Magnitude, global variation, and temporal development of the COVID-19 infection fatality burden

How deadly is an infection with SARS-CoV-2 worldwide over time? This information is critical for developing and assessing public health responses on the country and global levels. However, imperfect data have been the most limiting factor for estimating the COVID-19 infection fatality burden during the first year of the pandemic. Here we leverage recently emerged compelling data sources and broadly applicable modeling strategies to estimate the crude infection fatality rate (cIFR) in 77 countries from 28 March 2020 to 31 March 2021, using 2.4 million reported deaths and estimated 435 million infections by age, sex, country, and date. The global average of all cIFR estimates is 1.2% (10th to 90th percentile: 0.2% to 2.4%). The cIFR varies strongly across countries, but little within countries over time, and it is often lower for women than men. Cross-country differences in cIFR are largely driven by the age structures of both the general and the truly infected population. While the broad trends and patterns of the cIFR estimates are more robust, we show that their levels are uncertain and sensitive to input data and modeling choices. In consequence, increased efforts at collecting high-quality data are essential for accurately estimating the cIFR, which is a key indicator for better understanding the health and mortality consequences of this pandemic.

Evaluation of Nutritional Status and Correlation with Postoperative Complications in Elderly Patients Submitted to Surgical Treatment of Proximal Femoral Fractures.

Objective This study aims to evaluate and correlate the nutritional status with potential complications during the immediate postoperative period of elderly patients surgically treated for proximal femoral fractures. Methods A prospective, cross-sectional analytical study with a quantitative approach, targeting patients aged 60 years old or more who were admitted to a hospital in Amazonas, Brazil, for surgical treatment of proximal femoral fractures. Surgical complications during the immediate postoperative period and their relationship with the nutritional status of the patient were determined using the mini nutritional assessment (MNA); in addition, the lymphocyte numbers and serum albumin levels were determined and correlated with the length of hospital stay. Results The sample consisted of 19 elderly patients, of both genders, with a mean age of 70.8 years. Most of the subjects (68.4%) were female. Malnutrition was diagnosed in 15.8% of the subjects using the body mass index (BMI) as, an anthropometric variable, and the MNA identified 31.6% of the subjects with malnutrition. Regarding total lymphocyte count, 100% of the sample showed a positive association with malnutrition in varying degrees; using serum albumin level as a parameter, malnutrition was identified in 89.4% of the subjects. Malnourished patients had the highest average length of stay. Surgical complications as surgical site infections occurred in 10.5% of the patients at risk of malnutrition. Conclusion This study revealed a higher rate of postoperative complications in elderly patients diagnosed with malnutrition.

Evaluation of Nutritional Status and Correlation with Postoperative Complications in Elderly Patients Submitted to Surgical Treatment of Proximal Femoral Fractures / Avaliação do estado nutricional e correlação com complicações cirúrgicas em pacientes idosos submetidos a tratamento cirúrgico de fratura do fêmur proximal

Abstract Objective This study aims to evaluate and correlate the nutritional status with potential complications during the immediate postoperative period of elderly patients surgically treated for proximal femoral fractures. Methods A prospective, cross-sectional analytical study with a quantitative approach, targeting patients aged 60 years old or more who were admitted to a hospital in Amazonas, Brazil, for surgical treatment of proximal femoral fractures. Surgical complications during the immediate postoperative period and their relationship with the nutritional status of the patient were determined using the mini nutritional assessment (MNA); in addition, the lymphocyte numbers and serum albumin levels were determined and correlated with the length of hospital stay. Results The sample consisted of 19 elderly patients, of both genders, with a mean age of 70.8 years. Most of the subjects (68.4%) were female. Malnutrition was diagnosed in 15.8% of the subjects using the body mass index (BMI) as, an anthropometric variable, and the MNA identified 31.6% of the subjects with malnutrition. Regarding total lymphocyte count, 100% of the sample showed a positive association with malnutrition in varying degrees; using serum albumin level as a parameter, malnutrition was identified in 89.4% of the subjects. Malnourished patients had the highest average length of stay. Surgical complications as surgical site infections occurred in 10.5% of the patients at risk of malnutrition. Conclusion This study revealed a higher rate of postoperative complications in elderly patients diagnosed with malnutrition.

Resumo Objetivo Avaliar e correlacionar o estado nutricional com possíveis complicações no pós-operatório imediato de pacientes submetidos a tratamento cirúrgico de fraturas de fêmur proximal. Métodos Estudo transversal prospectivo analítico e de abordagem quantitativa, tendo como população-alvo pacientes com idade igual ou superior a 60 anos, internados em uma instituição hospitalar no Amazonas, submetidos a tratamento cirúrgico de fraturas de fêmur proximal. Foram avaliadas as complicações cirúrgicas no pós-operatório imediato e sua relação com o estado nutricional através da mini avaliação nutricional (MAN), assim como a mensuração da contagem de linfócitos e albumina e a sua correlação com o tempo de internação. Resultados A amostra foi composta por 19 pacientes idosos, de ambos os sexos, com média de idade de 70,8 anos. A maioria dos pacientes (68,4%) eram do sexo feminino. Por meio da variável antropométrica índice de massa corporal (IMC), identificou-se a presença de desnutrição em 15,8% dos pacientes e, por meio da MAN, de 31,6%. Na avaliação do cálculo da contagem total de linfócitos, 100% da amostra apresentou associação positiva com desnutrição em graus variáveis e, fazendo-se uso da albumina sérica como parâmetro, a desnutrição foi identificada em 89,4%. Os pacientes desnutridos apresentaram a maior média de tempo de internação. As complicações cirúrgicas, por infecções do sítio cirúrgico, ocorreram em 10,5% nos pacientes em risco nutricional. Conclusão Neste estudo, observou-se maior índice de complicações no pós-operatório em idosos diagnosticados com desnutrição.

COVeAGE-DB: A database of age-structured COVID-19 cases and deaths.

COVerAGE-DB is an open-access database including cumulative counts of confirmed COVID-19 cases, deaths, and tests by age and sex. The main goal of COVerAGE-DB is to provide a centralized, standardized, age-harmonized, and fully reproducible database of COVID-19 data. Original data and sources are provided alongside data and measures in age-harmonized formats. An international team, composed of more than 60 researchers, contributed to the collection of data and metadata in COVerAGE-DB from governmental institutions, as well as to the design and implementation of the data processing and validation pipeline. The database is still in development, and at this writing, it includes 89 countries, and 237 subnational areas. Cumulative counts of COVID-19 cases, deaths, and tests are recorded daily (when possible) since January 2020. Many time series thus fully capture the first pandemic wave and the beginning of later waves. Since collection efforts began for COVerAGE-DB several studies have used the data.

Global years of life lost to COVID-19

Understanding the mortality impact of COVID-19 requires not only counting the dead, but analyzing how premature the deaths are. We calculate years of life lost (YLL) across 42 countries due to COVID-19 attributable deaths, and also conduct an analysis based on estimated excess deaths. As of June 13th 2020, YLL in heavily affected countries are 2 to 6 times the average seasonal influenza; over two thirds of the YLL result from deaths in ages below 75 and one quarter from deaths below 55; and men have lost 47% more life years than women. The results confirm the large mortality impact of COVID-19 among the elderly. They also call for heightened awareness in devising policies that protect vulnerable demographics losing the largest number of life-years. One Sentence SummaryAcross 42 countries, the years of life lost due to COVID-19 are up to 6 times that of the average seasonal flu.

Monitoring trends and differences in COVID-19 case fatality rates using decomposition methods: Contributions of age structure and age-specific fatality

The population-level case-fatality rate (CFR) associated with COVID-19 varies substantially, both across countries time and within countries over time. We analyze the contribution of two key determinants of the variation in the observed CFR: the age-structure of diagnosed infection cases and age-specific case-fatality rates. We use data on diagnosed COVID-19 cases and death counts attributable to COVID-19 by age for China, Germany, Italy, South Korea, Spain, the United States, and New York City. We calculate the CFR for each population at the latest data point and also for Italy over time. We use demographic decomposition to break the difference between CFRs into unique contributions arising from the age-structure of confirmed cases and the age-specific case-fatality. In late April 2020, CFRs varied from 2.2% in South Korea to 13.0% in Italy. The age-structure of detected cases often explains more than two thirds of cross-country variation in the CFR. In Italy, the CFR increased from 4.2% to 13.0% between March 9 and April 22, 2020, and more than 90% of the change was due to increasing age-specific case-fatality rates. The importance of the age-structure of confirmed cases likely reflects several factors, including different testing regimes and differences in transmission trajectories; while increasing age-specific case-fatality rates in Italy could indicate other factors, such as the worsening health outcomes of those infected with COVID-19. Our findings lend support to recommendations for data to be disaggregated by age, and potentially other variables, to facilitate a better understanding of population-level differences in CFRs. They also show the need for well designed seroprevalence studies to ascertain the extent to which differences in testing regimes drive differences in the age-structure of detected cases.

Stimulated saliva flow rate patterns in children: A six-year longitudinal study.

OBJECTIVE: To find out whether the stimulated saliva flow rate (SSFR) is a variable and unpredictable characteristic as healthy children grow-up. DESIGN: Seven-year-old school children (53 boys and 57 girls) were recruited to measure their SSFR in mL/min. Paraffin-stimulated saliva was collected from each child at baseline and once annually, over six years. Forty-four boys and 46 girls remained in the cohort (dropout rate 18%). Cluster analysis was applied to evaluate the natural grouping of individuals according to their SSFR. Partition analysis was applied to calculate the SSFR cut-off value to predict a child's salivation trend. RESULTS: Cluster analysis revealed that as they grew-up these children consistently showed one of three different SSFR patterns. The cut-off values to predict a child's salivation trend were 1.76 mL/min for the high SSFR cluster, and 0.5 mL/min for the low SSFR cluster. CONCLUSIONS: These findings indicate that a high or low SSFR is a constant individual trait in children.