An assessment of the relationship between national rates of Covid-19 incidence and mortality as reported to an international comparison database: An ecological study.

Background and Aims: Making a judgment only based on formal national reports can be misleading. We aimed to assess the relationship between countries' development indicators and reported coronavirus disease 2019 (Covid-19)-related incidences and death. Methods: Covid-19 related incidence and death cases were extracted from the updated Humanitarian Data Exchange Website on October 8, 2021. Univariable and multivariable negative binomial regression were utilized to investigate the relationship between development indicator and incidence and mortality from Covid-19 by calculating the Incidence rate ratio (IRR), mortality rate ratio (MRR), and fatality risk ratio (FRR). Results: Very high human development index (HDI) compared with low HDI (IRR:3.56; MRR:9.04), the proportion of physicians (IRR:1.20; MRR:1.16), besides extreme poverty (IRR:1.01; MRR:1.01) were independently correlated with the mortality and incidence rate of Covid-19. Very high HDI and population density were inversely correlated with the fatality risk (FRRs of 0.54 and 0.99). The cross-continental comparison shows Europe and the North Americas, had significantly higher incidence and mortality rates with IRR of 3.56 and 1.84 as well as MRRs of 6.65 and 3.62, respectively. Also, they inversely correlated with the fatality (FRR:0.84 and 0.91, respectively). Conclusion: A positive correlation between the fatality rate ratio based on countries' development indicators and the reverse for the incidence and mortality rate was found. Developed countries with sensitive healthcare systems can diagnose infected cases as soon as possible. Also, the mortality rate of Covid-19 will be accurately registered and reported. Due to more access to diagnostic tests, patients are diagnosed at the initial stages and will have a better opportunity to receive treatment. This leads to higher reports of incidence/and/or mortality rates and lower fatality of COVID-19. In conclusion, more Covid-19 incidence and mortality cases in developed countries can result from a more comprehensive care system and a more accurate recording procedure.

The efficacy and effectiveness of COVID-19 vaccines around the world: a mini-review and meta-analysis.

OBJECTIVES: This meta-analysis evaluated the Efficacy and Effectiveness of several COVID-19 vaccines, including AstraZeneca, Pfizer, Moderna, Bharat, and Johnson & Johnson, to better estimate their immunogenicity, benefits, or side effects. METHODS: Studies reporting the Efficacy and Effectiveness of COVID-19 vaccines from November 2020 to April 2022 were included. The pooled Effectiveness/Efficacy with a 95% confidence interval (95% CI) with Metaprop order was calculated. The results were presented in forest plots. Predefined subgroup analyses and sensitivity analyses were also performed. RESULTS: A total of twenty articles were included in this meta-analysis. After the first dose of the vaccine, the total effectiveness of all COVID-19 vaccines in our study was 71% (95% CI 0.65, 0.78). The total effectiveness of vaccines after the second dose was 91% (95% CI 0.88, 0.94)). The total efficacy of vaccines after the first and second doses was 81% (95% CI 0.70, 0.91) and 71% (95% CI 0.62, 0.79), respectively. The effectiveness of the Moderna vaccine after the first and second dose was the highest among other studied vaccines ((74% (95% CI, 0.65, 0.83) and 93% (95% CI, 0.89, 0.97), respectively). The highest first dose overall effectiveness of the studied vaccines was against the Gamma variant (74% (95% CI, 0.73, 0.75)), and the highest effectiveness after the second dose was observed against the Beta variant (96% (95% CI, 0.96, 0.96)). The Efficacy for AstraZeneca and Pfizer vaccines after the first dose was 78% (95% CI, 0.62, 0.95) and 84% (95% CI, 0.77, 0.92), respectively. The second dose Efficacy for AstraZeneca, Pfizer, and Bharat was 67% (95% CI, 0.54, 0.80), 93% (95% CI, 0.85, 1.00), and 71% (95% CI, 0.61, 0.82), respectively. The overall efficacy of first and second dose vaccination against the Alfa variant was 84% (95% CI, 0.84, 0.84) and 77% (95% CI, 0.57, 0.97), respectively, the highest among other variants. CONCLUSION: mRNA-based vaccines against COVID-19 showed the highest total efficacy and effectiveness than other vaccines. In general, administering the second dose produced a more reliable response and higher effectiveness than a single dose.

The association between nutrients and occurrence of COVID-19 outcomes in the population of Western Iran: A cohort study.

INTRODUCTION: The study aimed to determine the association between nutrients (micronutrients, macronutrients, and antioxidants) and the occurrence of COVID-19-related outcomes (morbidity and hospitalization) using a cohort study in Western Iran. METHODS: The basic study information was collected from February 2019 to February 2020 from the baseline phase of the Dehgolan Prospective Cohort Study (DehPCS). The primary outcomes in this study included risk of contracting COVID-19 and hospitalization due to it at a specific time. To compare these outcomes based on different nutritional groups (macronutrients or micronutrients), Kaplan-Meier chart and log rank test were used. Also, univariate and multivariate regression models were used to investigate the association between different nutritional groups and desired outcomes (risk of contracting COVID-19 and hospitalization due to it at a certain time). RESULTS: The results showed that people having an insufficient intake of selenium (HR: 1.180; % 95 CI: 1.032-2.490; P: 0.042), vitamin A (HR: 1.119; % 95 CI: 1.020-1.442; p: 0.033), and vitamin E (HR: 1.544; % 95 CI: 1.136-3.093; p: 0.039) were significantly more infected with COVID-19 than the ones who had a sufficient intake of these nutrients. Also, the results showed that people having an insufficient intake of selenium (HR: 2.130; % 95 CI: 1.232-3.098; p: 0.018) and vitamin A (HR: 1.200; % 95 CI: 1.000-2.090; p: 0.043) were significantly hospitalized more than the ones who had a sufficient intake of these nutrients. CONCLUSION: Insufficient intake of selenium and vitamins A and E can significantly increase the incidence of COVID-19 and hospitalization due to it.

The association of chronic liver disorders with exacerbation of symptoms and complications related to COVID-19: A systematic review and meta-analysis of cohort studies.

INTRODUCTION: The aim of this review was to combine the results of published cohort studies to determine the exact association between chronic liver disorders, and the severe form of COVID-19, and its associated complications. METHODS: This meta-analysis employed a keyword search (COVID-19 and chronic liver disorders) using PubMed (Medline), Scopus, Web of Sciences, and Embase (Elsevier). All articles related from January 2019 to May 2022 were reviewed. The STATA software was used for analysis. RESULTS: The risk of death in COVID-19 patients with chronic liver disorders was higher than in ones without the chronic liver disease (RR: 1.52; CI 95%: 1.46-1.57; I2 : 86.14%). Also, the risk of acute respiratory distress syndrome (ARDS) and hospitalization in COVID-19 patients with chronic liver disorders was higher than in ones without the chronic liver disease ([RR: 1.65; CI 95%: 1.09-2.50; I2 : 0.00%] and [RR: 1.39; CI 95%: 1.23-1.58; I2 : 0.20%]). Also, the meta-analysis showed cough, headache, myalgia, nausea, diarrhea, and fatigue were 1.37 (CI 95%: 1.20-1.55), 1.23 (CI 95%: 1.09-1.38), 1.25 (CI 95%: 1.04-1.50), 1.19 (CI 95%: 1.02-1.40), 1.89 (CI 95%: 1.30-2.75), 1.49 (CI 95%: 1.07-2.09), and 1.14 (CI 95%: 0.98-1.33), respectively, whereas the risk of all these symptoms was higher in COVID-19 patients with chronic liver diseases than ones without chronic liver disorders. CONCLUSION: The mortality and complications due to COVID-19 were significantly different between patients with the chronic liver disease and the general population.

The effect of COVID-19 mRNA vaccines against postvaccination laboratory-confirmed SARS-CoV-2 infection, symptomatic COVID-19 infection, hospitalization, and mortality rate: a systematic review and meta-analysis.

OBJECTIVES: We systematically reviewed the literature to investigate the pooled effect of COVID-19 mRNA vaccination against SARS-CoV-2 infection and its clinical outcomes. METHODS: Scopus, Web of Science, PubMed (Medline), and Embase were searched on 9 September 2021. The odds ratio (OR) of COVID-19 infection and its clinical outcomes in fully/ partially vaccinated versus unvaccinated participants were calculated and pooled by using a random-effects model. RESULTS: The pooled analysis showed that among health care workers and general population, vaccinated participants with one or two doses were less likely to infect with SARS-CoV-2 (OR = 0.16; 95%CI: 0.08-0.32; I2 = 79.86%; 95%CI I2: 68.99-87.21%), to develop symptomatic COVID-19 infection (OR = 0.09; 95%CI: 0.03-0.32; I2 = 80.43%; 95%CI I2: 70.83-89.33%), to admit to the hospital because of COVID-19 (OR = 0.13; 95%CI: 0.06-0.28; I2 = 86.19%; 95%CI I2: 67.80-93.88%), and to die from COVID-19 (OR = 0.14; 95%CI: 0.06-0.35; I2 = 66.76%; 95%CI I2: 54.00-76.99%) than unvaccinated participants. CONCLUSIONS: COVID-19 mRNA vaccines, especially following administration of two doses, are extremely effective. It would be suggested further studies with large sample size and different ethnicities to be conducted among the general population to warrant these results.

Influenza incidence overlapped with COVID-19 or under COVID-19 control measures.

INTRODUCTION: COVID-19 pandemic caused infection when influenza was still prevalent. This study was conducted to examine influenza incidence overlapped with COVID-19 and the effect of the COVID-19 measures on influenza incidence as a proxy. METHODS: The routine sentinel surveillance data on COVID-19 and influenza was obtained from the national integrated care electronic health record system. Data were collected in 28 points from 11 months before the outbreak (from March 2019 to January 2020) and 17 months after the outbreak (February 2020 to June 2021). RESULTS: In Iran, the incidence rate of influenza was 51.1 cases per 100,000 populations in November 2019, while it was only 0.1 in November 2020. The average number of influenza cases specifically for the Kurdistan province during the seasonal flu peak in 2019-2020 was 2.5 cases per 100,000 populations, while the average of influenza cases in the preceding 4 years was 0.4 cases per 100,000 populations. In other words, the seasonal peak of influenza in Iran was significantly higher than that of previous and after years. CONCLUSION: It seems that some of the nonpharmaceutical interventions (NPIs) used to control COVID-19 are effective against influenza epidemics and the results indicated a marked decline in the number of influenza cases may cause after the implementation of public health measures for COVID-19. The results showed the seasonal peak of influenza in Iran was significantly higher than that of previous years, so it seems that the influenza winter peak season (November 2019) overlapped with SARS-CoV-2 causing observed undetected infection during influenza winter peak.

The Effect of HIV/AIDS Infection on the Clinical Outcomes of COVID-19: A Meta-Analysis.

PURPOSE: Patients with HIV may be more likely to become severely ill from COVID-19. The present meta-analysis aims to determine the impact of HIV/AIDS infection on the clinical outcomes of COVID-19. METHODS: A comprehensive literature search was performed to identify relevant cohort studies to evaluate the association of HIV/AIDS infection with clinical outcomes of COVID-19. International databases, including PubMed (Medline), Web of Sciences, Scopus, and Embase, were searched from the emergence of the COVID-19 pandemic until January 2022. We utilized the risk ratio (RR) with its 95% confidence interval (95% CI) to quantify the effect of cohort studies. RESULTS: Twelve cohort studies were included in this meta-analysis, which examined a total number of 17,786,384 patients. Among them, 40,386 were identified to be HIV positive, and 17,745,998 were HIV negative. The pooled analyses showed HIV positive patients who were co-infected with SARS-CoV-2 were 58% more likely to develop a fever (RR=1.58; 95% CI: 1.42, 1.75), 24% more likely to have dyspnea (RR=1.24; 95% CI: 1.08, 1.41), 45% more likely to be admitted to ICU (RR=1.45; 95% CI: 1.26, 1.67), and 37% more likely to die from to COVID-19 (RR=1.37; 95% CI: 1.30, 1.45) than HIV negative patients. CONCLUSION: HIV/AIDS coinfection with COVID 19 increased the risk of fever, dyspnea, ICU admission, and mortality.