Role of increased neutrophil extracellular trap formation on acute kidney injury in COVID-19 patients.

Background: A strong association between elevated neutrophil extracellular trap (NET) levels and poor clinical outcomes in patients with coronavirus infection 2019 (COVID-19) has been reported. However, while acute kidney injury (AKI) is a common complication of COVID-19, the role of NETs in COVID-19-associated AKI is unclear. We investigated the association between elevated NETs and AKI and the prognostic role of NETs in COVID-19 patients. Methods: Two representative markers of NETs, circulating nucleosomes and myeloperoxidase-DNA, were measured in 115 hospitalized patients. Serum levels of interleukin [IL]-6, monocyte chemotactic protein-1 [MCP-1], plasma von Willebrand factor (vWF) and urinary biomarkers of renal tubular damage (ß2-microglobulin [ß2M] and kidney injury molecule 1 [KIM-1]) were measured. Results: AKI was found in 43 patients (37.4%), and pre-existing chronic kidney disease (CKD) was a strong risk factor for AKI. Higher circulating NET levels were a significant predictor of increased risk of initial ICU admission, in-hospital mortality (adjusted HR 3.21, 95% CI 1.08-9.19) and AKI (OR 3.67, 95% CI 1.30-10.41), independent of age, diabetes, pre-existing CKD and IL-6 levels. There were strong correlations between circulating nucleosome levels and urinary KIM-1/creatinine (r=0.368, p=0.001) and ß2M (r=0.218, p=0.049) levels. NETs were also strongly closely associated with serum vWF (r = 0.356, p<0.001), but not with IL-6 or MCP-1 levels. Conclusions: Elevated NETs were closely associated with AKI, which was a strong predictor of mortality. The close association between NETs and vWF may suggest a role for NETs in COVID-19-associated vasculopathy leading to AKI.

Production of a Monoclonal Antibody to the Nucleocapsid Protein of SARS-CoV-2 and Its Application to ELISA-Based Detection Methods with Broad Specificity by Combined Use of Detector Antibodies.

The coronavirus disease 2019 pandemic, elicited by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is ongoing. Currently accessible antigen-detecting rapid diagnostic tests are limited by their low sensitivity and detection efficacy due to evolution of SARS-CoV-2 variants. Here, we produced and characterized an anti-SARS-CoV-2 nucleocapsid (N) protein-specific monoclonal antibody (mAb), 2A7H9. Monoclonal antibody 2A7H9 and a previously developed mAb, 1G10C4, have different specificities. The 2A7H9 mAb detected the N protein of S clade, delta, iota, and mu but not omicron, whereas the 1G10C4 antibody recognized the N protein of all variants under study. In a sandwich enzyme-linked immunosorbent assay, recombinant N protein bound to the 1G10C4 mAb could be detected by both 1G10C4 and 2A7H9 mAbs. Similarly, N protein bound to the 2A7H9 mAb was detected by both mAbs, confirming the existence of dimeric N protein. While the 1G10C4 mAb detected omicron and mu with higher efficiency than S clade, delta, and iota, the 2A7H9 mAb efficiently detected all the strains except omicron, with higher affinity to S clade and mu than others. Combined use of 1G10C4 and 2A7H9 mAb resulted in the detection of all the strains with considerable sensitivity, suggesting that antibody combinations can improve the simultaneous detection of virus variants. Therefore, our findings provide insights into the development and improvement of diagnostic tools with broader specificity and higher sensitivity to detect rapidly evolving SARS-CoV-2 variants.

Effect of Previous COVID-19 Vaccination on Humoral Immunity 3 Months after SARS-CoV-2 Omicron Infection and Booster Effect of a Fourth COVID-19 Vaccination 2 Months after SARS-CoV-2 Omicron Infection.

In this study, we aimed to determine the effect of COVID-19 vaccination on 3-month immune response and durability after natural infection by the Omicron variant and to assess the immune response to a fourth dose of COVID-19 vaccination in patients with prior natural infection with the Omicron variant. Overall, 86 patients aged ≥60 years with different vaccination histories and 39 health care workers (HCWs) vaccinated thrice before Omicron infection were enrolled. The sVNT50 titer was significantly lower in patients with incomplete vaccination before SARS-CoV-2 infection with the S clade (p < 0.001), Delta variant (p < 0.001), or Omicron variant (p = 0.003) than in those vaccinated thrice. The sVNT results against the Omicron variant did not differ significantly in patients aged ≥60 years (p = 0.49) and HCWs (p = 0.17), regardless of the recipient receiving the fourth dose 2 months after COVID-19. Incomplete COVID-19 vaccination before Omicron infection for individuals aged ≥60 years conferred limited protection against homologous and heterologous virus strains, whereas two or three doses of the vaccine provided cross-variant humoral immunity against Omicron infection for at least 3 months. However, a fourth dose 2 months after Omicron infection did not enhance immunity against the homologous strain. A future strategy using the bivalent Omicron-containing booster vaccine with appropriate timing will be crucial.

Clinical characteristics of patients with COVID-19 vaccine-related pneumonitis: a case series and literature review.

BACKGROUND/AIMS: Pulmonary toxicities of coronavirus disease 2019 (COVID-19) vaccination are exceedingly rare. However, there are a few reported cases after mRNA vaccination, especially from Asian countries. The purpose of this study was to report the clinical characteristics of patients with COVID-19 vaccine-related pneumonitis (CV-P) and to review cases reported in the literature. METHODS: We performed a prospective, observational case series analysis. RESULTS: Eleven patients with a median age of 80 years were enrolled. Ten patients developed CV-P after BNT162b2-mRNA vaccination and one after ChAdOx1 nCoV-19 vaccination. We identified various patterns of CV-P, including transient infiltration, life-threatening acute respiratory distress syndrome, and aggravation of underlying interstitial lung disease. Most patients showed favorable outcomes with good responses to corticosteroid therapy. CONCLUSION: Identifying the mechanism of CV-P requires further investigation; however, radiological and laboratory findings in our case series support inflammatory dysregulation in the lung parenchyma after vaccination. Clinicians should consider CV-P in patients with atypical lung infiltration, no specific etiologies, and recent COVID-19 vaccination.

Control of a nosocomial measles outbreak among previously vaccinated adults in a population with high vaccine coverage: Korea, 2019.

We describe a measles outbreak among previously vaccinated healthcare workers (HCWs) and inpatients and the control measures implemented at a tertiary care hospital in 2019. Case-patients were laboratory-confirmed measles with throat swabs tested by quantitative polymerase chain reactions (PCR), during April-May 2019. Medical histories and documented immunization records were obtained. We compared attack rates (ARs) among HCWs by occupational subgroup and age and examined the outbreak-associated costs. The index case was not ascertained. Among 26 measles case-patients (22 HCWs, four inpatients) aged 18-28 years, 25 had previously received measles-mumps-rubella (MMR) vaccine (12/26, 46% (two doses); 13/26, 50% (one dose)), and 16 (62%) had positive results of measles IgG prior to measles diagnosis. ARs were higher among HCWs aged < 30 years (1.88%), especially in the subgroup under 25 years of age (2.22%). Control measures included work restrictions for seronegative HCWs (218/2320, 9.4%) in immunity verification, administration of the MMR vaccine (207 HCWs) or intravenous immunoglobulin (2 HCWs and 11 inpatients), enhanced health surveillance of HCWs, and mandatory assessment of patients with measles-like symptoms at the infectious diseases screening units. The hospital spent 90,417,132 Korean won (US $79,733) in response to the outbreak. Measles outbreaks can occur in healthcare settings despite high population immunity, highlighting the importance of stronger vaccination policies, particularly among young HCWs. Moreover, an effective outbreak response comprising immunization activities and enhanced surveillance of HCWs and patients to rapidly detect measles-like symptoms at a prodromal phase is essential to control nosocomial measles outbreaks.

Clinical impact and benefits of a simultaneous cardio‐pulmonary rehabilitation in a COVID‐19‐infected patient following cardiac arrest: A case report

Since the advent of the pandemic, cardio‐pulmonary rehabilitation (CR) has been shown to be an effective treatment. However, there are no studies showing data to substantiate its simultaneous application. A 62‐year‐old man was resuscitated for asystole during the work‐up after presenting with a 2‐day history of difficulty breathing. PCR test was positive for COVID‐19. He was intubated and admitted to a negative pressure zone. Symptoms improved in response to acute treatment. Following extubation, respiratory distress persisted, and CR was implemented. Clinical indicators of cardiopulmonary function improved resulting in a successful return to community participation. The decline in cardiopulmonary function has been on the rise among COVID‐19 survivors. The simultaneous application of CR treatment in our patient resulted in improved clinical indicators of cardiopulmonary function. The patient regained full function for independent community participation. As COVID‐19 cases rise, the application of rehabilitation following acute treatment is increasing. This case emphasizes the critical need for cardio‐pulmonary rehabilitation for functional restoration after cardiac arrest and COVID‐19 treatment.

Clinical impact and benefits of a simultaneous cardio-pulmonary rehabilitation in a COVID-19-infected patient following cardiac arrest: A case report.

Since the advent of the pandemic, cardio-pulmonary rehabilitation (CR) has been shown to be an effective treatment. However, there are no studies showing data to substantiate its simultaneous application. A 62-year-old man was resuscitated for asystole during the work-up after presenting with a 2-day history of difficulty breathing. PCR test was positive for COVID-19. He was intubated and admitted to a negative pressure zone. Symptoms improved in response to acute treatment. Following extubation, respiratory distress persisted, and CR was implemented. Clinical indicators of cardiopulmonary function improved resulting in a successful return to community participation. The decline in cardiopulmonary function has been on the rise among COVID-19 survivors. The simultaneous application of CR treatment in our patient resulted in improved clinical indicators of cardiopulmonary function. The patient regained full function for independent community participation.

A strategic response map for cascading pandemics: Lessons learned from the response to COVID-19 in the Republic of Korea.

COVID 19 is a still on-going fatal risk that affects the whole world. COVID-19 pandemic has been characterized as a systemic risk. Accordingly, this paper aims to identify the features of systemic risk of COVID-19 and draw policy implications for effective response. For this, we traced the COVID-19 related risk in Korea from January 2020 to August 2021 by utilizing the official data of the Korea Disease Control and Prevention Agency. Analyzing the relationship between anticipated, emerging, amplified, and lingering risk and response measure through actual data, it was revealed that the risk flow model for cascading risk proposed by the author can be readily applied. In addition, through the analysis of actual response measures against the risks for 1 year and 8 months, the authors proposed a strategic response map against cascading pandemics. Five policy implication derived through this study can be extended for identifying strategic approach against cascading pandemics and for developing guidelines for effective preparedness, risk reduction, and resilience building.

COVID-19: Systemic risk and response management in the Republic of Korea.

This study aimed to investigate the different kinds of risks associated with the novel coronavirus infection in the Republic of Korea and how those risks have been changed by the countermeasures taken by the Korean authorities and citizens. To this end, the authors explored the official database of the Korea Centers for Disease Control and Prevention (KCDC) in order to extract risk-related data from January 2020 to April 2021, and then identified the disaster risks and countermeasures from the government press briefings and news media in the same period. Consequently, this study identified three important approaches to enhance the infectious disease response management. First, the government has to respond immediately, even when they lack information and knowledge about the new type of risk. Second, a multi-sectoral response must be prepared to cope with systemic risks. Third, the government should prioritize transparency, inclusive risk governance, and innovative technologies during the initial response stage against risks with high uncertainty and novelty. Aside from these approaches, the types of risks were divided into four categories based on the response measures: anticipated risk against which countermeasures can be planned in advance, lingering risk against which adaptive response should be taken promptly, amplified risk, and emerging risk; the last two risks require the established plan to be modified drastically in order to secure higher-level engagement and additional resources. Finally, the authors proposed a risk management flow that can be applied to an in-depth analysis of the intersection between risk and response.

Changes in respiratory virus infection trends during the COVID-19 pandemic in South Korea: the effectiveness of public health measures.

BACKGROUND/AIMS: Studies on the effectiveness of public health measures to prevent respiratory virus transmission in real-world settings are lacking. We investigated the effectiveness of universal mask use and adherence to other personal preventive measures on the changing viral respiratory infection patterns during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Data were extracted from the South Korean National Respiratory Virus Sentinel Surveillance System. During the COVID-19 pandemic, a cross-sectional survey on adherence to personal preventive measures was conducted. Additionally, the number of subway passengers was analyzed to estimate physical distancing compliance. RESULTS: During the pandemic, adherence to personal preventive measures significantly increased, particularly indoors and on public transportation. Respiratory virus trends were compared based on laboratory surveillance data of 47,675 patients with acute respiratory infections (2016 to 2020). The 2019 to 2020 influenza epidemic ended within 3 weeks, from the epidemic peak to the epidemic end, quickly ending the inf luenza season; with a 1.8- to 2.5-fold faster decline than in previous seasons. Previously, the overall respiratory virus positivity rate remained high after the influenza seasons had ended (47.7% to 69.9%). During the COVID-19 pandemic, this positive rate, 26.5%, was significantly lower than those in previous years. Hospital-based surveillance showed a decreased number of hospitalized patients with acute viral respiratory illnesses. CONCLUSION: This study suggests that high compliance to the use of personal preventive measures in public might reduce the incidence of all respiratory virus infections and its hospitalization rates, with no additional quarantine, isolation, or contact screening.

Reflection of Challenges and Opportunities within the COVID-19 Pandemic to Include Biological Hazards into DRR Planning.

COVID-19 has reinforced the need to revisit the integration of health within disaster risk reduction (DRR) strategies for biological hazards in a system-wide approach. In November 2020, DRR experts attended the Asia-Pacific Partnership for Disaster Risk Reduction (APP-DRR) Forum to share progress and learnings in the areas of health system resilience, data management, residual risk management, risk communication, digital literacy, and knowledge product marketing. Advancements for health in DRR included the importance of multi-sectoral, multi-hazard action plans; adaptation to technological advancements in data collection, dissemination and protection; promoting the health and wellbeing of essential and nonprofessional workers; and improving inclusivity in digital literacy. COVID-19 has affected progress towards the Sustainable Development Goals (SDG) and created a unique opportunity within DRR to re-evaluate the adequacy of response mechanisms against concurrent, cascading or interacting risks of future biological hazards. Health emergency disaster risk management (Health-EDRM) is a new World Health Organization paradigm that includes DRR at intra-, inter- and multidisciplinary levels. Scientific advancement under Health-EDRM is necessary for health and non-health actors in DRR education and research. Continuous education on the multifaceted risk governance is a key to building awareness, capacity and accelerating towards achieving the international DRR and the SDG targets.

Governance, technology and citizen behavior in pandemic: Lessons from COVID-19 in East Asia.

Corona Virus (CODID-19) was first reported in Wuhan in December 2019, then spread in different parts of China, and gradually became a global pandemic in March 2020. While the death toll is still increasing, the epicenter of casualty has shifted from Asia to Europe, and that of the affected people has shifted to USA. This paper analyzes the responses in East Asian countries, in China, Japan and South Korea, and provides some commonalities and lessons. While countries have different governance mechanism, it was found that a few governance decisions in respective countries made a difference, along with strong community solidarity and community behavior. Extensive use of emerging technologies is made along with medical/health care treatment to make the response more effective and reduce the risk of the spread of the disease. Although the pandemic was a global one, its responses were local, depending on the local governance, socio-economic and cultural context.