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1.
Sci Rep ; 11(1): 24171, 2021 12 17.
Article in English | MEDLINE | ID: covidwho-1593554

ABSTRACT

The transmission of COVID-19 is dependent on social mixing, the basic rate of which varies with sociodemographic, cultural, and geographic factors. Alterations in social mixing and subsequent changes in transmission dynamics eventually affect hospital admissions. We employ these observations to model and predict regional hospital admissions in Sweden during the COVID-19 pandemic. We use an SEIR-model for each region in Sweden in which the social mixing is assumed to depend on mobility data from public transport utilisation and locations for mobile phone usage. The results show that the model could capture the timing of the first and beginning of the second wave of the pandemic 3 weeks in advance without any additional assumptions about seasonality. Further, we show that for two major regions of Sweden, models with public transport data outperform models using mobile phone usage. We conclude that a model based on routinely collected mobility data makes it possible to predict future hospital admissions for COVID-19 3 weeks in advance.


Subject(s)
Algorithms , COVID-19/transmission , Cell Phone/statistics & numerical data , Hospitalization/statistics & numerical data , Models, Theoretical , Patient Admission/statistics & numerical data , COVID-19/epidemiology , COVID-19/virology , Disease Transmission, Infectious/statistics & numerical data , Forecasting/methods , Geography , Hospitalization/trends , Humans , Pandemics/prevention & control , Patient Admission/trends , Retrospective Studies , SARS-CoV-2/physiology , Sweden/epidemiology , Travel/statistics & numerical data
2.
Sci Rep ; 11(1): 23963, 2021 12 14.
Article in English | MEDLINE | ID: covidwho-1585798

ABSTRACT

We demonstrate that finite impulse response (FIR) models can be applied to analyze the time evolution of an epidemic with its impact on deaths and healthcare strain. Using time series data for COVID-19-related cases, ICU admissions and deaths from Sweden, the FIR model gives a consistent epidemiological trajectory for a simple delta filter function. This results in a consistent scaling between the time series if appropriate time delays are applied and allows the reconstruction of cases for times before July 2020, when RT-PCR testing was not widely available. Combined with randomized RT-PCR study results, we utilize this approach to estimate the total number of infections in Sweden, and the corresponding infection-to-fatality ratio (IFR), infection-to-case ratio (ICR), and infection-to-ICU admission ratio (IIAR). Our values for IFR, ICR and IIAR are essentially constant over large parts of 2020 in contrast with claims of healthcare adaptation or mutated virus variants importantly affecting these ratios. We observe a diminished IFR in late summer 2020 as well as a strong decline during 2021, following the launch of a nation-wide vaccination program. The total number of infections during 2020 is estimated to 1.3 million, indicating that Sweden was far from herd immunity.


Subject(s)
COVID-19/epidemiology , Mortality/trends , SARS-CoV-2/isolation & purification , COVID-19/mortality , COVID-19 Nucleic Acid Testing , Finite Element Analysis , Hospitalization/statistics & numerical data , Humans , Intensive Care Units , SARS-CoV-2/genetics , Sweden/epidemiology , Time Factors
3.
PLoS One ; 16(12): e0260453, 2021.
Article in English | MEDLINE | ID: covidwho-1581783

ABSTRACT

A majority of SARS-CoV-2 infections are transmitted from a minority of infected subjects, some of which may be symptomatic or pre-symptomatic. We aimed to quantify potential infectiousness among asymptomatic healthcare workers (HCWs) in relation to prior or later symptomatic disease. We previously (at the onset of the SARS-CoV-2 epidemic) performed a cohort study of SARS-CoV-2 infections among 27,000 healthcare workers (HCWs) at work in the capital region of Sweden. We performed both SARS-CoV-2 RT-PCR and serology. Furthermore, the cohort was comprehensively followed for sick leave, both before and after sampling. In the present report, we used the cohort database to quantify potential infectiousness among HCWs at work. Those who had sick leave either before or after sampling were classified as post-symptomatic or pre-symptomatic, whereas the virus-positive subjects with no sick leave were considered asymptomatic. About 0.2% (19/9449) of HCW at work were potentially infectious and pre-symptomatic (later had disease) and 0.17% (16/9449) were potentially infectious and asymptomatic (never had sick leave either before nor after sampling). Thus, 33% and 28% of all the 57 potentially infectious subjects were pre-symptomatic or asymptomatic, respectively. When a questionnaire was administered to HCWs with past infection, only 10,5% of HCWs had had no indication at all of having had SARS-CoV-2 infection ("truly asymptomatic"). Our findings provide a unique quantification of the different groups of asymptomatic, potentially infectious HCWs.


Subject(s)
Asymptomatic Infections/epidemiology , COVID-19/epidemiology , Health Personnel/statistics & numerical data , Sick Leave/statistics & numerical data , Adult , Cohort Studies , Female , Humans , Male , Middle Aged , Sweden/epidemiology
4.
Front Public Health ; 9: 768624, 2021.
Article in English | MEDLINE | ID: covidwho-1581114

ABSTRACT

The COVID-19 pandemic coincided with a multi-national federally funded research project examining the potential for health and care services in small rural areas to identify and implement innovations in service delivery. The project has a strong focus on electronic health (eHealth) but covers other areas of innovation as well. The project has been designed as an ethnography to prelude a realist evaluation, asking the question under what conditions can local health and care services take responsibility for designing and implementing new service models that meet local needs? The project had already engaged with several health care practitioners and research students based in Canada, Sweden, Australia, and the United States. Our attention is particularly on rural communities with fewer than 5,000 residents and which are relatively isolated from larger service centres. Between March and September 2020, the project team undertook ethnographic and auto-ethnographic research in their own communities to investigate what the service model responses to the pandemic were, and the extent to which local service managers were able to customize their responses to suit the needs of their communities. An initial program theory drawn from the extant literature suggested that "successful" response to the pandemic would depend on a level of local autonomy, "absorptive capacity,*" strong service-community connections, an "anti-fragile†" approach to implementing change, and a realistic recognition of the historical barriers to implementing eHealth and other innovations in these types of rural communities. The field research in 2020 has refined the theory by focusing even more attention on absorptive capacity and community connections, and by suggesting that some level of ignorance of the barriers to innovation may be beneficial. The research also emphasized the role and power of external actors to the community which had not been well-explored in the literature. This paper will summarize both what the field research revealed about the capacity to respond well to the COVID-19 challenge and highlight the gaps in innovative strategies at a managerial level required for rapid response to system stress. *Absorptive Capacity is defined as the ability of an organization (community, clinic, hospital) to adapt to change. Organizations with flexible capacity can incorporate change in a productive fashion, while those with rigid capacity take longer to adapt, and may do so inappropriately. †Antifragility is defined as an entities' ability to gain stability through stress. Biological examples include building muscle through consistent use, and bones becoming stronger through subtle stress. Antifragility has been used as a guiding principle in programme implementation in the past.


Subject(s)
COVID-19 , Pandemics , Anthropology, Cultural , Australia/epidemiology , Canada/epidemiology , Humans , Pandemics/prevention & control , Rural Health , SARS-CoV-2 , Sweden , United States/epidemiology
5.
BMC Public Health ; 21(1): 1914, 2021 10 21.
Article in English | MEDLINE | ID: covidwho-1560103

ABSTRACT

BACKGROUND: Sick-leave due to COVID-19 vary in length and might lead to re-current episodes. The aim was to investigate recurrent sick leave due to COVID-19 during the first wave. METHODS: This is a registry-based cohort study. The study comprises all people with sickness benefit due to COVID-19 in Sweden in March 1-August 31, 2020. Data from the Swedish Social Insurance Agency, the Swedish National Board of Health and Welfare, and Statistics Sweden were merged. RESULTS: Within the follow-up period of 4 months, 11,955 people were subject to sickness benefit due to COVID-19, whereof 242 people (2.0%) took recurrent sick leave due to COVID-19, and of those 136 (56.2%) remained on sick leave at the end of follow-up. People with recurrent sick leave were older, more often women, and more likely to have been on sick leave prior to the COVID-19 pandemic. CONCLUSION: A group of people presented with recurrent sick leave due to COVID-19. For half of them, the second sick leave lasted throughout the follow-up. People with recurrent sick leave differ in several aspects from those with shorter sick leave. To capture long-term sick-leave patterns due to COVID-19, a longer period of follow-up is needed.


Subject(s)
COVID-19 , Pandemics , Cohort Studies , Female , Humans , Registries , SARS-CoV-2 , Sick Leave , Sweden/epidemiology
6.
BMC Res Notes ; 14(1): 429, 2021 Nov 25.
Article in English | MEDLINE | ID: covidwho-1538087

ABSTRACT

OBJECTIVE: During the COVID pandemic, government authorities worldwide have tried to limit the spread of the virus. Sweden's distinctive feature was the use of voluntary public health recommendations. Few studies have evaluated the effectiveness of this strategy. Based on data collected in the spring of 2020, this study explored associations between compliance with recommendations and observed symptoms of contagion in others, using self-report data from university students. RESULTS: Compliance with recommendations ranged between 69.7 and 95.7 percent. Observations of moderate symptoms of contagion in "Someone else I have had contact with" and "Another person" were markedly associated with reported self-quarantine, which is the most restrictive recommendation, complied with by 81.2% of participants. Uncertainty regarding the incidence and severity of contagion in cohabitants was markedly associated with the recommendation to avoid public transportation, a recommendation being followed by 69.7%. It is concluded that students largely followed the voluntary recommendations implemented in Sweden, suggesting that coercive measures were not necessary. Compliance with recommendations were associated with the symptoms students saw in others, and with the perceived risk of contagion in the student's immediate vicinity. It is recommended that voluntary recommendations should stress personal relevance, and that close relatives are at risk.


Subject(s)
COVID-19 , Humans , SARS-CoV-2 , Self Report , Students , Sweden/epidemiology , Universities
7.
BMC Res Notes ; 14(1): 424, 2021 Nov 24.
Article in English | MEDLINE | ID: covidwho-1533276

ABSTRACT

OBJECTIVE: To analyze changes in primary care utilization as a result of the Covid-19 pandemic. Swedish national register data from 2019 to 2020 on utilization of services were used to compare overall utilization levels and across types of contacts and patient groups. A specific objective was to assess the extent to which remote types of patient consultations were able to compensate for any observed fall in on-site visits. Data were stratified by sex and age to investigate any demographic pattern. RESULTS: Findings show significant reductions in overall utilization of services as the pandemic occurred in the first quarter of 2020. On-site visits fell during the first wave of the pandemic and rebounded thereafter. Patients over 65 years of age appear to have reduced utilization to a larger extent compared with younger groups. Simultaneously, remote contacts increased from around 12% before the pandemic to 17% of the total number of consultations. However, the net effect of changes in service utilization suggests an overall reduction of around 12 percent in the number of primary care consultations as a result of the pandemic. No differences between men and women were observed. Further research will continue to monitor changes in primary care utilization as the pandemic continues.


Subject(s)
COVID-19 , Pandemics , Female , Humans , Male , Primary Health Care , SARS-CoV-2 , Sweden/epidemiology
8.
Acta Paediatr ; 110(12): 3329-3330, 2021 12.
Article in English | MEDLINE | ID: covidwho-1532734
10.
Int J Environ Res Public Health ; 18(21)2021 11 04.
Article in English | MEDLINE | ID: covidwho-1502434

ABSTRACT

An estimated 14-20% of people infected with COVID-19 require medical care. The aim of the present study was to evaluate physical function, cognitive function, and daily activities in patients hospitalized due to COVID-19, and to investigate differences depending on age and admission to the intensive care unit (ICU). This prospective descriptive cross-sectional study included a consecutive sample of 211 patients (mean age 65.1 years, 67.3% men) hospitalized due to COVID-19 in Sweden. Data regarding physical function and daily activities were collected in hospital from July 2020 to February 2021. The average length of hospital stay was 33.8 days, and 48.8% of the patients were admitted to the ICU. Physical function (grip- and lower body strength) was reduced in both groups, and significantly more in the older group, ≥65 years old, compared to the younger. Furthermore, the older group also had significantly less ability to perform activities in daily life, and had significantly reduced cognitive function as compared to the younger age group. In patients treated in the ICU, physical impairments as well as the activity level were significantly more pronounced compared to patients not treated in the ICU. Patients hospitalized due to COVID-19 are physically impaired, have mild cognitive impairments, and have difficulties performing daily activities. The findings in this study indicate the need for out-patient follow-up and rehabilitation for patients hospitalized due to COVID-19, especially in older patients and patients treated in the ICU.


Subject(s)
COVID-19 , Aged , Cognition , Cross-Sectional Studies , Female , Humans , Intensive Care Units , Male , Prospective Studies , SARS-CoV-2 , Sweden/epidemiology
11.
Environ Health ; 20(1): 65, 2021 05 27.
Article in English | MEDLINE | ID: covidwho-1496182

ABSTRACT

BACKGROUND: Alzheimer's disease (AD) and other dementias currently represent the fifth most common cause of death in the world, according to the World Health Organization, with a projected future increase as the proportion of the elderly in the population is growing. Air pollution has emerged as a plausible risk factor for AD, but studies estimating dementia cases attributable to exposure to fine particulate matter (PM2.5) air pollution and resulting monetary estimates are lacking. METHODS: We used data on average population-weighted exposure to ambient PM2.5 for the entire population of Sweden above 30 years of age. To estimate the annual number of dementia cases attributable to air pollution in the Swedish population above 60 years of age, we used the latest concentration response functions (CRF) between PM2.5 exposure and dementia incidence, based on ten longitudinal cohort studies, for the population above 60 years of age. To estimate the monetary burden of attributable cases, we calculated total costs related to dementia, including direct and indirect lifetime costs and intangible costs by including quality-adjusted life years (QALYs) lost. Two different monetary valuations of QALYs in Sweden were used to estimate the monetary value of reduced quality-of-life from two different payer perspectives. RESULTS: The annual number of dementia cases attributable to PM2.5 exposure was estimated to be 820, which represents 5% of the annual dementia cases in Sweden. Direct and indirect lifetime average cost per dementia case was estimated to correspond € 213,000. A reduction of PM2.5 by 1 µg/m3 was estimated to yield 101 fewer cases of dementia incidences annually, resulting in an estimated monetary benefit ranging up to 0.01% of the Swedish GDP in 2019. CONCLUSION: This study estimated that 5% of annual dementia cases could be attributed to PM2.5 exposure, and that the resulting monetary burden is substantial. These findings suggest the need to consider airborne toxic pollutants associated with dementia incidence in public health policy decisions.


Subject(s)
Dementia , Environmental Exposure , Environmental Pollutants , Particulate Matter , Aged , Aged, 80 and over , Cost of Illness , Dementia/economics , Dementia/epidemiology , Environmental Exposure/adverse effects , Environmental Exposure/analysis , Environmental Exposure/economics , Environmental Pollutants/adverse effects , Environmental Pollutants/analysis , Environmental Pollutants/economics , Humans , Incidence , Middle Aged , Particulate Matter/adverse effects , Particulate Matter/analysis , Particulate Matter/economics , Quality of Life , Sweden/epidemiology
12.
Int J Equity Health ; 20(1): 215, 2021 09 26.
Article in English | MEDLINE | ID: covidwho-1496181

ABSTRACT

BACKGROUND: Lack of control over life situations is an important social determinant that may negatively affect parental and child health. This study took place in an area of Stockholm, Sweden with high indications of socioeconomic disadvantage, a large part of the population with foreign background, as well as higher levels of poor health than the county average. It investigated staff perceptions of pathways from situations of low control, potentially leading to health inequities, affecting families enrolled in an early childhood home visiting programme during the Covid-19 pandemic. METHODS: Semi-structured interviews were carried out with 23 child health care nurses and parental advisors working in a home visiting programme. The data was analysed using Reflexive Thematic Analysis. RESULTS: The analysis resulted in five pathways on two explanatory levels, affecting parents' health and parenting capacity and children's health and well-being, potentially damaging health and leading to health inequities. The first four pathways related to control at the personal explanatory level: Families facing instability and insecurity; Caring for children in crowded and poor housing conditions; Experiencing restricted access to resources; and Parenting with limited social support. The fifth pathway, Living in a segregated society, covered the collective experience of lack of control on community level. The Covid-19 pandemic was observed to negatively affect all pathways and thus potentially aggravate health inequities for this population. The pandemic has also limited the delivery of home visits to the families which creates further barriers in families' access to resources and increases isolation for parents with already limited social support. CONCLUSIONS: The diversity of pathways connected to health inequities presented in this study highlights the importance of considering this variety of influences when designing interventions for socioeconomically disadvantaged areas. The additional negative consequences of Covid-19 indicate the need for sustainable preventive early childhood interventions for families in such areas. The study also emphasizes the need for further research as well as policy action on possible long-term effects of changing behaviours during the Covid-19 period on child health and health equity. TRIAL REGISTRATION: The study was retrospectively registered (11 August 2016) in the ISRCTN registry ( ISRCTN11832097 ).


Subject(s)
COVID-19 , Family , Health Status Disparities , Pandemics , Poverty Areas , COVID-19/epidemiology , House Calls , Humans , Observation , Qualitative Research , Sweden/epidemiology
13.
Med Anthropol ; 40(8): 815-829, 2021.
Article in English | MEDLINE | ID: covidwho-1483215

ABSTRACT

During the early COVID-19 pandemic, many countries took compulsory measures to combating the virus's spread, while Sweden took a more voluntary approach. This led to polarized reactions in the international media, with some praising it and others proclaiming it disastrous. Using the concept of "moral panic" I examine how actors within the global media environment portrayed Swedes as a deviant population, using persuasive language, exaggeration, and selective reporting, and how an amplification of media attention served to solidify the deviant label. I also argue that Sweden was made deviant partly to justify restrictive measures in other countries.


Subject(s)
COVID-19 , Pandemics , Anthropology, Medical , Humans , SARS-CoV-2 , Sweden
14.
Int J Environ Res Public Health ; 18(20)2021 10 19.
Article in English | MEDLINE | ID: covidwho-1477948

ABSTRACT

Social distancing measures have been a key component in government strategies to mitigate COVID-19 globally. Based on official documents, this study aimed to identify, compare and analyse public social distancing policy measures adopted in Denmark and Sweden regarding the coronavirus from 1 March 2020 until 1 October 2020. A key difference was the greater emphasis on laws and executive orders (sticks) in Denmark, which allowed the country to adopt many stricter policy measures than Sweden, which relied mostly on general guidelines and recommendations (sermons). The main policy adopters in Denmark were the government and the Danish Parliament, whereas the Public Health Agency issued most policies in Sweden, reflecting a difference in political governance and administrative structure in the two countries. During the study period, Sweden had noticeably higher rates of COVID-19 deaths and hospitalizations per 100,000 population than Denmark, yet it is difficult to determine the impact or relative effectiveness of sermons and sticks, particularly with regard to broader and longer-term health, economic and societal effects.


Subject(s)
COVID-19 , Physical Distancing , Denmark/epidemiology , Humans , Public Policy , SARS-CoV-2 , Sweden/epidemiology
15.
PLoS One ; 16(10): e0258778, 2021.
Article in English | MEDLINE | ID: covidwho-1470666

ABSTRACT

A rapid stream of research confirms that the COVID-19 pandemic is a global threat to mental health and psychological well-being. It is therefore important to identify both hazardous and protective individual factors during the pandemic. The current research explored the relationships between self-reported affective responding, perceived personal consequences of the COVID-19 pandemic, and subjective well-being. An online survey (N = 471) conducted in Sweden between June and September, 2020, showed that higher levels of irritability, impulsivity, and the tendency to experience and express anger were generally associated with more severe personal consequences of the pandemic, particularly in areas related to family life, work/study, and finances. While more severe impacts of the pandemic in these areas of life were directly associated with lower subjective well-being, emotion regulation through cognitive reappraisal appeared to moderate the extent to which consequences of the pandemic in other areas of life (i.e., social, free-time and physical activities) translated into decreased well-being. This suggests that cognitive reappraisal may serve to protect against some of the debilitating effects of the COVID-19 pandemic on mental health. Overall, the results indicate that the perceived consequences of the pandemic are multifaceted and that future research should examine these consequences using a multidimensional approach.


Subject(s)
COVID-19 , Emotions , Mental Health , SARS-CoV-2 , Self Report , Adolescent , Adult , Aged , COVID-19/epidemiology , COVID-19/psychology , Female , Humans , Male , Middle Aged , Pandemics , Sweden/epidemiology
16.
PLoS One ; 16(10): e0257891, 2021.
Article in English | MEDLINE | ID: covidwho-1468161

ABSTRACT

BACKGROUND: Previous studies have shown that a high body mass index (BMI) is a risk factor for severe COVID-19. The aim of the present study was to assess whether a high BMI affects the risk of death or prolonged length of stay (LOS) in patients with COVID-19 during intensive care in Sweden. METHODS AND FINDINGS: In this observational, register-based study, we included patients with COVID-19 from the Swedish Intensive Care Registry admitted to intensive care units (ICUs) in Sweden. Outcomes assessed were death during intensive care and ICU LOS ≥14 days. We used logistic regression models to evaluate the association (odds ratio [OR] and 95% confidence interval [CI]) between BMI and the outcomes. Valid weight and height information could be retrieved in 1,649 patients (1,227 (74.4%) males) with COVID-19. We found a significant association between BMI and the risk of the composite outcome death or LOS ≥14 days in survivors (OR per standard deviation [SD] increase 1.30, 95%CI 1.16-1.44, adjusted for sex, age and comorbidities), and this association remained after further adjustment for severity of illness (simplified acute physiology score; SAPS3) at ICU admission (OR 1.30 per SD, 95%CI 1.17-1.45). Individuals with a BMI ≥ 35 kg/m2 had a doubled risk of the composite outcome. A high BMI was also associated with death during intensive care and a prolonged LOS in survivors assessed as separate outcomes. The main limitations were the restriction to the first wave of the pandemic, and the lack of information on socioeconomic status as well as smoking. CONCLUSIONS: In this large cohort of Swedish ICU patients with COVID-19, a high BMI was associated with increasing risk of death and prolonged length of stay in the ICU. Based on our findings, we suggest that individuals with obesity should be more closely monitored when hospitalized for COVID-19.


Subject(s)
COVID-19/diagnosis , Obesity/pathology , Adult , Body Mass Index , COVID-19/complications , COVID-19/virology , Cohort Studies , Critical Care , Female , Humans , Intensive Care Units , Length of Stay , Male , Middle Aged , Obesity/complications , Odds Ratio , Registries , Risk Factors , SARS-CoV-2/isolation & purification , SARS-CoV-2/metabolism , Sweden
17.
PLoS Med ; 18(10): e1003820, 2021 10.
Article in English | MEDLINE | ID: covidwho-1468149

ABSTRACT

BACKGROUND: The relationship between statin treatment and Coronavirus Disease 2019 (COVID-19) mortality has been discussed due to the pleiotropic effects of statins on coagulation and immune mechanisms. However, available observational studies are hampered by study design flaws, resulting in substantial heterogeneity and ambiguities. Here, we aim to determine the relationship between statin treatment and COVID-19 mortality. METHODS AND FINDINGS: This cohort study included all Stockholm residents aged 45 or older (N = 963,876), followed up from 1 March 2020 until 11 November 2020. The exposure was statin treatment initiated before the COVID-19-pandemic, defined as recorded statin dispensation in the Swedish Prescribed Drug Register between 1 March 2019 and 29 February 2020. COVID-19-specific mortality was ascertained from the Swedish Cause of Death Registry. Hazard ratios (HRs) were calculated using multivariable Cox regression models. We further performed a target trial emulation restricted to initiators of statins. In the cohort (51.6% female), 169,642 individuals (17.6%) were statin users. Statin users were older (71.0 versus 58.0 years), more likely to be male (53.3% versus 46.7%), more often diagnosed with comorbidities (for example, ischemic heart disease 23.3% versus 1.6%), more frequently on anticoagulant and antihypertensive treatments, less likely to have a university-level education (34.5% versus 45.4%), and more likely to have a low disposable income (20.6% versus 25.2%), but less likely to reside in crowded housing (6.1% versus 10.3%). A total of 2,545 individuals died from COVID-19 during follow-up, including 765 (0.5%) of the statin users and 1,780 (0.2%) of the nonusers. Statin treatment was associated with a lowered COVID-19 mortality (adjusted HR, 0.88; 95% CI, 0.79 to 0.97, P = 0.01), and this association did not vary appreciably across age groups, sexes, or COVID-19 risk groups. The confounder adjusted HR for statin treatment initiators was 0.78 (95% CI, 0.59 to 1.05, P = 0.10) in the emulated target trial. Limitations of this study include the observational design, reliance on dispensation data, and the inability to study specific drug regimens. CONCLUSIONS: Statin treatment had a modest negative association with COVID-19 mortality. While this finding needs confirmation from randomized clinical trials, it supports the continued use of statin treatment for medical prevention according to current recommendations also during the COVID-19 pandemic.


Subject(s)
COVID-19/mortality , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Aged , Aged, 80 and over , COVID-19/prevention & control , Female , Humans , Male , Middle Aged , Registries , Sweden/epidemiology
18.
Acta Oncol ; 60(11): 1459-1465, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1467204

ABSTRACT

INTRODUCTION: Cancer patients are considered to have a higher risk of dying and developing severe Coronavirus Disease 2019 (COVID-19). To date, there are few studies including co-morbidities and sociodemographic factors when investigating the outcome of COVID-19 in a cohort of cancer patients. In this study, we analyzed cancer patients that have been hospitalized due to COVID-19 during the first wave of the pandemic in Sweden to investigate the impact of COVID-19 on mortality and morbidity. PATIENTS AND METHODS: We retrospectively collected data on all patients with cancer that were hospitalized due to COVID-19-related symptoms at Uppsala University Hospital and Karolinska University Hospital between 1 March and 31 August 2020. The primary endpoint was COVID-19-related death and the secondary endpoint was to describe COVID-19 severity, defined as symptom severity (grades 0-4) and length of stay (LOS) at the university hospitals. RESULTS: In total, 193 patients were included among which 31% died due to COVID-19 and 8% died of other causes. In a multivariable analysis, older age >70 (OR 3.6; 95% CI [1.8-7.3], p < 0.001) and male gender (OR 2.8 [1.4-5.8], p = 0.005) were factors associated with higher likelihood of COVID-19-related death. Several comorbidities ≥2 (OR 5.4 [2.0-14.3], p = 0.001) was independently associated with COVID-19 severity. Treatment with chemotherapy within 90 days prior to COVID-19 diagnosis were not associated with COVID-19-related death or severity. CONCLUSION: Factors associated with higher likelihood of COVID-19-related death were older age and male gender. More severe COVID-19 symptoms were seen in patients with multiple comorbidities. We did not see any associations between COVID-19-related death or severity and recent treatment including chemotherapy. In summary, this supports a thorough assessment regarding potential risks with COVID-19 infection in patients with cancer, with a combination of individual risk factors in addition to cancer treatments.


Subject(s)
COVID-19 , Neoplasms , Aged , COVID-19 Testing , Cohort Studies , Humans , Male , Morbidity , Neoplasms/drug therapy , Neoplasms/epidemiology , Retrospective Studies , SARS-CoV-2 , Sweden/epidemiology
19.
Int J Environ Res Public Health ; 18(20)2021 10 12.
Article in English | MEDLINE | ID: covidwho-1463698

ABSTRACT

There is concern that immunotoxic environmental contaminants, particularly perfluoroalkyl substances (PFAS), may play a role in the clinical course of COVID-19 and epidemiologic studies are needed to answer if high-exposed populations are especially vulnerable in light of the ongoing pandemic. The objective was, therefore, to determine if exposure to highly PFAS-contaminated drinking water was associated with an increased incidence of COVID-19 in Ronneby, Sweden, during the first year of the pandemic. We conducted an ecological study determining the sex- and age-standardized incidence ratio (SIR) in the adult population relative to a neighboring reference town with similar demographic characteristics but with only background levels of exposure. In Sweden, COVID-19 is subject to mandatory reporting, and we retrieved aggregated data on all verified cases until 3 March 2021 from the Public Health Agency of Sweden. The SIR in Ronneby was estimated at 1.19 (95% CI: 1.12; 1.27). The results suggest a potential link between high PFAS exposure and susceptibility to COVID-19 that warrants further research to clarify causality.


Subject(s)
Alkanesulfonic Acids , COVID-19 , Drinking Water , Fluorocarbons , Water Pollutants, Chemical , Adult , Alkanesulfonic Acids/analysis , Alkanesulfonic Acids/toxicity , Drinking Water/analysis , Fluorocarbons/analysis , Fluorocarbons/toxicity , Humans , SARS-CoV-2 , Sweden/epidemiology , Water Pollutants, Chemical/analysis , Water Pollutants, Chemical/toxicity
20.
Ther Adv Respir Dis ; 15: 17534666211049738, 2021.
Article in English | MEDLINE | ID: covidwho-1463195

ABSTRACT

BACKGROUND: Patients with obstructive lung diseases may be at risk of hospitalization and/or death due to COVID-19. AIM: To estimate the frequency of severe COVID-19, and COVID-19-related mortality in a well-defined large population of patients with asthma and chronic inflammatory lung disease (COPD). Further to assess the frequency of asthma and COPD as registered comorbidities at discharge from hospital, and in death certificates. METHODS: At the start of the pandemic, the Swedish National Airway Register (SNAR) included 271,404 patients with a physician diagnosis of asthma and/or COPD. In September 2020, after the first COVID-19 wave in Sweden, the database was linked with the National Patient Register (NPR), the Swedish Intensive Care Register and the Swedish Cause of Death Register, which all provide data about COVID-19 based on International Classification of Diseases (ICD-10) codes. Severe COVID-19 was defined as hospitalization and/or intensive care or death due to COVID-19. RESULTS: Among patients in SNAR, 0.5% with asthma, and 1.2% with COPD were identified with severe COVID-19. Among patients < 18 years with asthma, only 0.02% were severely infected. Of hospitalized adults, 14% with asthma and 29% with COPD died. Further, of patients in SNAR, 56% with asthma and 81% with COPD were also registered in the NPR, while on death certificates the agreement was lower (asthma 24% and COPD 71%). CONCLUSION: The frequency of severe COVID-19 in asthma and COPD was relative low. Mortality for those hospitalized was double as high in COPD compared to asthma. Comorbid asthma and COPD were not always identified among patients with severe COVID-19.


Subject(s)
Asthma/epidemiology , COVID-19/physiopathology , Hospitalization , Pulmonary Disease, Chronic Obstructive/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Asthma/mortality , COVID-19/mortality , Databases, Factual , Female , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/mortality , Registries , Severity of Illness Index , Sweden/epidemiology , Young Adult
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