Estimating the risk reduction of isolation on COVID-19 nonhousehold transmission and severe/critical illness in nonimmune individuals: September to November 2021.

There is growing scientific interest in immunity mandates/passports (IMP) for viral diseases in light of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. IMP isolate those who remain nonimmune from various settings to reduce nonhousehold transmissions from the nonimmune and reduce severe/critical illness among the nonimmune. A major limitation in the scientific literature is that there are currently no methods to quantify how many nonimmune individuals need to be isolated to achieve these purported benefits. This paper develops a procedure for estimating the benefits of IMP using a novel variant of the number needed to treat which we call the number needed to isolate (NNI). We use data from the SARS-CoV-2 pandemic to demonstrate the properties and utility of the NNI and to inform the debate about IMP. We focus on data from the European Union, United Kingdom, United States, Canada, Australia, and Israel during the fall 2021 when the Delta (B.1.617.2) variant predominated.

Risk reduction of hospitalisation and severe disease in vaccinated COVID-19 cases during the SARS-CoV-2 variant Omicron BA.1-predominant period, Navarre, Spain, January to March 2022.

BackgroundAs COVID-19 vaccine effectiveness against SARS-CoV-2 infection was lower for cases of the Omicron vs the Delta variant, understanding the effect of vaccination in reducing risk of hospitalisation and severe disease among COVID-19 cases is crucial.AimTo evaluate risk reduction of hospitalisation and severe disease in vaccinated COVID-19 cases during the Omicron BA.1-predominant period in Navarre, Spain.MethodsA case-to-case comparison included COVID-19 epidemiological surveillance data in adults ≥ 18 years from 3 January-20 March 2022. COVID-19 vaccination status was compared between hospitalised and non-hospitalised cases, and between severe (intensive care unit admission or death) and non-severe cases using logistic regression models.ResultsAmong 58,952 COVID-19 cases, 565 (1.0%) were hospitalised and 156 (0.3%) were severe. The risk of hospitalisation was reduced within the first 6 months after full COVID-19 vaccination (complete primary series) (adjusted odds ratio (aOR): 0.06; 95% CI: 0.04-0.09) and after 6 months (aOR: 0.16; 95% CI: 0.12-0.21; pcomparison < 0.001), as well as after a booster dose (aOR: 0.06: 95% CI: 0.04-0.07). Similarly, the risk of severe disease was reduced (aOR: 0.13, 0.18, and 0.06, respectively). Compared with cases fully vaccinated 6 months or more before a positive test, those who had received a booster dose had lower risk of hospitalisation (aOR: 0.38; 95% CI: 0.28-0.52) and severe disease (aOR: 0.38; 95% CI: 0.21-0.68).ConclusionsFull COVID-19 vaccination greatly reduced the risk of hospitalisation and severe outcomes in COVID-19 cases with the Omicron variant, and a booster dose improved this effect in people aged over 65 years.

Targeted reduction of airborne viral transmission risk in long-term residential aged care.

COVID-19 has demonstrated the devastating consequences of the rapid spread of an airborne virus in residential aged care. We report the use of CO2-based ventilation assessment to empirically identify potential 'super-spreader' zones within an aged care facility, and determine the efficacy of rapidly implemented, inexpensive, risk reduction measures.

Human activity and mobility data reveal disparities in exposure risk reduction indicators among socially vulnerable populations during COVID-19 for five U.S. metropolitan cities.

Non-pharmacologic interventions (NPIs) promote protective actions to lessen exposure risk to COVID-19 by reducing mobility patterns. However, there is a limited understanding of the underlying mechanisms associated with reducing mobility patterns especially for socially vulnerable populations. The research examines two datasets at a granular scale for five urban locations. Through exploratory analysis of networks, statistics, and spatial clustering, the research extensively investigates the exposure risk reduction after the implementation of NPIs to socially vulnerable populations, specifically lower income and non-white populations. The mobility dataset tracks population movement across ZIP codes for an origin-destination (O-D) network analysis. The population activity dataset uses the visits from census block groups (cbg) to points-of-interest (POIs) for network analysis of population-facilities interactions. The mobility dataset originates from a collaboration with StreetLight Data, a company focusing on transportation analytics, whereas the population activity dataset originates from a collaboration with SafeGraph, a company focusing on POI data. Both datasets indicated that low-income and non-white populations faced higher exposure risk. These findings can assist emergency planners and public health officials in comprehending how different populations are able to implement protective actions and it can inform more equitable and data-driven NPI policies for future epidemics.

Multidomain interventions for risk reduction and prevention of cognitive decline and dementia: current developments.

PURPOSE OF REVIEW: The potential for dementia prevention is deemed substantial if modifiable risk factors were addressed. First large-scale multidomain lifestyle interventions aiming at reducing risk of cognitive decline and dementia have yielded mixed but promising evidence. RECENT FINDINGS: Despite the impact of the COVID-19 pandemic on trials conduction, causing interruptions and delays, the research landscape on multidomain interventions is growing rapidly. The successful Finish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) has led to an adaptation of the FINGER model in trials underway or being planned in over 40 countries. Recent studies identified barriers and facilitators of and adherence to multidomain interventions, showed the suitability of dementia risk scores as surrogate outcomes, and suggested mechanisms. Multidomain interventions are increasingly conducted in the Global South, and study protocols are increasingly testing expanded FINGER models, for example, with pharmacological components, in digital/remote settings and co-designed personalized interventions. SUMMARY: Though results remain mixed, the many ongoing trials will provide more conclusive evidence within the next few years and help to optimize interventions. Continued international collaboration is pivotal to scale and accelerate the development and implementation of effective multidomain interventions as part of larger public health strategies to counteract the global dementia increase.

Treating Insulin Resistance with Intermittent Personalized Nutrition to Sustain Metabolic Health and Functioning Immune System for Risk Reduction of Viral Diseases Especially COVID-19 and Long-COVID.

The Covid-19 pandemic has provided new and strong evidence for poor outcomes of viral infection in patients with poor metabolic health. Insulin resistance is at the root of many metabolic conditions and a key driver of their progression as it promotes ineffectual inflammation whilst impairing immune functions. In a vicious circle, insulin resistance facilitates SARS-CoV-2 infection, whilst infection drives insulin resistance. We discuss the underlying mechanisms and explore ways to improve metabolic health and prevent insulin resistance through early detection and targeted nutritional interventions. With proven efficacy in prediabetes, type 2 diabetes, and their cardiovascular and organ complications, as much as non-alcoholic liver disease, we argue to extend such approaches to ensure resilience to the current pandemic and viral challenges beyond.

Unmasked: an insight into three patients' rare disease experiences during the COVID-19 pandemic.

This article describes my reflections of speaking with three patients and their families living with mastocytosis, who I was introduced to through the UK Mastocytosis Support Group. I discuss the various ways in which the condition affects their day-to-day lives and how this has changed during the Covid-19 pandemic. I have tried to give an insight into the particular difficulties that this patient group faces, both during and before the pandemic, whilst also considering how these challenges may resonate more widely with other patient groups in the rare disease community. Pseudonyms are used throughout to protect patient anonymity.

Depression, anxiety and stress among patients with inflammatory bowel disease during the COVID-19 pandemic: Australian national survey.

BACKGROUND: The global COVID-19 pandemic has impacted on the mental health of individuals, particularly those with chronic illnesses. We aimed to quantify stress, anxiety and depression among individuals with Inflammatory bowel disease (IBD) in Australia during the pandemic. METHODS: An electronic survey was made available to IBD patients Australia-wide from 17 June to 12 July 2020. Respondents with an underlying diagnosis of IBD and over 18 years of age were included. A validated questionnaire (Depression, Anxiety, Stress Score-21, DASS21) was used to assess depression, anxiety and stress. Data on potential predictors of depression, anxiety and stress were collected. RESULTS: 352 participated in the survey across Australia. 60.5% of respondents fulfilled DASS criteria for at least moderate depression, anxiety or stress. 45% reported a pre-existing diagnosis of depression and/or anxiety. Over 2/3 of these respondents reported worsening of their pre-existing depression/anxiety due to the current pandemic. Of those without a pre-existing diagnosis of anxiety or depression, high rates of at least moderate to severe depression (34.9%), anxiety (32.0%) and stress (29.7%) were noted. Younger age (OR 0.96, 95% CI 0.94 to 0.98, p<0.001), lack of access to an IBD nurse (OR 1.81, 95% CI 1.03 to 3.19, p=0.04) and lack of education on reducing infection risk (OR 1.99, 95% CI 1.13 to 3.50, p=0.017) were associated with significant stress, anxiety and/or depression. CONCLUSION: High prevalence of undiagnosed depression, anxiety and stress was identified among respondents. Improved access to IBD nurse support and greater attention to education are modifiable factors that may reduce depression, anxiety and/or stress among patients with IBD during the pandemic.

Influence of Empathy Disposition and Risk Perception on the Psychological Impact of Lockdown During the Coronavirus Disease Pandemic Outbreak.

During the current COVID-19 pandemic, and especially in the absence of availability of an effective treatment or a vaccine, the main health measure is neither chemical nor biological, but behavioral. To reduce the exponential growth of infections due to the new coronavirus (SARS-CoV-2) and the resulting overburdening of the healthcare system, many European Countries, parts of the US and Switzerland gradually implemented measures of quarantine and isolation defined as lockdown. This consideration leads to the need to understand how individuals are motivated to protect themselves and others. Recent research suggested that prosocial mental dispositions, such as empathy, might promote adherence to social norms of distancing. Other research conducted during the COVID-19 outbreak indicates, however, that empathy levels might fluctuate according to anxiety linked to the risk of death, and this negatively predicted prosocial willingness. The present protocol proposes a study on whether people's empathic dispositions, interacting with the levels of risk, influence the psychological impact of lockdown. The rationale is that emphatic dispositions, encouraging the acceptance of the lockdown, determine a better psychological adaptation and less distress. One retrospective study will be developed in Switzerland and, if the pandemic conditions force a new wave of lockdown on the population, one prospective study as well. A total of 120 participants will be involved, distinguished by their level of objective risk: (1) high objective risk (COVID-19 positive patients, hospitalized in isolation in post-acute phase); (2) moderate objective risk (COVID-19 positive patients, isolated at home); (3) minimum objective risk (non-positive adults, in lockdown). Measures of perceived risk of being contagious for third parties, empathic dispositions and acceptance of lockdown will be collected. The expected results provide important answers related to the immediate impact of empathic dispositions, effective risk and risk perception on the psychological impact of lockdown during a pandemic outbreak. Data gathered from this study could inform policy makers and public health managers about the best communication strategies that will take into account the various stages of health risk and, in particular, to modulate messages to the population aimed at inducing self-isolation behaviors.

Dynamic Public Perceptions of the Coronavirus Disease Crisis, the Netherlands, 2020.

A key component of outbreak control is monitoring public perceptions and public response. To determine public perceptions and public responses during the first 3 months of the coronavirus disease (COVID-19) outbreak in the Netherlands, we conducted 6 repeated surveys of ≈3,000 persons. Generalized estimating equations analyses revealed changes over time as well as differences between groups at low and high risk. Overall, respondents perceived the risks associated with COVID-19 to be considerable, were positive about the mitigation measures, trusted the information and the measures from authorities, and adopted protective measures. Substantial increases were observed in risk perceptions and self-reported protective behavior in the first weeks of the outbreak. Individual differences were based mainly on participants' age and health condition. We recommend that authorities constantly adjust their COVID-19 communication and mitigation strategies to fit public perceptions and public responses and that they tailor the information for different groups.

Reasoned therapeutic protocol in outpatients with COVID-19.

BACKGROUND: Seventy percent of patients affected by SARS-COV-2 disease are asymptomatic or with symptoms that not required Hospitalization. A prodromal period lasting about 5 days can be identified. In this phase a patient with a positive swab for viral RNA may or may not evolve towards the phase of symptomatic disease. METHODS: In this paper we reviewed the literature related to COVID-19 therapy we propose a reasoned treatment protocols in outpatients according to the age and the comorbidity. RESULTS: The aim of this study was to reduce the impact of the virus by reducing its ability to attack cells and the inflammatory burden and the prothrombotic effects proposing two therapeutic schemes of proven efficacy according to the age of the patients and the comorbidities. CONCLUSIONS: We aimed to reduce worsening of clinical status and hospitalization while protecting patients at home.

The Role of Nutrition During the COVID-19 Pandemic: What We Know.

BACKGROUND: Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) (COVID-19) infection provokes serious clinical consequences, which in many situations need hospitalization of the patient in Intensive Care Unit. Additionally, SARS-COV-2 infection can indirectly cause deaths in aged individuals as well as in patients with co-morbidities. OBJECTIVE: To evaluate the effects of nutrition during the COVID-19 pandemic in both hospitalized patients and the general population. METHODS: Authors searched Medline (PubMed), Web of Science, EMBASE, Cochrane Library, Google, and Institutional websites for medical subheadings terms and free full text referred to "SARS-CoV-2", COVID-19", "nutrition", "immune system", before 31st July 2020. RESULTS: A total of 20 articles describing different nutritional interventions for patients with SARS-- CoV-2 infection focusing on the general population have been included. Of these, 6 studies are dealing with nutritional interventions for patients with SARS-CoV2 infection. The others are focalized on a potential beneficial effect exerted by a Mediterranean diet (MD), related to the supplementation of micronutrients and vitamins. CONCLUSION: A correct lifestyle, including the consumption of nutrients largely present in MD, may be beneficial for preventing or improving prognosis in the SARS-CoV-2 infection.

Effect of lockdown during COVID-19 on migraine: A longitudinal cohort study.

BACKGROUND: The objective of this study was to assess whether migraine-related outcomes changed during intelligent lockdown when compared with the prior period. METHODS: This was a cohort study evaluating the first month of intelligent lockdown in the Netherlands (12 March to 8 April 2020) compared with one baseline month (13 February to 11 March 2020). We identified 870 migraine patients treated at the Leiden Headache Center with headache e-diaries during the period of interest. Adherence to the e-diary had to be ≥80%, yielding 592 enrolled patients. RESULTS: Intelligent lockdown led to a decrease in monthly migraine days (-0.48; 95% CI: -0.78 to -0.18, p = 0.002) and acute medication days (-0.48; 95% CI: -0.76 to -0.20, p < 0.001), and an increase in general well-being (0.11; 95% CI: 0.06 to 0.17, p < 0.001). No differences in non-migrainous headache days and pain coping were observed. Consistent results were found in a subset that was followed for 4 months. CONCLUSIONS: Our findings imply that intelligent lockdown measures can improve migraine disability despite of the potential negative effects of COVID-19 and lockdown. We hypothesise that this effect is a combined result of working from home, scaling down demanding social lives, and freedom to choose how to organise one's time.

Uncertainty Management and Curve Flattening Behaviors in the Wake of COVID-19's First Wave.

The coronavirus (COVID-19) outbreak poses a substantial threat to public health. Individual efforts to engage in COVID-19 precautionary behaviors are necessary to flatten the pandemic's curve in the waiting period before a vaccine is developed. This study sought to apply the Theory of Motivated Information Management to investigate the relationships among COVID-19 illness uncertainty, information management, and actual precautionary behaviors, both preparatory and preventative. The results of a national opt-in online panel demonstrate that uncertainty discrepancy, anxiety, and information management strategies are key predictors of the adoption of COVID-19 preparation and prevention behaviors. The results further identify diverging associations across age groups with respect to associations between information management and precautionary behaviors. Implications for theory and practice are discussed.

Association of COVID-19 Misinformation with Face Mask Wearing and Social Distancing in a Nationally Representative US Sample.

Wide-spread misinformation about the COVID-19 pandemic has presented challenges for communicating public health recommendations. Should campaigns to promote protective behaviors focus on debunking misinformation or targeting behavior-specific beliefs? To address this question, we examine whether belief in COVID-19 misinformation is directly associated with two behaviors (face mask wearing and social distancing), and whether behavior-specific beliefs can account for this association and better predict behavior, consistent with behavior-change theory. We conducted a nationally representative two-wave survey of U.S. adults from 5/26/20-6/12/20 (n = 1074) and 7/15/20-7/21//20 (n = 889; follow-up response 83%). Scales were developed and validated for COVID-19 related misinformation beliefs, social distancing and face mask wearing, and beliefs about the consequences of both behaviors. Cross-lagged panel linear regression models assessed relationships among the variables. While belief in misinformation was negatively associated with both face mask wearing (B = -.27, SE =.06) and social-distancing behaviors (B = -.46, SE =.08) measured at the same time, misinformation did not predict concurrent or lagged behavior when the behavior-specific beliefs were incorporated in the models. Beliefs about behavioral outcomes accounted for face mask wearing and social distancing, both cross-sectionally (B =.43, SE =.05; B =.63, SE =.09) and lagged over time (B =.20, SE = 04; B =.30, SE =.08). In conclusion, belief in COVID-19-related misinformation is less relevant to protective behaviors, but beliefs about the consequences of these behaviors are important predictors. With regard to misinformation, we recommend health campaigns aimed at promoting protective behaviors emphasize the benefits of these behaviors, rather than debunking unrelated false claims.