 were hospital COVID-19 deaths, 47 non-COVID-19 deaths and 36 deaths after discharge; of the 4628 NCA, there were 239 in-hospital deaths (2 COVID-19) and 94 deaths after discharge. Of the 223 074 adults not admitted, 407 died. Age, gender, multimorbidity and black ethnicity (OR 2.1 (95% CI 1.5 to 3.2), p<0.001, compared with white ethnicity, absolute excess risk of <1/1000) were associated with CA and mortality. The South Asian cohort had lower CA and NCA, lower mortality compared with the white group (CA, 0.5 (0.3 to 0.8), p<0.01; NCA, 0.4 (0.3 to 0.6), p<0.001) and community deaths (0.5 (0.3 to 0.7), p<0.001). Despite many common risk factors for CA and NCA, ethnic groups had different admission rates and within-group differing association of risk factors. Deprivation impacted only the white ethnicity, in the oldest age bracket and in a lesser (not most) deprived quintile. CONCLUSIONS: Wolverhampton's results, reflecting high ethnic diversity and deprivation, are similar to other studies of black ethnicity, age and comorbidity risk in COVID-19 but strikingly different in South Asians and for deprivation. Sequentially considering population and then hospital-based NCA and CA outcomes, we present a complete single health economy picture. Risk factors may differ within ethnic groups; our data may be more representative of communities with high Black, Asian and minority ethnic populations, highlighting the need for locally focused public health strategies. We emphasise the need for a more comprehensible and nuanced conveyance of risk.


Subject(s)
/mortality , Ethnic Groups , Hospitalization , Pandemics , Adult , Aftercare , Aged , Aged, 80 and over , Hospitals , Humans , Male , Middle Aged , Patient Discharge , United Kingdom/epidemiology
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