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1.
Int J Cancer ; 151(3): 381-395, 2022 Aug 01.
Article in English | MEDLINE | ID: covidwho-1787663

ABSTRACT

The severity of the COVID-19 pandemic and subsequent mitigation strategies have varied across the Nordic countries. In a joint Nordic population-based effort, we compared patterns of new cancer cases and notifications between the Nordic countries during 2020. We used pathology notifications to cancer registries in Denmark, the Faroe Islands, Finland, Iceland, Norway and Sweden to determine monthly numbers of pathology notifications of malignant and in situ tumours from January to December 2020 compared to 2019 (2017-2019 for Iceland and the Faroe Islands). We compared new cancer cases per month based on unique individuals with pathology notifications. In April and May 2020, the numbers of new malignant cases declined in all Nordic countries, except the Faroe Islands, compared to previous year(s). The largest reduction was observed in Sweden (May: -31.2%, 95% CI -33.9, -28.3), followed by significant declines in Finland, Denmark and Norway, and a nonsignificant decline in Iceland. In Denmark, Norway, Sweden and Finland the reporting rates during the second half of 2020 rose to almost the same level as in 2019. However, in Sweden and Finland, the increase did not compensate for the spring decline (annual reduction -6.2% and -3.6%, respectively). Overall, similar patterns were observed for in situ tumours. The COVID-19 pandemic led to a decline in rates of new cancer cases in Sweden, Finland, Denmark and Norway, with the most pronounced reduction in Sweden. Possible explanations include the severity of the pandemic, temporary halting of screening activities and changes in healthcare seeking behaviour.


Subject(s)
COVID-19 , Neoplasms , COVID-19/epidemiology , Denmark/epidemiology , Finland/epidemiology , Humans , Iceland/epidemiology , Neoplasms/diagnosis , Neoplasms/epidemiology , Norway , Pandemics , Scandinavian and Nordic Countries/epidemiology , Sweden/epidemiology
2.
Laeknabladid ; 108(4): 182-188, 2022 Apr.
Article in Icelandic | MEDLINE | ID: covidwho-1766223

ABSTRACT

INTRODUCTON: Nonpharmaceutical interventions to contain the spread of COVID-19 infections in Iceland in 2020 were successful, but the effects of these measures on incidence and diagnosis of other diseases is unknown. The aim of this study was to evaluate the impact of the COVID-19 pandemic on the diagnosis of myocardial infarction (MI) and selected infections with different transmission routes. MATERIALS AND METHODS: Health records of individuals 18 years or older who were admitted to Landspitali University Hospital (LUH) in 2016-2020 with pneumonia or MI were extracted from the hospital registry. We acquired data from the clinical laboratories regarding diagnostic testing for Chlamydia trachomatis, influenza, HIV and blood cultures positive for Enterobacterales species. Standardized incidence ratio (SIR) for 2020 was calculated with 95% confidence intervals (95%CI) and compared to 2016-2019. RESULTS: Discharge diagnoses due to pneumonia decreased by 31% in 2020, excluding COVID-19 pneumonia (SIR 0.69 (95%CI 0.64-0.75)). Discharge diagnoses of MI decreased by 18% (SIR 0.82 (95%CI 0.75-0.90)), and emergency cardiac catheterizations due to acute coronary syndrome by 23% (SIR 0.77 (95%CI 0.71-0.83)), while there was a 15% increase in blood stream infections for Enterobacterales species (SIR 1.15 (95%CI 1.04-1.28)). Testing for Chlamydia trachomatis decreased by 14.8% and positive tests decreased by 16.3%. Tests for HIV were reduced by 10.9%, while samples positive for influenza decreased by 23.6% despite doubling of tests being performed. CONCLUSION: The number of pneumonia cases of other causes than COVID-19 requiring admission dropped by a quarter in 2020. MI, chlamydia and influensa diagnoses decreased notably. These results likely reflect a true decrease, probably due to altered behaviour during the pandemic.


Subject(s)
COVID-19 , Myocardial Infarction , COVID-19/diagnosis , COVID-19/epidemiology , Humans , Iceland/epidemiology , Incidence , Myocardial Infarction/diagnosis , Myocardial Infarction/epidemiology , Pandemics/prevention & control
3.
Clin Microbiol Infect ; 28(6): 852-858, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1693760

ABSTRACT

OBJECTIVES: The spread of SARS-CoV-2 is dependent on several factors, both biological and behavioural. The effectiveness of nonpharmaceutical interventions can be attributed largely to changes in human behaviour, but quantifying this effect remains challenging. Reconstructing the transmission tree of the third wave of SARS-CoV-2 infections in Iceland using contact tracing and viral sequence data from 2522 cases enables us to directly compare the infectiousness of distinct groups of persons. METHODS: The transmission tree enables us to model the effect that a given population prevalence of vaccination would have had on the third wave had one of three different vaccination strategies been implemented before that time. This allows us to compare the effectiveness of the strategies in terms of minimizing the number of cases, deaths, critical cases, and severe cases. RESULTS: We found that people diagnosed outside of quarantine (Rˆ=1.31) were 89% more infectious than those diagnosed while in quarantine (Rˆ=0.70) and that infectiousness decreased as a function of time spent in quarantine before diagnosis, with people diagnosed outside of quarantine being 144% more infectious than those diagnosed after ≥3 days in quarantine (Rˆ=0.54). People of working age, 16 to 66 years (Rˆ=1.08), were 46% more infectious than those outside of that age range (Rˆ=0.74). DISCUSSION: We found that vaccinating the population in order of ascending age or uniformly at random would have prevented more infections per vaccination than vaccinating in order of descending age, without significantly affecting the expected number of deaths, critical cases, or severe cases.


Subject(s)
COVID-19 , Adolescent , Adult , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Disease Outbreaks/prevention & control , Humans , Iceland/epidemiology , Middle Aged , Models, Theoretical , SARS-CoV-2 , Vaccination , Young Adult
4.
Eur J Public Health ; 32(2): 316-321, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1604433

ABSTRACT

BACKGROUND: COVID-19 became a global pandemic within weeks, as every country including small states and islands experienced a surge in cases. Small islands are known to face several challenges in the quest to curb the viral spread, but with the absence of land boarders and small population size, these factors should have played to their advantage to minimize the spread. The aim of this article was to compare and contrast the COVID-19 situation, restrictions, preparedness, management and the healthcare systems between the small population island states of Cyprus, Iceland and Malta. METHODS: Data were obtained from Ministry of Health websites and COVID dashboards of the three respective Island states in Europe. Comparisons were made between the reported cases, deaths, excess deaths, years of life lost, swabbing rates, restrictive measures, vaccination roll-out and healthcare system structures. RESULTS: Cyprus and Malta contained the COVID-19 spread better than Iceland during the first wave. However, a significantly higher viral spread and mortality rates were observed in Malta during the second waves. Similar healthcare preparedness and services, restrictions and relaxation measures were implemented across the three islands with some exceptions. Covid-19 vaccination has initiated across all Islands with Malta leading the vaccination roll-out. CONCLUSION: The small population size and island status proved to be an asset during the first wave of COVID-19, but different governance approaches led to a different COVID-19 outcomes, including high mortality rates during the transition phases and the subsequent waves.


Subject(s)
COVID-19 , COVID-19/epidemiology , COVID-19 Vaccines , Cyprus , Humans , Iceland/epidemiology , Malta/epidemiology
5.
PLoS One ; 16(12): e0261346, 2021.
Article in English | MEDLINE | ID: covidwho-1571993

ABSTRACT

OBJECTIVE: COVID-19 has affected people's health in various ways. University students are a particularly sensitive group for mental and physical health issues. The aim of this study was to assess and compare the mental and physical health of male and female first-year university students during and before COVID-19. METHOD: Total of 115 first-year university students (54% male) answered questions about mental and physical health. The students were asked to estimate their physical activity, sedentary behavior, loneliness, stress, and sleep quality during COVID-19 opposed to before the pandemic. RESULT: Males had fewer symptoms of anxiety and depression, and their self-esteem was higher than females (p<0.05). Over 50% of both genders estimated their mental health to be worse than before COVID-19. Larger proportion of males (69%) compared to females (38%) estimated that their physical health had worsened than before the pandemic. Larger proportion of females (38%) than males (14%) experience increased loneliness and stress (68% vs. 48%). Over 70% of both genders estimated increased sedentary behavior than before the pandemic, and larger proportion of males (76%), compared to females (56%), estimated that they were less physically active than before COVID-19. About 50% of participants estimated their sleep quality was worse than before COVID-19. CONCLUSION: University students estimated their mental and physical health to have deteriorated during the pandemic. Therefore, it is important that the school and healthcare systems assist students in unwinding these negative health and lifestyle changes that have accompanied the pandemic.


Subject(s)
Anxiety/epidemiology , COVID-19/epidemiology , Loneliness/psychology , Students/psychology , Adult , COVID-19/psychology , Female , Humans , Iceland/epidemiology , Male , Mental Health , Pandemics , Sedentary Behavior , Sex Characteristics , Young Adult
6.
Blood Cancer J ; 11(12): 191, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1545601

ABSTRACT

Multiple myeloma (MM) patients have increased risk of severe coronavirus disease 2019 (COVID-19) when infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Monoclonal gammopathy of undetermined significance (MGUS), the precursor of MM has been associated with immune dysfunction which may lead to severe COVID-19. No systematic data have been published on COVID-19 in individuals with MGUS. We conducted a large population-based cohort study evaluating the risk of SARS-CoV-2 infection and severe COVID-19 among individuals with MGUS. We included 75,422 Icelanders born before 1976, who had been screened for MGUS in the Iceland Screens Treats or Prevents Multiple Myeloma study (iStopMM). Data on SARS-CoV-2 testing and COVID-19 severity were acquired from the Icelandic COVID-19 Study Group. Using a test-negative study design, we included 32,047 iStopMM participants who had been tested for SARS-CoV-2, of whom 1754 had MGUS. Among these participants, 1100 participants, tested positive, 65 of whom had MGUS. Severe COVID-19 developed in 230 participants, including 16 with MGUS. MGUS was not associated with SARS-CoV-2 infection (Odds ratio (OR): 1.05; 95% confidence interval (CI): 0.81-1.36; p = 0.72) or severe COVID-19 (OR: 0.99; 95%CI: 0.52-1.91; p = 0.99). These findings indicate that MGUS does not affect the susceptibility to SARS-CoV-2 or the severity of COVID-19.


Subject(s)
COVID-19/epidemiology , Monoclonal Gammopathy of Undetermined Significance/epidemiology , Adult , Aged , Cohort Studies , Female , Humans , Iceland/epidemiology , Male , Middle Aged , Risk Factors , SARS-CoV-2
9.
Nat Commun ; 12(1): 3633, 2021 06 15.
Article in English | MEDLINE | ID: covidwho-1387349

ABSTRACT

A pressing concern in the SARS-CoV-2 epidemic and other viral outbreaks, is the extent to which the containment measures are halting the viral spread. A straightforward way to assess this is to tally the active cases and the recovered ones throughout the epidemic. Here, we show how epidemic control can be assessed with molecular information during a well characterized epidemic in Iceland. We demonstrate how the viral concentration decreased in those newly diagnosed as the epidemic transitioned from exponential growth phase to containment phase. The viral concentration in the cases identified in population screening decreased faster than in those symptomatic and considered at high risk and that were targeted by the healthcare system. The viral concentration persists in recovering individuals as we found that half of the cases are still positive after two weeks. We demonstrate that accumulation of mutations in SARS-CoV-2 genome can be exploited to track the rate of new viral generations throughout the different phases of the epidemic, where the accumulation of mutations decreases as the transmission rate decreases in the containment phase. Overall, the molecular signatures of SARS-CoV-2 infections contain valuable epidemiological information that can be used to assess the effectiveness of containment measures.


Subject(s)
Benchmarking/methods , COVID-19/epidemiology , Epidemics , SARS-CoV-2/genetics , Animals , COVID-19/virology , Humans , Iceland/epidemiology , Molecular Epidemiology , Mutation , RNA, Viral
10.
Proc Natl Acad Sci U S A ; 118(6)2021 02 09.
Article in English | MEDLINE | ID: covidwho-1371647

ABSTRACT

Epidemic preparedness depends on our ability to predict the trajectory of an epidemic and the human behavior that drives spread in the event of an outbreak. Changes to behavior during an outbreak limit the reliability of syndromic surveillance using large-scale data sources, such as online social media or search behavior, which could otherwise supplement healthcare-based outbreak-prediction methods. Here, we measure behavior change reflected in mobile-phone call-detail records (CDRs), a source of passively collected real-time behavioral information, using an anonymously linked dataset of cell-phone users and their date of influenza-like illness diagnosis during the 2009 H1N1v pandemic. We demonstrate that mobile-phone use during illness differs measurably from routine behavior: Diagnosed individuals exhibit less movement than normal (1.1 to 1.4 fewer unique tower locations; [Formula: see text]), on average, in the 2 to 4 d around diagnosis and place fewer calls (2.3 to 3.3 fewer calls; [Formula: see text]) while spending longer on the phone (41- to 66-s average increase; [Formula: see text]) than usual on the day following diagnosis. The results suggest that anonymously linked CDRs and health data may be sufficiently granular to augment epidemic surveillance efforts and that infectious disease-modeling efforts lacking explicit behavior-change mechanisms need to be revisited.


Subject(s)
Behavior , Cell Phone , Communicable Diseases/epidemiology , Cell Phone Use , Communicable Diseases/diagnosis , Geography , Humans , Iceland/epidemiology , Information Dissemination , Movement , Privacy
11.
Euro Surveill ; 26(29)2021 07.
Article in English | MEDLINE | ID: covidwho-1350236

ABSTRACT

Since the introduction of non-pharmacological interventions to control COVID-19, respiratory syncytial virus (RSV) activity in Europe has been limited. Surveillance data for 17 countries showed delayed RSV epidemics in France (≥ 12 w) and Iceland (≥ 4 w) during the 2020/21 season. RSV cases (predominantly small children) in France and Iceland were older compared with previous seasons. We hypothesise that future RSV epidemic(s) could start outside the usual autumn/winter season and be larger than expected. Year-round surveillance of RSV is of critical importance.


Subject(s)
COVID-19 , Respiratory Syncytial Virus Infections , Respiratory Syncytial Virus, Human , Child , Europe/epidemiology , France/epidemiology , Humans , Iceland/epidemiology , Infant , Respiratory Syncytial Virus Infections/epidemiology , Respiratory Syncytial Virus Infections/prevention & control , SARS-CoV-2 , Seasons
12.
BMJ Open ; 11(7): e049967, 2021 07 23.
Article in English | MEDLINE | ID: covidwho-1322824

ABSTRACT

OBJECTIVE: To test if patients recovering from COVID-19 are at increased risk of mental morbidities and to what extent such risk is exacerbated by illness severity. DESIGN: Population-based cross-sectional study. SETTING: Iceland. PARTICIPANTS: A total of 22 861 individuals were recruited through invitations to existing nationwide cohorts and a social media campaign from 24 April to 22 July 2020, of which 373 were patients recovering from COVID-19. MAIN OUTCOME MEASURES: Symptoms of depression (Patient Health Questionnaire), anxiety (General Anxiety Disorder Scale) and posttraumatic stress disorder (PTSD; modified Primary Care PTSD Screen for DSM-5) above screening thresholds. Adjusting for multiple covariates and comorbidities, multivariable Poisson regression was used to assess the association between COVID-19 severity and mental morbidities. RESULTS: Compared with individuals without a diagnosis of COVID-19, patients recovering from COVID-19 had increased risk of depression (22.1% vs 16.2%; adjusted relative risk (aRR) 1.48, 95% CI 1.20 to 1.82) and PTSD (19.5% vs 15.6%; aRR 1.38, 95% CI 1.09 to 1.75) but not anxiety (13.1% vs 11.3%; aRR 1.24, 95% CI 0.93 to 1.64). Elevated relative risks were limited to patients recovering from COVID-19 that were 40 years or older and were particularly high among individuals with university education. Among patients recovering from COVID-19, symptoms of depression were particularly common among those in the highest, compared with the lowest tertile of influenza-like symptom burden (47.1% vs 5.8%; aRR 6.42, 95% CI 2.77 to 14.87), among patients confined to bed for 7 days or longer compared with those never confined to bed (33.3% vs 10.9%; aRR 3.67, 95% CI 1.97 to 6.86) and among patients hospitalised for COVID-19 compared with those never admitted to hospital (48.1% vs 19.9%; aRR 2.72, 95% CI 1.67 to 4.44). CONCLUSIONS: Severe disease course is associated with increased risk of depression and PTSD among patients recovering from COVID-19.


Subject(s)
COVID-19 , Anxiety/epidemiology , Cross-Sectional Studies , Depression/epidemiology , Humans , Iceland/epidemiology , Morbidity , SARS-CoV-2
14.
Lancet Psychiatry ; 8(8): 663-672, 2021 08.
Article in English | MEDLINE | ID: covidwho-1253795

ABSTRACT

BACKGROUND: Adolescence represents a crucial developmental period in shaping mental health trajectories. In this study, we investigated the effect of the COVID-19 pandemic on mental health and substance use during this sensitive developmental stage. METHODS: In this longitudinal, population-based study, surveys were administered to a nationwide sample of 13-18-year-olds in Iceland in October or February in 2016 and 2018, and in October, 2020 (during the COVID-19 pandemic). The surveys assessed depressive symptoms with the Symptom Checklist-90, mental wellbeing with the Short Warwick Edinburgh Mental Wellbeing Scale, and the frequency of cigarette smoking, e-cigarette use, and alcohol intoxication. Demographic data were collected, which included language spoken at home although not ethnicity data. We used mixed effects models to study the effect of gender, age, and survey year on trends in mental health outcomes. FINDINGS: 59 701 survey responses were included; response rates ranged from 63% to 86%. An increase in depressive symptoms (ß 0·57, 95% CI 0·53 to 0·60) and worsened mental wellbeing (ß -0·46, 95% CI -0·49 to -0·42) were observed across all age groups during the pandemic compared with same-aged peers before COVID-19. These outcomes were significantly worse in adolescent girls compared with boys (ß 4·16, 95% CI 4·05 to 4·28, and ß -1·13, 95% CI -1·23 to -1·03, respectively). Cigarette smoking (OR 2·61, 95% CI 2·59 to 2·66), e-cigarette use (OR 2·61, 95% CI 2·59 to 2·64), and alcohol intoxication (OR 2·59, 95% CI 2·56 to 2·64) declined among 15-18-year-olds during COVID-19, with no similar gender differences. INTERPRETATION: Our results suggest that COVID-19 has significantly impaired adolescent mental health. However, the decrease observed in substance use during the pandemic might be an unintended benefit of isolation, and might serve as a protective factor against future substance use disorders and dependence. Population-level prevention efforts, especially for girls, are warranted. FUNDING: Icelandic Research Fund. TRANSLATION: For the Icelandic translation of the abstract see Supplementary Materials section.


Subject(s)
COVID-19/psychology , Depression/epidemiology , Mental Health , Substance-Related Disorders/epidemiology , Adolescent , Age Factors , Brief Psychiatric Rating Scale , Electronic Nicotine Delivery Systems/statistics & numerical data , Female , Humans , Iceland/epidemiology , Longitudinal Studies , Male , Sex Factors , Surveys and Questionnaires
15.
Risk Anal ; 41(12): 2266-2285, 2021 12.
Article in English | MEDLINE | ID: covidwho-1197180

ABSTRACT

Human civilization is vulnerable to global catastrophic biological threats and existential threats. Policy to mitigate the impact of major biological threats should consider worst-case scenarios. We aimed to strengthen existing research on island refuges as a mitigating mechanism against such threats by considering five additional factors as well as recent literature on catastrophic risks and resilience. We also analyzed the performance of potential refuge islands during early phases the COVID-19 pandemic. Using a composite indicator (scored from 0-1) based on 14 global macroindices, we present analysis supporting Australia (0.71), New Zealand (0.64), and Iceland (0.58) as the leading candidate island nation refuges to safeguard the survival of humanity and a flourishing technological civilization from the threat of a catastrophic pandemic. Data from the COVID-19 pandemic supports this finding where islands have performed relatively well. We discuss the persisting weaknesses of even the best candidate refuges and the growing literature describing what preparations such a refuge should ensure to enhance resilience. Refuge preparations by Australia and New Zealand, in particular, may additionally provide some immunity against winter-inducing catastrophes such as global nuclear war. Existing disaster resilience frameworks such as the Sendai framework could be worded to mandate preventive measures against global catastrophic and existential threats. The issue of island refuges against certain global catastrophic risks should be raised at relevant international political summits.


Subject(s)
COVID-19/epidemiology , Disaster Planning , Health Priorities , Refugees , Australia/epidemiology , COVID-19/virology , Humans , Iceland/epidemiology , New Zealand/epidemiology , SARS-CoV-2/isolation & purification
16.
PLoS One ; 16(3): e0248176, 2021.
Article in English | MEDLINE | ID: covidwho-1119476

ABSTRACT

Testing and case identification are key strategies in controlling the COVID-19 pandemic. Contact tracing and isolation are only possible if cases have been identified. The effectiveness of testing should be assessed, but a single comprehensive metric is not available to assess testing effectiveness, and no timely estimates of case detection rate are available globally, making inter-country comparisons difficult. The purpose of this paper was to propose a single, comprehensive metric, called the COVID-19 Testing Index (CovTI) scaled from 0 to 100, derived from epidemiological indicators of testing, and to identify factors associated with this outcome. The index was based on case-fatality rate, test positivity rate, active cases, and an estimate of the detection rate. It used parsimonious modeling to estimate the true total number of COVID-19 cases based on deaths, testing, health system capacity, and government transparency. Publicly reported data from 165 countries and territories that had reported at least 100 confirmed cases by June 3, 2020 were included in the index. Estimates of detection rates aligned satisfactorily with previous estimates in literature (R2 = 0.44). As of June 3, 2020, the states with the highest CovTI included Hong Kong (93.7), Australia (93.5), Iceland (91.8), Cambodia (91.3), New Zealand (90.6), Vietnam (90.2), and Taiwan (89.9). Bivariate analyses showed the mean CovTI in countries with open public testing policies (66.9, 95% CI 61.0-72.8) was significantly higher than in countries with no testing policy (29.7, 95% CI 17.6-41.9) (p<0.0001). A multiple linear regression model assessed the association of independent grouping variables with CovTI. Open public testing and extensive contact tracing were shown to significantly increase CovTI, after adjusting for extrinsic factors, including geographic isolation and centralized forms of government. The correlation of testing and contact tracing policies with improved outcomes demonstrates the validity of this model to assess testing effectiveness and also suggests these policies were effective at improving health outcomes. This tool can be combined with other databases to identify other factors or may be useful as a standalone tool to help inform policymakers.


Subject(s)
COVID-19 Testing , COVID-19/diagnosis , COVID-19/epidemiology , Australia/epidemiology , COVID-19 Testing/methods , Cambodia/epidemiology , Contact Tracing , Health Policy , Hong Kong/epidemiology , Humans , Iceland/epidemiology , Linear Models , New Zealand/epidemiology , SARS-CoV-2/isolation & purification , Taiwan/epidemiology , Vietnam/epidemiology
18.
BMJ ; 371: m4529, 2020 12 02.
Article in English | MEDLINE | ID: covidwho-955486

ABSTRACT

OBJECTIVE: To characterise the symptoms of coronavirus disease 2019 (covid-19). DESIGN: Population based cohort study. SETTING: Iceland. PARTICIPANTS: All individuals who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription polymerase chain reaction (RT-PCR) between 17 March and 30 April 2020. Cases were identified by three testing strategies: targeted testing guided by clinical suspicion, open invitation population screening based on self referral, and random population screening. All identified cases were enrolled in a telehealth monitoring service, and symptoms were systematically monitored from diagnosis to recovery. MAIN OUTCOME MEASURES: Occurrence of one or more of 19 predefined symptoms during follow-up. RESULTS: Among 1564 people positive for SARS-CoV-2, the most common presenting symptoms were myalgia (55%), headache (51%), and non-productive cough (49%). At the time of diagnosis, 83 (5.3%) individuals reported no symptoms, of whom 49 (59%) remained asymptomatic during follow-up. At diagnosis, 216 (14%) and 349 (22%) people did not meet the case definition of the Centers for Disease Control and Prevention and the World Health Organization, respectively. Most (67%) of the SARS-CoV-2-positive patients had mild symptoms throughout the course of their disease. CONCLUSION: In the setting of broad access to RT-PCR testing, most SARS-CoV-2-positive people were found to have mild symptoms. Fever and dyspnoea were less common than previously reported. A substantial proportion of SARS-CoV-2-positive people did not meet recommended case definitions at the time of diagnosis.


Subject(s)
COVID-19/epidemiology , Adolescent , Adult , Aged , COVID-19/diagnosis , Child , Child, Preschool , Cohort Studies , Disease Progression , Female , Humans , Iceland/epidemiology , Infant , Infant, Newborn , Male , Middle Aged , Pandemics , Prospective Studies , Symptom Assessment , Young Adult
19.
Laeknabladid ; 106(12): 574-579, 2020 Dec.
Article in Icelandic | MEDLINE | ID: covidwho-948771

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has caused public health and economic turmoil across the globe. Severe COVID-19 disease most often presents with pneumonia and complications in acutely ill patients often stem from the lungs. The associations of lung disease, smoking and e-cigarette use with the incidence and severity of COVID-19 are unclear on a population level. METHODS: Data on 1761 patients from the Icelandic outpatient Landspitali COVID-19 Clinic were used. The prevalence of smoking, e-cigarette use and underlying lung diseases was calculated in the cohort, with stratification based on age groups and a clinical classification of symptom severity. It was tested whether these prevalences differed between age groups and classes of symptom severity. RESULTS: Most patients were in the age group between 35-54 years of age and a large majority had mild symptoms at diagnosis. The prevalence of smoking was 6% with the highest prevalence among 35-54 year olds. The prevalence of e-cigarette use was 4%. It was most prevalent in the age group between 18-34 years. There was no difference in the prevalence of smoking or e-cigarette use between classes of symptom severity. The prevalence of lung disease was 9%. It was higher among older patients and patients with more severe symptoms. CONCLUSION: The age distribution and prevalence of lung disease and their risk factors are described in the context of COVID-19 incidence and symptom severity in a whole-nation cohort of Icelanders. The cohort is younger and had less severe symptoms than in many previosly published studies of COVID-19. Interestingly, the prevalences of smoking and e-cigarette use were lower than in the Icelandic general population and they were not associated with symptom severity at diagnosis. To conclude, the results presented here indicate that underlying lung diseases are prevalent among people with severe COVID-19 symptoms but fail to demonstrate an association between cigarette smoking or e-cigarette smoking with COVID-19 severity.


Subject(s)
COVID-19/epidemiology , Cigarette Smoking/adverse effects , Lung Diseases/epidemiology , Vaping/adverse effects , Adult , Age Distribution , Age Factors , COVID-19/diagnosis , Cigarette Smoking/epidemiology , Female , Humans , Iceland/epidemiology , Lung Diseases/diagnosis , Male , Middle Aged , Prevalence , Risk Assessment , Risk Factors , Severity of Illness Index , Vaping/epidemiology
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