A synthetic delivery vector for mucosal vaccination (preprint)

The success of mRNA-based vaccines during the Covid-19 pandemic has highlighted the value of this new platform for vaccine development against infectious disease. However, the CD8+ T cell response remains modest with mRNA vaccines, and these do not induce mucosal immunity, which would be needed to prevent viral spread in the healthy population. To address this drawback, we developed a dendritic cell targeting mucosal vaccination vector, the homopentameric STxB. Here, we describe the highly efficient chemical synthesis of the protein, and its in vitro folding. This straightforward preparation led to a synthetic delivery tool whose biophysical and intracellular trafficking characteristics were largely indistinguishable from recombinant STxB. The chemical approach allowed for the generation of new variants with bioorthogonal handles. Selected variants were chemically coupled to several types of antigens derived from the mucosal viruses SARS-CoV-2 and type 16 human papillomavirus. Upon intranasal administration in mice, mucosal immunity, including resident memory CD8+ T cells and IgA antibodies was induced against these antigens. Our study thereby identifies a novel synthetic antigen delivery tool for mucosal vaccination with an unmatched potential to respond to an urgent medical need.

Destination social responsibility drives destination brand loyalty: a case study of domestic tourists in Danang city, Vietnam

PurposeThis study aims to identify how perceived destination social responsibility (DSR) drives destination brand loyalty through a jointly and independently mediated mechanism of cognitive and affective components (e.g. tourist-destination identification, cognitive image, affective image and tourist satisfaction) and to examine the moderating role of individual-level collectivist values in linking perceived DSR and tourist behaviors.Design/methodology/approachAn online survey is conducted to collect the data of 351 domestic tourists visiting an urban tourism destination (e.g. Danang City) in Vietnam. A serial multiple mediation model and moderation model were examined by applying covariance-based structural equation modeling.FindingsThis research's results highlight the leading factors of perceived DSR in the process of forming destination brand loyalty and confirm the vital role of the intermediary mechanism of tourists' cognition and affect during this process. The chain of causal relationships DSR → TDI → CI → AI → TS → DBL confirms the role of perceived DSR as an essential prerequisite factor of DBL, creating a close connection to tourists' cognition and affect and contributing to improving destination brand loyalty. Individual-level collectivist values were found to positively moderate the links between perceived DSR and tourist-destination identification, affective image and destination brand loyalty.Research limitations/implicationsFuture research would provide insights into the links between perceived DSR and tourist behaviors by considering moderating variables (e.g. cultural distance and tourist types) and uncovering specific insights into each destination stakeholder's DSR activities.Originality/valueA new integrated model of destination brand loyalty development is proposed to explore a new path for destination brand loyalty formation through cognitive, affective and cognitive-affective pathways. This moderating stream of examining individual-level collectivist values can make a significant contribution to the extant tourism literature by promoting a more positive tourist perception of DSR, thereby increasing tourists' knowledge, beliefs and emotions and enhancing destination brand loyalty.

Comparison of the Basic Reproduction Numbers for COVID-19 through Four Waves of the Pandemic in Vietnam

Estimating the basic reproduction number (R0) of an infectious disease is a crucial step to describe the contagiousness and provides suggestions for interventions. To lift the effectiveness of preventive measures for the COVID-19 pandemic, we need to minimize the newly infected cases by reaching adequate herd immunity. This study thus aimed to compare the R0 through four waves of COVID-19 outbreaks in Vietnam and to calculate the minimal vaccination coverage in different populations. The data on the number of daily confirmed COVID-19 patients were collected from 21 January 2020 to 16 November 2021 from the daily reports through the four waves of the pandemic in Vietnam. The R0 values were estimated by exponential growth and the maximum likelihood methods to range from 1.04 to 3.31 from the first to the third wave. The fourth wave was the most severe, especially in the southern provinces, and the highest R0 was in Ho Chi Minh City. The herd immunity would range from 43.50% to 95.76% by various R0 values from different populations. Overall, the presence of new viral mutants increased the infectiousness and the vaccination coverage was higher to establish the required herd immunity in a high-density population. The results provide the basis for policy recommendations and resource allocation for vaccine management and distribution at a time when the COVID-19 pandemic is not yet over.

Balancing the aquatic export supply chain strategy- A case study of the Vietnam pangasius industry

COVID-19 has called more attention to the importance of supply chains (SCs) in the global food market. The supply chain for Vietnamese pangasius is expanding at a rapid rate, and export shares are changing in the EU, the US, China, and ASEAN markets. Increased international competition in the whitefish market and other emerging Asian markets have forced the Vietnam pangasius industry to re-examine its SC strategy. The questions raised are: Should the pangasius industry employ a responsive SC, where aquatic products achieve international certificates and respond to consumer demand, or embrace a cost-efficient supply chain with large export volumes, low selling prices, and increased stakeholder profits? Based on the concepts of cost responsiveness and efficient frontier, using time series data for 2010–2019, we attempted to identify and describe the factors influencing Vietnamese pangasius strategic balance along this frontier. Vietnam's pangasius strategic balance is between a responsive supply chain and a cost-effective SC with greater emphasis on responsive supply chain management. However, there is insufficient attention to changing consumer trends and demands, and although the laws directing each node of the supply chain are numerous, there is inadequate enforcement and oversight of their implementation. The strategy of cost minimization is facing many challenges: the market share is declining in some major markets, profits have tightened due to low selling prices, there is competition with other whitefish species, and distribution channels have improved but remain inefficient. The recommendation requires the adoption of a supply chain strategy that balances between a cost-efficient and a responsive chain for the pangasius industry to remain competitive.

An at-home and electro-free COVID-19 rapid test based on colorimetric RT-LAMP (preprint)

Purpose: In the fight against virus-caused pandemics like COVID-19, the use of diagnostic tests based on RT-qPCR is essential but sometimes limited by their dependence on expensive, specialized equipment and skilled personnel. Consequently, an alternative nucleic acid detection technique that gets over these restrictions, called loop-mediated isothermal amplification following reverse transcription (RT-LAMP), has been broadly investigated. Nevertheless, the developed RT-LAMP assays for SARS-CoV-2 detection still require laboratory devices and are electrically dependent, limiting their widespread use as rapid home tests. In this work, a flexible RT-LAMP assay that gets beyond the drawbacks of the available isothermal LAMP-based SARS-CoV-2 detection was developed, establishing a simple and effective at-home diagnosis tool for COVID-19. Methods: A multiplex direct RT-LAMP assay modified from the previously developed test was applied to simultaneously identify the two genes of SARS-CoV-2. We used a colorimetric readout, lyophilized reagents, and benchmarked an electro-free and micropipette-free method that enables sensitive and specific detection of SARS-CoV-2 in home settings. Results: Forty-one nasopharyngeal swab samples were tested using the home-testing RT-LAMP (HT-LAMP) assay developed, showing 100% agreement with the RT-qPCR results. Conclusions: This is the first electrically independent RT-LAMP assay successfully developed for SARS-CoV-2 detection at home setting. Our HT-LAMP assay is thus an important development for diagnosing COVID-19 or any other infectious pandemic on a population scale.

High Seroprevalence of Anti-SARS-CoV-2 Antibodies in Children in Vietnam: An Observational, Hospital-based Study (preprint)

Background: The robustness of sero-surveillence has delineated the high burden of SARS-CoV-2 infection in children; however, these existing data showed wide variation. This study aimed to identify the serostatus of antibodies against SARS-CoV-2 and associated factors among children following the fourth pandemic wave in Vietnam. Methods: A cross-sectional study was conducted at Vietnam National Children’s Hospital (VNCH) between March 13 and April 3, 2022. 4,032 eligible children seeking medical care for any medical condition not related to acute Covid-19 infections was tested for IgG SARS-CoV-2 Antibodies by ADVIA Centaur® SARS-CoV-2 IgG (sCOVG) assay using the residuals of routine blood samples. Results: The median age of enrolled children was 39 (IQR=14-82) months. The overall seropositive prevalence was 59.2%, and the median antibody titer was 4.78 [IQR 2.38-9.57] UI/mL. The risk of seropositivity and the median antibody titer was not related to gender (58.6% versus 60.1%, 4.9 versus 4.6 UI/mL, all p>0.05). Among age groups, the highest seroprevalence was reported in the children aged 13 to <36 months old. Children aged ≤12 months were likely to be seropositive compared to children aged 36 to <60 months (59.2% versus 57.5%, p=0.49) and those aged ≥144 months (59.2% versus 65.5%, p=0.16). Children aged ≥144 months exhibited a significantly higher titer of protective COVID-19 antibodies than other age groups (p <0.001). In multivariate logistic regression, we observed independent factors associated with SARS-CoV-2 seropositivity, including the age 13 to <36 months (OR=1.29, 95%CI=1.06-1.56, p=0.01), 60 to <144 months (OR=79, 95%CI=0.67-0.95, p=0.01), ≥144 months (OR=1.84, 95%CI=1.21-2.8, p=0.005), the presence of infected household members (OR=2.36, 95%CI=2.06–2.70, p<0.001), participants from Hanoi (OR=1.54, 95%CI=1.34-1.77, p<0.001), underlying conditions (OR=0.71, 95%CI=0.60-0.85, p<=0.001), and using corticosteroids or immunosuppressants (OR=0.64, 95%CI=0.48-0.86, p=0.003). Conclusions: This study highlights a high seroprevalence of antibodies against SARS-CoV-2 among children seeking medical care for non-COVID-19-related conditions in a tertiary children’s hospital in Hanoi, Vietnam. In the context of reopening in-person schools and future emerged COVID-19 variants, this point will also be a key message about the necessity of “rush-out” immunization coverage for children, especially those under the age of three years.

Feasibility, acceptability, and bacterial recovery for community-based biological sample collection to estimate antibiotic resistance in commensal gut and upper respiratory tract bacteria: a cross-sectional mixed-methods study (preprint)

Background: Vietnam has high rates of antibiotic resistance, driven by overuse in agriculture, hospital, and community healthcare. Measures of resistance in commensal bacteria could provide a hard indicator for progress in evaluating the impact of interventions to reduce antibiotic use in the community. This study aimed to evaluate the feasibility, acceptability, and bacterial recovery for health-worker (HW) administered compared to self-administered swabs to recover Streptococcus pneumoniae , and stool collection to recover Enterobacterales in a community-based pilot study. Methods We conducted a cross-sectional mixed methods study in a rural community in Ha Nam Province, northern Vietnam. Between 16 July 2018 and 10 April 2019, 389 households were invited to participate in a household survey, Households were randomly selected and allocated in a 2:1 ratio to provide self-administered nasal swabs, or HW-administered nasopharyngeal swabs. Structured interviews were conducted with each household, and stool samples were self-collected from all household members. In-depth interviews with participants and health-workers were conducted in August 2018 to explore perspectives about different sample collection methods. Results 324 households participated (83%), representing 1502 individuals. Stool samples were collected from 1498 individuals, self-administered nasal swabs from 1002 and HW-administered nasopharyngeal swabs from 496. S. pneumoniae were recovered from 11.1% (128/1,149) of the total population and 26.2% (48/183) of those under 5-years. Recovery was higher for HW-administered swabs (13.7%, 48/350) than self-administered swabs (10.0%, 80/799) (OR 2.06, 95% CI 1.07–3.96). Five main themes related to feasibility emerged through qualitative interviews: workload for data collectors; sample collection procedures; concerns about quality; storage and transportation; and disruptions. Nasopharyngeal swabs administered by health-workers took longer to collect, caused more discomfort and were more difficult to take from children. Costs per swab were cheaper for self-administered ($7.26) than HW-administered swabs ($8.63), but the total cost for 100 positive samples was higher ($7,260 and $6,300 respectively). Only 3 households refused to participate, representing a high acceptability of taking part. Factors affecting motivation to participate included sense of contribution, perceived trade-offs between benefits and effort, influence from others. Reluctance was related to stool sampling and negative perceptions of research. Conclusions This study provides important evidence for planning community-based carriage studies, including cost, logistics, and participant feedback about acceptability of different methods. Self-administered swabs had lower recovery, and though cheaper and quicker, this would translate to higher costs for large population-based studies requiring adequate numbers of positive samples for further testing. Factors that might improve recovery for self-administered swabs include swab-type, transport medium, and improved cold-chain to lab.

Analysis of the Spatial Effect of Capital Misallocation on Agricultural Output—Taking the Main Grain Producing Areas in Northeast China as an Example

Increasing agricultural output by reducing capital misallocation is a capital-saving strategy, as it does not require the usage of additional inputs. Based on the panel data of 36 prefecture-level cities in Northeast China from 2011 to 2020, this paper uses the spatial Durbin model to test the impact of capital mismatch on agricultural output and its mechanisms. We found that capital misallocation is prevalent in prefecture-level cities, showing a spatial distribution characteristic of “north-south confrontation and central collapse”, with a significant spatial spillover effect. A one-unit increase in capital misallocation leads to a 16.00% decrease in local agricultural output and a 1.80% decrease in adjacent areas. However, with the optimization and upgrading of the agricultural industry and agricultural technology progress, the inhibitory effect of capital misallocation on the growth of agricultural output is constantly weakening. The above conclusion still holds after a series of robustness tests. The conclusion of this paper provides policy inspiration for promoting the rational allocation of factors between cities and regions, coordinating regional coordinated development, and then promoting the sustainable growth of agricultural output.

Semi-nested RT-PCR enables sensitive and high-throughput detection of SARS-CoV-2 based on melting analysis.

BACKGROUND: Asymptomatic transmission was found to be the Achilles' heel of the symptom-based screening strategy, necessitating the implementation of mass testing to efficiently contain the transmission of COVID-19 pandemic. However, the global shortage of molecular reagents and the low throughput of available realtime PCR facilities were major limiting factors. METHODS: A novel semi-nested and heptaplex (7-plex) RT-PCR assay with melting analysis for detection of SARS-CoV-2 RNA has been established for either individual testing or 96-sample pooled testing. The complex melting spectrum collected from the heptaplex RT-PCR amplicons was interpreted with the support of an artificial intelligence algorithm for the detection of SARS-CoV-2 RNA. The analytical and clinical performance of the semi-nested RT-PCR assay was evaluated using RNAs synthesized in-vitro and those isolated from nasopharyngeal samples. RESULTS: The LOD of the assay for individual testing was estimated to be 7.2 copies/reaction. Clinical performance evaluation indicated a sensitivity of 100% (95% CI: 97.83-100) and a specificity of 99.87% (95% CI: 99.55-99.98). More importantly, the assay supports a breakthrough sample pooling method, which makes possible parallel screening of up to 96 samples in one real-time PCR well without loss of sensitivity. As a result, up to 8,820 individual pre-amplified samples could be screened for SARS-CoV-2 within each 96-well plate of realtime PCR using the pooled testing procedure. CONCLUSION: The novel semi-nested RT-PCR assay provides a solution for highly multiplex (7-plex) detection of SARS-CoV-2 and enables 96-sample pooled detection for increase of testing capacity. .

Intimate partner violence during pregnancy and maternal and child health outcomes: a scoping review of the literature from low-and-middle income countries from 2016 - 2021.

BACKGROUND: Intimate partner violence (IPV) during pregnancy is significantly associated with negative outcomes for both mother and child. Current evidence indicates an association between low levels of social support and IPV, however there is less evidence from low-and-middle income countries (LMIC) than high-income countries. Globally, the COVID-19 pandemic has radically altered how women can access social support. Hence since 2020, studies investigating IPV and pregnancy have occurred within the changing social context of the pandemic. OBJECTIVE: This scoping review summarizes the evidence from LMICs about the effects of IPV during pregnancy on maternal and child health. The review includes the impact of the COVID-19 pandemic on social support as mentioned in studies conducted since 2020. DESIGN: Library databases were used to identify papers from 2016 to 2021. These studies reported the maternal and child health outcomes of IPV during pregnancy, and described how social support during pregnancy, and the COVID-19 pandemic, were associated with rates of IPV during pregnancy. Observational study designs, qualitative and mixed methods studies were included. RESULTS: Twenty - six studies from 13 LMICs were included. Half (n = 13) were cross sectional studies which only collected data at one time-point. IPV during pregnancy was significantly associated with higher odds of postpartum depression, low birth weight, preterm birth and less breastfeeding in the year after birth. Lower levels of social support increased the odds of experiencing IPV during pregnancy, whilst higher levels of social support reduced antenatal anxiety and depression in women experiencing IPV during pregnancy. Of the four studies that investigated IPV during pregnancy throughout the COVID-19 pandemic, only one compared prevalence before and after the pandemic and unexpectedly reported a lower prevalence. CONCLUSIONS: Further research on the impact of IPV during pregnancy on maternal and child outcomes in LMICs is required, especially evidence from longitudinal studies investigating a wider range of outcomes. To date, there is limited evidence on the impact of the COVID-19 pandemic on IPV during pregnancy in LMICs, and this should be prioritized as the pandemic continues to affect women's access to social support globally.

Efficacy of COVID-19 vaccination on the symptoms of patients with long COVID: a target trial emulation using data from the ComPaRe e-cohort in France (preprint)

We used data from 910 adult patients included the ComPaRe long COVID cohort to emulate a target trial evaluating the effect of vaccination on the symptoms of patients who already had long COVID. We used propensity score matching to compare the outcomes, at 120 days, of patients who received a first COVID-19 vaccine injection (n=455) and those who did not (n=455). Vaccination reduced the number of long COVID symptoms (mean difference: -1.8, 95% CI -3.0 to -0.5), the proportion of patients with an unacceptable symptom state (risk difference -7.5%, 95% CI -14.4 to -0.5), and doubled the remission rate (16.6% vs 7.5%, HR: 1.97, 95% CI 1.23 to 3.15). In the vaccination group, two (0.4%) patients reported serious adverse events leading to hospitalisation. Vaccination lowered the severity and life impact of long COVID, at 120 days, among patients with persistent symptoms.

Course of long COVID symptoms over time in the ComPaRe long COVID prospective e-cohort (preprint)

About 10% of people infected by severe acute respiratory syndrome coronavirus 2 experience post COVID-19 disease. We analysed data from 968 adult patients (5350 person-months) with a confirmed infection enrolled in the ComPaRe long COVID cohort, a disease prevalent prospective e-cohort of such patients in France. Day-by-day prevalence of post COVID-19 symptoms was determined from patients’ responses to the Long COVID Symptom Tool, an online validated self-reported questionnaire assessing 53 post COVID-19 disease symptoms. One year after symptom onset, 84.9% patients still reported their persistence, with a progressively lower prevalence of 27/53 symptoms (e.g., loss of taste/smell); 18/53 symptoms (e.g., dyspnoea) were stable, while the prevalence of 8/53 symptoms (e.g., paraesthesia) had increased. The disease impact on patients’ lives began increasing 6 months after onset, as patients realized they had a chronic disease. Our results should be useful for researchers seeking the potential pathophysiological mechanisms underlying post COVID-19 disease.

Efficacy of COVID-19 Vaccination on the Symptoms of Patients With Long COVID: A Target Trial Emulation Using Data From the ComPaRe e-Cohort in France (preprint)

Background: Long COVID is a complex multiorgan disorder that can affect patients’ lives severely. Recent reports suggest that symptoms improve after COVID-19 vaccination. Methods: We used data from the ComPaRe long COVID cohort to emulate a target trial evaluating the effect of vaccination among patients with long COVID who still had persistent symptoms at baseline. Vaccinated patients were matched to unvaccinated controls in a 1:1 ratio by their propensity scores. Outcomes, all measured at 120 days after baseline, include disease severity (long COVID ST, range 0-53), rate of complete remission (ie, disappearance of all symptoms), disease impact on patients’ lives (long covid IT, range 0-60), and the proportion of patients reporting an unacceptable symptom state. Vaccinated patients reported all adverse events occurring after vaccination in free text. Findings: In total, 455 patients were allocated to the vaccination group and 455 to the control group; 545 (60·1%) had confirmed infections, and 81 (8·9%) had been hospitalized during their acute COVID-19. By 120 days, vaccination reduced the long COVID symptoms (mean (SD) ST score in the vaccination group 13·0 (9·4) vs. 14·8 (9·8) in the control group; mean difference: -1·8, 95% CI -2·5 to -1·0) and doubled the rate of patients in complete remission (remission rate 16·6% vs 7·5%, HR: 1·97, 95% CI 1·23 to 3·15). Furthermore, vaccination reduced both disease impact on patients’ lives (mean (SD) IT score 24.3 (16·7) vs 27·6 (16·7); mean difference: -3·3, 95% CI -6·2 to -0·5) and the proportion of patients with an unacceptable symptom state (38.9% vs 46.4%, risk difference -7·5%, 95% CI -14·4 to -0·5). In the vaccination group, two (0·4%) patients reported serious adverse events leading to hospitalisation. Interpretation: COVID-19 vaccination lowers the severity and life impact of long COVID at 120 days among patients with persistent symptoms.Funding Information: The authors received no specific funding for this work.Declaration of Interests: The authors declare no competing interests and no financial associations that may be relevant or seen as relevant to the submitted manuscript. The authors have no association with commercial entities that could be viewed as having an interest in the general area of the submitted manuscript.Ethics Approval Statement: All patients provided online consent before participating in the cohort. The Institutional Review Board of Hôtel-Dieu Hospital, Paris, approved the study (IRB: 0008367).

Modeling behavioral intention toward traveling in times of a health-related crisis

This study proposes an integrated model based on the Risk Perception Attitude (RPA) framework and the Theory of Planned Behavior (TPB) model to investigate behavioral intention toward traveling in times of a health-related crisis. A survey was conducted via online networks of travelers, yielding 338 valid cases. The findings indicate that health risk perception is affected by information search about the Covid-19 disease. The relationship between health risk perception and behavioral intention toward traveling during a health-related crisis is not direct, but indirect via health self-efficacy and attitude about their future trip. The study contributes to understand a cognitive process of tourists? behavior intention toward traveling in a health-related crisis. Practically, this study?s findings provide tourists, government agencies, tourism marketers, and policy-makers and other tourism stakeholders with important suggestions for tourism recovery during and after the pandemic.

Divergent early antibody responses define COVID-19 disease trajectories (preprint)

Serologic markers that predict severe COVID-19 disease trajectories could enable early medical interventions and reduce morbidity and mortality. We found that distinct features of IgG Fab and Fc domain structures were present within three days of a positive test that predicted two separate disease trajectories in a prospective cohort of patients with COVID-19. One trajectory was defined by early production of neutralizing antibodies and led to mild disease. A distinct trajectory, characterized by an initial period of mild symptoms followed by rapid progression to more severe outcomes, was predicted by the absence of early neutralizing antibody responses with concomitant production of afucosylated IgGs. Elevated frequencies of monocytes expressing the receptor for afucosylated IgGs, Fc{gamma}RIIIa (CD16a), were an additional antecedent in patients with the more severe outcomes. In mechanistic studies, afucosylated immune complexes in the lung triggered an inflammatory infiltrate and cytokine production that was dependent on CD16a. Finally, in healthy subjects, mRNA SARS-CoV-2 vaccination elicited neutralizing antibodies that were enriched for Fc fucosylation and sialylation and distinct from both infection-induced trajectories. These data show the importance of combined Fab and Fc domain functions in the antiviral response, define an early antibody signature in people who progressed to more severe COVID-19 outcomes and have implications for novel therapeutic strategies targeting Fc{gamma}RIIIa pathways.

Development and validation of the long covid symptom and impact tools, a set of patient-reported instruments constructed from patients’ lived experience (preprint)

Objectives To develop and validate patient-reported instruments, based on patients’ lived experiences, for monitoring the symptoms and impact of long covid. Design The long covid Symptom and Impact Tools (ST and IT) were constructed from the answers to a survey with open-ended questions to 492 patients with long covid. Validation of the tools involved adult patients with suspected or confirmed covid-19 and symptoms extending over three weeks after onset. Construct validity was assessed by examining the relations of the ST and IT scores with health related quality of life (EQ-5D-5L), function (PCFS, post-covid functional scale), and perceived health (MYMOP2). Reliability was determined by a test-retest. The “patient acceptable symptomatic state” (PASS) was determined by the percentile method. Results Validation involved 1022 participants (55% with confirmed covid-19, 79% female and 12.5% hospitalised for covid-19). The long covid ST and IT scores were strongly correlated with the EQ-5D-5L (r s = −0.45 and r s = −0.59 respectively), the PCFS (r s = −0.39 and r s = −0.55), and the MYMOP2 (r s = −0.40 and r s = −0.59). Reproducibility was excellent with an interclass correlation coefficient of 0.83 (95% confidence interval 0.80 to 0.86) for the ST score and 0.84 (0.80 to 0.87) for the IT score. In total, 793 (77.5%) patients reported an unacceptable symptomatic state, thereby setting the PASS for the long covid IT score at 30 (28 to 33). Conclusions The long covid ST and IT tools, constructed from patients’ lived experiences, provide the first validated and reliable instruments for monitoring the symptoms and impact of long covid. Short summary We developed the long covid Symptom and Impact Tools (ST and IT) from the experiences of 492 patients, captured during a survey with open-ended questions, and assessed their validity and reliability in a sample of 1022 patients with long covid.

Corticosteroids are associated with increased survival in elderly presenting severe SARS-Cov2 infection (preprint)

To assess the effectiveness of corticosteroids among elderly patients with COVID-19 pneumonia requiring oxygen. Design Comparative observational study based on routine care data. Baseline characteristics of patients were balanced using propensity-score inverse probability of treatment weighting. Setting Geriatric and infectious diseases wards from 36 hospitals in France and Luxembourg. Participants Adults [≥] 80 years old PCR confirmed SARS-CoV-2 infection or typical CT-scan images, requiring oxygen [≥] 3L/min and with an inflammatory syndrome (C-reactive protein [≥] 40mg/L). Measurements The primary outcome was overall survival at day 14. The secondary outcome was the proportion of patients discharged from hospital to home/rehabilitation on day 14. Adverse events were abstracted from electronic health records. Results Among the 267 patients included in the analysis, 96 were assigned to the treatment group. Median age was 86, interquartile range 83 to 90 and 95% had a SARS-CoV-2 PCR-confirmed diagnosis. Use of corticosteroids was significantly associated with an increased survival (weighted hazard ratio [wHR] 0.66, 95% CI 0.44 to 0.97). There was no significant difference between the treatment and control groups regarding the proportion of patients discharged to home/rehabilitation at day 14 (wRR 1.11, 95% CI 0.68 to 1.81). Twenty-two (16.7%) patients receiving corticosteroids developed adverse events while only 11 (6.4%) from the control group did. Conclusions Corticosteroids were associated with a significant increase the day-14 overall survival of patients over 80 years old hospitalized for severe COVID-19.

Association between corticosteroids and intubation or death among patients with COVID-19 pneumonia in non-ICU settings: an observational study using of real-world data from 51 hospitals in France and Luxembourg (preprint)

Objective To assess the effectiveness of corticosteroids on outcomes of patients with mild COVID-19 pneumonia. Methods We used routine care data from 51 hospitals in France and Luxembourg to assess the effectiveness of corticosteroids at 0.8 mg/kg/day eq. prednisone (CTC group) vs standard of care (no-CTC group) among patients [≤] 80 years old with COVID-19 pneumonia requiring oxygen without mechanical ventilation. The primary outcome was intubation or death at Day 28. Baseline characteristics of patients were balanced using propensity score inverse probability of treatment weighting. Results Among the 891 patients included in the analysis, 203 were assigned to the CTC group. At day 28, corticosteroids did not reduce the rate of the primary outcome (wHR 0.92, 95% CI 0.61 to 1.39) nor the cumulative death rate (wHR 1.03, 95% CI 0.54 to 1.98). Corticosteroids significantly reduced the rate of the primary outcome for patients requiring oxygen [≥] at 3L/min (wHR 0.50, 95% CI 0.30 to 0.85) or C-Reactive Protein (CRP) [≥] 100mg/L (wHR 0.44, 95%CI 0.23 to 0.85). We found a higher number of hyperglycaemia events among patients who received corticosteroids, but number of infections were similar across the two groups. Conclusions We found no association between the use of corticosteroids and intubation or death in the broad population of patients [≤]80 years old with COVID-19 hospitalized in non-ICU settings. However, the treatment was beneficial for patients with [≥] 3L/min oxygen or CRP [≥] 100mg/L at baseline. These data support the need to confirm the right timing of corticosteroids for patients with mild COVID.

Knowledge and attitude toward COVID-19 among healthcare workers at District 2 Hospital, Ho Chi Minh City

Objective: To assess the knowledge and attitude toward coronavirus disease-2019 (COVID-19) among healthcare workers at District 2 Hospital in Ho Chi Minh City (HCMC). Methods: A cross-sectional study was performed between January 2020 and February 2020 at District 2 Hospital. A systematic random sampling strategy was carried out and the data was collected through a self-administered questionnaire of the knowledge and attitude of healthcare workers regarding COVID-19. Descriptive analysis was reported to describe the demographic, mean knowledge and attitude score of healthcare workers. Inferential statistics including t-test, ANOVA and Spearman's correlation were used to evaluate the relationship between study variables. Results: A total of 327 eligible healthcare workers had a mean score of knowledge and attitude of 8.17±1.3 (range 4-10) and 1.86±0.43 (range 1-5), respectively. They showed good knowledge and a positive attitude. However, approximately two thirds of the participants knew the mode of transmission, the isolation period and treatment (67.0%, 65.8%, and 58.4%, respectively), and 82.3% and 79.8%, respectively, held positive attitude regarding the risk of personal and family members getting illness. There was a negative correlation between knowledge scores and attitude scores (r=-0.21, P<0.001). Additionally, healthcare workerspredominately used social media to inform themselves about COVID-19 (91.1%). Conclusions: The majority of healthcare workers had good knowledge and positive attitude toward COVID-19. However, the level of some knowledge and attitude lower than that expected for their position level towards the virus. Additional education interventions and campaigns are required for healthcare workers.