Synergistic influence of air temperature and vaccination on COVID-19 transmission and mortality in 146 countries or regions.

OBJECTIVE: We aimed to determine the influence of vaccination and air temperature on COVID-19 transmission and severity. METHODS: The study data in 146 countries from January 6, 2020 to July 28, 2022 were aggregated into 19,856 weeks. Country-level weekly incidence, time-varying reproduction number (Rt), mortality, and infection-fatality ratio (IFR) were compared among groups of these weeks with different vaccination rates and air temperatures. RESULTS: Weeks with <15 °C air temperature and 60% vaccination showed the highest incidence (mean, 604; SD, 855; 95% CI, 553-656, unit, /100,000 persons; N = 1073) and the highest rate of weeks with >1 Rt (mean, 41.6%; SD, 1.49%; 95% CI, 39.2-45.2%; N = 1090), while weeks with >25 °C and <20% showed the lowest incidence (mean, 24; SD, 75; 95% CI, 22-26; N = 5805) and the lowest rate of weeks with >1 Rt (mean, 15.3%; SD, 0.461%; 95% CI, 14.2-16.2%; N = 6122). Mortality in weeks with <15 °C (mean, 2.1; SD, 2.8; 95% CI, 2.0-2.2, unit, /100,000 persons; N = 4365) was five times of the mortality in weeks with >25 °C (mean, 0.44; SD, 1; 95% CI, 0.41-0.46; N = 7741). IFR ranged between 2% and 2.6% (SD, 1.9%-2.4%; 95% CI, 2.0-2.7%) at < 20% vaccination level, 1.8% (SD, 2%-2.2%; 95% CI, 1.7-2.0%) at 20-60% vaccination level, and 0.7%-1% (SD, 1%-1.8%; 95% CI, 0.7-1.1%) at > 60% vaccination level and at all air temperatures (all P < 0.001). CONCLUSIONS: Vaccination was insufficient to mitigate the transmission since the significantly elevated weekly incidence and >1 Rt rate in weeks with high vaccination, while IFR was reduced by high vaccination. Countries with long-term low air temperature were affected by high transmission and high mortality.

The Inflammatory Factors Associated with Disease Severity to Predict COVID-19 Progression.

Coronavirus disease 2019 (COVID-19) is associated with immune dysregulation and cytokine storm. Exploring the immune-inflammatory characteristics of COVID-19 patients is essential to reveal pathogenesis and predict progression. In this study, COVID-19 patients showed decreased CD3+, CD4+, and CD8+ T cells but increased neutrophils in circulation, exhibiting upregulated neutrophil-to-lymphocyte and neutrophil-to-CD8+ T cell ratio. IL-6, TNF-α, IL-1ß, IL-18, IL-12/IL-23p40, IL-10, Tim-3, IL-8, neutrophil extracellular trap-related proteinase 3, and S100A8/A9 were elevated, whereas IFN-γ and C-type lectin domain family 9 member A (clec9A) were decreased in COVID-19 patients compared with healthy controls. When compared with influenza patients, the expressions of TNF-α, IL-18, IL-12/IL-23p40, IL-8, S100A8/A9 and Tim-3 were significantly increased in critical COVID-19 patients, and carcinoembryonic Ag, IL-8, and S100A8/A9 could serve as clinically available hematologic indexes for identifying COVID-19 from influenza. Moreover, IL-6, IL-8, IL-1ß, TNF-α, proteinase 3, and S100A8/A9 were increased in bronchoalveolar lavage fluid of severe/critical patients compared with moderate patients, despite decreased CD4+ T cells, CD8+ T cells, B cells, and NK cells. Interestingly, bronchoalveolar IL-6, carcinoembryonic Ag, IL-8, S100A8/A9, and proteinase 3 were found to be predictive of COVID-19 severity and may serve as potential biomarkers for predicting COVID-19 progression and potential targets in therapeutic intervention of COVID-19.

Delayed-phase thrombocytopenia in patients with coronavirus disease 2019 (COVID-19).

Coronavirus disease 2019 (COVID-19) can affect the haematopoietic system. Thrombocytopenia at admission was prevalent, while late-phase or delayed-phase thrombocytopenia (occurred 14 days after symptom onset) is rare. This retrospective, single-centre study screened 450 COVID-19 patients and enrolled 271 patients at the Union Hospital, Wuhan, China, from January 25 to March 9, 2020. COVID-19-associated delayed-phase thrombocytopenia occurred in 11·8% of enrolling patients. The delayed-phase thrombocytopenia in COVID-19 is prone to develop in elderly patients or patients with low lymphocyte count on admission. The delayed-phase thrombocytopenia is significantly associated with increased length of hospital stay and higher mortality rate. Delayed-phase nadir platelet counts demonstrated a significantly negative correlation with B cell percentages. We also provided and described bone marrow aspiration pathology of three patients with delayed-phase thrombocytopenia, showing impaired maturation of megakaryocytes. We speculated that immune-mediated platelet destruction might account for the delayed-phase thrombocytopenia in a group of patients. In addition, clinicians need to pay attention to the delayed-phase thrombocytopenia especially at 3-4 weeks after symptom onset.

CSC Expert Consensus on Principles of Clinical Management of Patients With Severe Emergent Cardiovascular Diseases During the COVID-19 Epidemic.

In response to the outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, the Chinese Society of Cardiology (CSC) issued this consensus statement after consulting with 125 medical experts in the fields of cardiovascular disease and infectious disease. The over-arching principles laid out here are the following: 1) Consider the prevention and control of COVID-19 transmission as the highest priority, including self-protection of medical staff; 2) Patient risk assessment of both infection and cardiovascular issues. Where appropriate, preferential use of conservative medical therapeutic approaches to minimize disease spread; 3) At all times, medical practices and interventional procedures should be conducted in accordance with the directives of the infection control department of local hospitals and local health commissions.