Presumed Asymptomatic Carrier Transmission of COVID-19

Embracing Controversy: A Second Look at CDC Reform Efforts in the Wake of COVID-19

The US Centers for Disease Control and Prevention (CDC) has responded to criticism claiming that the agency's COVID-19 response was lacking by proposing internal reforms intended to improve its performance during the next pandemic. The reforms are aimed at improving surveillance, analytic capacity, and agency communications. This article conducts a counterfactual analysis of the CDC's proposed reforms to ask how they might have changed outcomes in four cases of guidance controversy during the pandemic if they had been completed in advance of COVID-19. Although the CDC's planned reforms have merit, they are predicated on the ability to come to scientific closure in a highly charged political environment. To improve outcomes in a future pandemic, the agency should consider how it plans to communicate with the public when recovering from error and when addressing controversy spurred by criticism from credible experts. However, the ability of future presidents to limit CDC performance and communications in the next pandemic and the lack of political consensus around the value of independent public health expertise are likely to threaten any effort to improve pandemic response.

Acute type A aortic dissection patients undergoing surgical repair during the COVID-19 pandemic

BACKGROUND

Acute type A aortic dissection (ATAAD) is a deadly form of acute aortic syndrome which necessitates emergency surgical repair. Coronavirus disease-19 (COVID-19) pandemic has caused a significant impact on surgery globally. The influence of the COVID-19 pandemic on ATAAD patients undergoing surgical repair remains undetermined.

METHODS

We conducted a systematic review and meta-analysis of studies comparing ATAAD patients undergoing aortic surgery before versus during the COVID-19 pandemic and literature review of published cases reporting COVID-19 patients undergoing surgical repair for ATAAD. PubMed, China National Knowledge Infrastructure, VIP, WANFANG, and SinoMed databases were searched for relevant studies and case reports till January 21st, 2023, and the database search was updated on January 3rd, 2024. Meta-analysis was performed by utilizing RevMan. Pooled odds ratio (OR) and 95% confidence interval (CI) were estimated for dichotomous data, and weighted mean difference (WMD) and 95% CI for continuous data, respectively. All P-values were 2-sided and statistical significance was defined as P < .05.

RESULTS

Meta-analysis of 5 included studies comparing ATAAD patients undergoing aortic surgery before versus during the COVID-19 pandemic demonstrated that, the patients in Group During-Pandemic (DP) were older than those in Group Before-Pandemic (BP; P = .005), and the body mass index of the patients in Group DP was lower than that of the patients in Group BP (P = .002), more patients in Group DP were smokers (P = .02). Meta-analysis also showed that, either the composite incidence of mortality and morbidities or individual morbidity was comparable between 2 groups, except that more patients in Group DP developed pneumonia (P = .05). Literature reviews of 24 published cases reporting COVID-19 patients undergoing surgical repair for ATAAD demonstrated that, twenty (83.3%) patients recovered well after aortic surgery and were finally discharged from hospital. Unfortunately, 4 patients died postoperatively, 3 due to multiple organ failure and one due to respiratory failure (RF). Reported postoperative complications included hypoxia, endotracheal re-intubation, RF, renal failure, coagulopathy, fever, multi-organ failure and shock.

CONCLUSION

The hospitalized outcomes of ATAAD patients undergoing surgical repair before versus during the COVID-19 were mostly comparable. ATAAD patients with concomitant COVID-19 infection who underwent emergent surgical repair had a high risk of mortality and morbidities.

Jerusalem's CoVID-19 Experience-The Effect of Ethnicity on Disease Prevalence and Adherence to Testing

BACKGROUND

The management of the SARS-CoV-2 pandemic depends amongst other factors on disease prevalence in the general population. The gap between the true rate of infection and the detected rate of infection may vary, especially between sub-groups of the population. Identifying subpopulations with high rates of undetected infection can guide authorities to direct resource distribution in order to improve health equity.

METHODS

A cross-sectional epidemiological survey was conducted between April and July 2021 in the Pediatric Emergency Department of the Shaare Zedek Medical Center, Jerusalem, Israel. We compared three categories: unconfirmed disease (UD), positive serology test result with no history of positive PCR; confirmed disease (CD), history of a positive PCR test result, regardless of serology test result; and no disease (ND), negative serology and no history of PCR. These categories were applied to local prevailing subpopulations: ultra-orthodox Jews (UO), National Religious Jews (NRJ), secular Jews (SJ), and Muslim Arabs (MA).

RESULTS

Comparing the different subpopulations groups, MAs and UOs had the greatest rate of confirmed or unconfirmed disease. MA had the highest rate of UD and UO had the highest rate of CD. UD significantly correlated with ethnicity, with a low prevalence in NRJ and SJ. UD was also associated with larger family size and housing density defined as family size per number of rooms.

CONCLUSION

This study highlights the effect of ethnicity on disease burden. These findings should serve to heighten awareness to disease burden in weaker populations and direct a suitable prevention program to each subpopulation's needs. Early awareness and possible intervention may lower morbidity and mortality.

Mapping the viral battlefield: SARS-CoV-2 infection dynamics among healthcare workers in Brazil

BACKGROUND

Understanding the dynamics of SARS-CoV-2 viral infection and factors associated with in-hospital transmission rates among healthcare workers (HCW) is crucial for their protection. Brazil experienced high mortality rates due to COVID-19, and limited data are available on transmission of SARS-CoV-2 infection among HCW. This cohort study aimed to assess the dynamic of SARS-CoV-2 infections in HCW from two tertiary hospitals in central Brazil, one of them a Reference Hospital for COVID-19.

METHODS

From May 2020 to January 2021, 554 HCW directly involved with COVID-19 care were followed through 12 biweekly visits. During these visits, blood, nasal, and oropharyngeal samples were collected, and participants underwent interviews. SARS-CoV-2 detection was carried out using RT-qPCR, while the assessment of seroprevalence was based on IgG detection. Additionally, 35 positive samples underwent viral whole-genome sequencing.

RESULTS

The infection prevalence, as per RT-qPCR, was 28.5% (24.9-32.4), reflecting an overall attack rate ranging from 0.5% to 9.5%, marked by two peaks in August and December 2020. Oligosymptomatic and asymptomatic infections accounted for 14% of prevalent infections. The seroprevalence rate stood at 25.8%. The hospitalization rate was 8.2%, with a fatality rate of 1.3%. Risk factors associated with a positive diagnosis of COVID-19 included being male, working at the referral hospital, having a graduate-education level, and using hydroxychloroquine and zinc for prevention or treatment. One reinfection was identified. Absenteeism was 56.6%. The infection dynamics mirrored the pattern observed in the general population.

CONCLUSION

One-third of the professionals in the followed cohort were infected. Being male, working in a COVID-19 referral center, having a low level of education, and using medications for preventive treatment represented risk factors. Healthcare workers at the COVID-19 referral hospital exhibited a higher incidence rate compared to those at the non-referral hospital, increasing the plausibility that some of the infections occur in the hospital environment.

Pandemic Times and Health Care Exclusion: Attitudes toward Health Care Exclusion of Undocumented Immigrants

CONTEXT

Most of the 11 million undocumented immigrants living in the United States are excluded from government health care programs. Yet, health care inequities pose significant dangers to all members of society during a pandemic. This project explores to what extent undocumented immigrants, in the context of a pandemic, can be seen as deserving of access to government health care programs.

METHODS

The project's first survey experiment explores whether work ethic can affect perceptions of undocumented immigrants as deserving of government health care programs. The second survey experiment tests to what extent appeals to fairness and self-interest, during a pandemic, shape health care deservingness attitudes.

FINDINGS

The results show that respondents view undocumented immigrants as less deserving of health care than citizens, even when undocumented immigrants have a solid work history. The second survey experiment, however, shows that appeals to fairness and self-interest trigger substantial increases in support for undocumented immigrants among both Republicans and Democrats.

CONCLUSIONS

The results suggest that while undocumented immigrants are seen as less deserving of access, appeals to fairness and self-interest can trigger increased support.

3D modelling and simulation of thermal effects and dispersion of particles carrying infectious respiratory agents in a railway transport coach

Even though the COVID-19 pandemic now belongs to the long history of infectious diseases that have struck humanity, pathogenic biological agents continue to pose a recurring threat in private places, but also and mainly in places where the public congregates. In our recent research published in this journal in 2022 and 2023, we considered the illustrative example of a commuter train coach in which a symptomatic or asymptomatic passenger, assumed to be infected with a respiratory disease, sits among other travellers. The passenger emits liquid particles containing, for example, COVID-19 virions or any other pathogen. The size spectrum of particles varies depending on whether they are produced during breathing, speaking, coughing or sneezing. More specifically, droplets associated with breathing are in the range of 1-10 µm in aerodynamic diameter, while at the other end of the spectrum, drops associated with coughing can reach 100-1000 µm. In the first part of our research, we used Computational Fluid Dynamics (CFD) to model and simulate in 3D the transport and dispersion of particles from 1 µm to 1 mm in the turbulent flow generated by the ventilation of the railway coach. We used both the Eulerian approach and the Lagrangian approach and showed that the results were strictly similar and illustrated the very distinct aerodynamics, on one hand, of the aerosol of droplets suspended in the air and, on the other hand, of the drops falling or behaving like projectiles depending on their initial speed. In the second part of our research, we developed a model of filtration through a typical surgical mask and possible leaks around the mask if it is poorly adjusted. We resumed the twin experiment of the railway coach and compared the distribution of droplets depending on whether the passengers (including the infected one) wear masks or not and whether the masks are perfectly fitted or worn loosely. Our method made it possible to quantify the particles suspended in the air of the railway coach depending on whether the infected passenger wore their mask more or less well. In this third article, we specifically explore how thermal effects due to the presence of passengers influence the spatio-temporal distribution in the railway coach of aerosols produced by the breathing infected person. We demonstrate that the influence of thermal effects on aerodynamics is very significant and can be very favourable for air decontamination if the ventilation system is judiciously configured. Beyond its application to a commuter train, our work confirms the value of validated CFD tools for describing the airflow and dispersion of particles in complex spaces that do not always allow experimentation. The models that we have developed are applicable to any other semi-confined, ventilated public place, such as a classroom, a hospital room or a performance hall, and they enable the objective assessment of whether the occupation of these spaces could be critical with regard to infectious contamination and of how to limit this ubiquitous risk.

A narrative review focusing on randomized clinical trials of vitamin D supplementation for COVID-19 disease

Current evidence is inconsistent on whether vitamin D supplementation can prevent COVID-19 infection or improve its clinical outcomes. To better understand and look into the issue, we went through the background knowledge of COVID-19 and vitamin D, searched in Pubmed [by using key words in the title containing "randomized clinical trial", "COVID-19", and "vitamin D (25-hydroxyvitamin D, or cholecalciferol, or calcidiol, or calcifediol) supplementation"] for publications of studies on vitamin D/supplementation in COVID-19 patients, especially those about the randomized clinical trials (RCTs). After reviewing these papers, we did a short background review of vitamin D and the pathophysiology of COVID-19, summarized the key features of the 25 RCTs in text and tabulated in a table of some of the features, commented, compared and discussed the differences between RCTs (for example, change the serum 25-hydroxyvitamin D concentration from nmol/L to ng/mL, making the comparison easier). The take-home question of the review is that serum 25-hydroxyvitamin D concentration is an important indicator of the supplementation effect of vitamin D correction but may not be reliable in predicting the supplementation effect on the clinical outcomes of COVID-19.

A bidirectional Mendelian randomization analysis between COVID-19 and cardiac arrest

Epidemiological studies link COVID-19 to increased cardiac arrest (CA) risk, but causality remains unclear due to potential confounding factors in observational studies . We conducted a Mendelian randomization (MR) analysis using genome-wide association study (GWAS) data, employing COVID-19-associated single nucleotide polymorphisms (SNPs) with significance values smaller than 5 × 10⁻⁸. We calculated inverse-variance weighted (IVW) MR estimates and performed sensitivity analyses using MR methods robust to horizontal pleiotropy. Additionally, a reverse MR analysis was conducted using CA-associated SNPs with significance values smaller than 1 × 10⁻⁵. Results indicated that infected COVID-19 (OR = 1.12, 95% CI = 0.47-2.67, p = 0.79), hospitalized COVID-19 (OR = 1.02, 95% CI = 0.70-1.49, p = 0.920), and severe respiratory COVID-19 (OR = 0.99, 95% CI = 0.81-1.21, p = 0.945) did not causally influence CA risk. Reverse MR analysis also did not support a causal effect of CA on COVID-19. Thus, associations in observational studies may stem from shared biological factors or environmental confounding.

SARS-CoV-2 Infections in a Triad of Primary School Learners (Grades 1-7), Their Parents, and Teachers in KwaZulu-Natal, South Africa: Protocol for a Cross-Sectional and Nested Case-Cohort Study

BACKGROUND

In low- and middle-income countries (LMICs) such as South Africa, there is paucity of data on SARS-CoV-2 infections among children attending school, including seroprevalence and transmission dynamics.

OBJECTIVE

This pilot study aims to assess (1) the prevalence of self-reported or confirmed SARS-CoV-2 prior infections, COVID-19 symptoms (including long COVID), seroprevalence of SARS-CoV-2 antibodies, and general/mental health, (2) longitudinal changes in SARS-CoV-2 seroprevalence, and (3) SARS-CoV-2 acute infections, immune responses, transmission dynamics, and symptomatic versus asymptomatic contacts in a unique cohort of unvaccinated primary school learners, their parents, teachers, and close contacts in semirural primary school settings.

METHODS

Learners (grades 1-7) from primary schools in KwaZulu-Natal, South Africa, their parents, and teachers will be invited to enroll into the COVID kids school study (CoKiDSS). CoKiDSS comprises 3 parts: a cross-sectional survey (N=640), a follow-up survey (n=300), and a nested case-cohort substudy. Finger-prick blood and saliva samples will be collected for serological and future testing, respectively, in the cross-sectional (451 learners:147 parents:42 teachers) and follow-up (210 learners:70 parents:20 teachers) surveys. The nested case-cohort substudy will include cases from the cross-sectional survey with confirmed current SARS-CoV-2 infection (n=30) and their close contacts (n=up to 10 per infected participant). Finger-prick blood (from all substudy participants), venous blood (from cases), and nasal swabs (from cases and contacts) will be collected for serological testing, immunological testing, and viral genome sequencing, respectively. Questionnaires covering sociodemographic and general and mental health information, prior and current SARS-CoV-2 symptoms and testing information, vaccination status, preventative behavior, and lifestyle will be administered. Statistical methods will include generalized linear mixed models, intracluster correlation, descriptive analysis, and graphical techniques.

RESULTS

A total of 645 participants were enrolled into the cross-sectional survey between May and August 2023. A subset of 300 participants were followed up in the follow-up survey in October 2023. Screening of the participants into the nested case-cohort substudy is planned between November 2023 and September 2024. Data cleanup and analysis for the cross-sectional survey is complete, while those for the follow-up survey and nested case substudy will be completed by the third quarter of 2024. The dissemination and publication of results is anticipated for the fourth quarter of 2024.

CONCLUSIONS

This study provides data from an LMIC setting on the impact of SARS-CoV-2 on school-attending learners, their parents, and teachers 3 years after the SARS-CoV-2 pandemic was declared and 21-24 months after resumption of normal school attendance. In particular, this study will provide data on the prevalence of self-reported or confirmed SARS-CoV-2 prior infection, prior and current symptoms, seroprevalence, changes in seroprevalence, SARS-CoV-2 transmission, SARS-CoV-2 adaptive immune responses, and symptoms of long COVID and mental health among a triad of learners, their parents, and teachers.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52713.

Healthcare workers' well-being and perspectives on support during the COVID-19 pandemic: a systematic review and meta-synthesis of qualitative studies

BACKGROUND

Since the outbreak of the COVID-19 pandemic, healthcare workers (HCWs) have faced multiple difficulties in their work and personal lives. However, most of the quantitative reviews have focused on the extent of the pandemic's impact on the HCWs and have thus failed to fully capture the HCWs' experiences and the complexity of the problems they encountered. Therefore, this qualitative systematic review elucidates the HCWs' challenges brought about by the pandemic, their perceptions of the existing support and the support that require further attention.

METHODS

The literature search spanned five databases: Scopus, PubMed, Web of Science, CINAHL and PsycInfo, targeting qualitative studies of HCWs' pandemic experiences from December 2019 to December 2023. These studies underwent strict quality and relevance assessment, emphasising critical appraisal and selection. Findings were unified through meta-synthesis, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study was registered in PROSPERO.

RESULTS

This study analysed 29 qualitative studies on HCWs' experiences during the pandemic and their perceptions of support, identifying four themes of HCWs' physical and mental well-being, the impact of the pandemic on their professional and personal lives, their work environments and the support they received. These themes encompassed 8 main categories and 25 codes. The research revealed that the pandemic and work conditions negatively influenced their health, affecting their professional and personal lives. Current support has lessened the pandemic's effects on HCWs but should also address future requirements like long-term psychological support.

CONCLUSION

The studies identified the challenges faced by HCWs during the pandemic, and the existing support. However, due to the complex interactions between the work and environmental factors, the effectiveness of the existing support remains challenging. To improve their effectiveness, the future support should target the interactions between the HCWs and the work system.

PROSPERO REGISTRATION NUMBER

CRD42023426238.

An epidemiological model for analysing pandemic trends of novel coronavirus transmission with optimal control

Symptomatic and asymptomatic individuals play a significant role in the transmission dynamics of novel Coronaviruses. By considering the dynamical behaviour of symptomatic and asymptomatic individuals, this study examines the temporal dynamics and optimal control of Coronavirus disease propagation using an epidemiological model. Biologically and mathematically, the well-posed epidemic problem is examined, as well as the threshold quantity with parameter sensitivity. Model parameters are quantified and their relative impact on the disease is evaluated. Additionally, the steady states are investigated to determine the model's stability and bifurcation. Using the dynamics and parameters sensitivity, we then introduce optimal control strategies for the elimination of the disease. Using real disease data, numerical simulations and model validation are performed to support theoretical findings and show the effects of control strategies.

The Value of Common Laboratory Markers in Predicting the Severity of COVID-19 Patients

Purpose

The aim of the present study was to identify more effective laboratory markers to assess the severity of corona virus disease 2019 and predict the progression of the disease by collecting more laboratory markers and variables.

Patients and Methods

In this study, most risk factors, including epidemiological characteristics, blood cell counts, cytokines, and infection markers, were collected from 126 patients with COVID-19 to assess their predictive value.

Results

The area under curve (AUC) of Albumin (Alb) to fibrinogen (Fib) ratio (AFR) (0.791), Lactate dehydrogenase (LDH) (0.792), myoglobin (MYO) (0.795), C-reactive protein (CRP) (0.801) and lymphocyte count (0.859) were higher than other markers to distinguish severe from non-severe patients in receiver operating characteristic (ROC) analysis. In the univariate logistic regression analysis, thirty-six out of 46 risk factors, including 34 laboratory markers, were significantly associated with increased odds of severe patients. Multivariate logistic regression analysis showed that the CD19+ lymphocyte count, MYO, LDH, and AFR were associated with increased odds of severe disease. Moreover, Lymphocyte count and AFR levels increased, LDH and CRP levels decreased during hospitalization in recovered severe patients, whereas severe lymphocytopenia and continuously increasing LDH levels were observed in deteriorated patients. AFR level increased and CRP level decreased before the disease worsened in the deteriorated patients; however, when the patients deteriorated, AFR decreased and CRP increased significantly.

Conclusion

CD19+ lymphocyte count, MYO, LDH, and AFR are independent biomarkers for early identification of severe COVID-19. Lymphocyte count, AFR, LDH, and CRP levels were helpful in predicting the clinical progression of the disease.\.

Design and psychometrics of a tool for measuring social cognitive factors related to the preventive behaviors toward Covid-19 in the society

With the emergence of new strains of Covid-19, the adoption of preventive behaviors is still considered a requirement to control this disease. Therefore, considering the importance of social cognitive factors in adopting various types of preventive behaviors, the present study was conducted to design and psychometrically measure the social cognitive factors related to Covid-19 preventive behaviors. A cross-sectional study was conducted on 526 people ages 18 and over with multi-stage stratified, cluster and random sampling in Isfahan, Iran in 2022. The questionnaire was validated and formulated in three stages: designing, creating and reducing items. After collecting information and creating a bank of items, qualitative and quantitative methods were used to calculate the tool's validity. Data analysis was done in SPSS23 software at a significance level of less than 0.05. In the present study, the average age score of the participants was 39.16 ± 11.48. The results related to the construct validity in the exploratory part show that the five factors (Outcome expectations, self-efficacy, social support, self-regulation and barrier self-efficacy) obtained have a specific value higher than one and range from 1.376 to 9.343. Correlation between factors shows that all factors have a relatively high relationship with each other (P < 0.05). According to the exploratory factor analysis, the final questionnaire contains 29 items and 5 constructs from socio-cognitive theory. The results showed that the thematically and technically designed tool has been prepared in an appropriate way for each of the structures and can accurately measure the structures of outcome expectations, self-efficacy, social support, self-regulation and barrier self-efficacy to explain the preventive behaviors of Covid-19 to evaluate.

Preconcentration and detection of SARS-CoV-2 in wastewater: A comprehensive review

Severe acute respiratory syndrome coronaviruses 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) affected the health of human beings and the global economy. The patients with SARS-CoV-2 infection had viral RNA or live infectious viruses in feces. Thus, the possible transmission of SARS-CoV-2 through wastewater received great attentions. Moreover, SARS-CoV-2 in wastewater can serve as an early indicator of the infection within communities. We summarized the preconcentration and detection technology of SARS-CoV-2 in wastewater aiming at the complex matrices of wastewater and low virus concentration and compared their performance characteristics. We described the emerging tests that would be possible to realize the rapid detection of SARS-CoV-2 in fields and encourage academics to advance their technologies beyond conception. We concluded with a brief discussion on the outlook for integrating preconcentration and the detection of SARS-CoV-2 with emerging technologies.

Unraveling the impact of ORF3a Q57H mutation on SARS-CoV-2: insights from molecular dynamics

ORF3a is a conserved accessory protein of SARS-CoV-2, linked to viral infection and pathogenesis, with acquired mutations at various locations. Previous studies have shown that the occurrence of the Q57H mutation is higher in comparison to other positions in ORF3a. This mutation is known to induce conformational changes, yet the extent of structural alteration and its role in the viral adaptation process remain unknown. Here we performed molecular dynamics (MD) simulations of wt-ORF3a, Q57H, and Q57A mutants to analyze structural changes caused by mutations compared to the native protein. The MD analysis revealed that Q57H and Q57A mutants show significant structural changes in the dimer conformation than the wt-ORF3a. This dimer conformer narrows down the ion channel cavity, which reduces Na + or K + permeability leading to decrease the antigenic response that can help the virus to escape the host immune system. Non-bonding interaction analysis shows the Q57H mutant has more interacting residues, resulting in more stability within dimer conformation than the wt-ORF3a and Q57A. Moreover, both mutant dimers (Q57H and Q57A) form a novel salt-bridge interaction at the same position between A:Asp142 and B:Lys61, whereas such an interaction is absent in the wt-ORF3a dimer. We have also noticed that the TM3 domain's flexibility in Q57H is increased because of strong inter-domain interactions of TM1 and TM2 within the dimer conformation. These unusual interactions and flexibility of Q57H mutant can have significant impacts on the SARS-CoV-2 adaptations, virulence, transmission, and immune system evasion. Our findings are consistent with the previous experimental data and provided details information on the structural perturbation in ORF3a caused by mutations, which can help better understand the structural change at the molecular level as well as the reason for the high virulence properties of this variant.Communicated by Ramaswamy H. Sarma.

Controlling the first wave of the COVID-19 pandemic in Malawi: Results from a multi-round study

We investigated behavioral responses to COVID-19 in Malawi, where a first wave of the pandemic occurred between June and August 2020. Contrary to many countries on the African continent, the Government of Malawi did not impose a lockdown or a stay-at-home order in response to the initial spread of SARS-CoV-2. We hypothesized that, in the absence of such requirements to restrict social interactions, individuals would primarily seek to reduce the risk of SARS-CoV-2 transmission during contacts, rather than reduce the extent of their social contacts. We analyzed 4 rounds of a panel survey spanning time periods before, during and after the first wave of the COVID-19 pandemic in Malawi. Five hundred and forty-three participants completed 4 survey interviews between April and November 2020. We found that the likelihood of attending various places and events where individuals work and/or socialize remained largely unchanged during that time. Over the same time frame, however, participants reported adopting on a large scale several behaviors that reduce the transmissibility of SARS-CoV-2 during contacts. The percentage of panel participants who reported practicing physical distancing thus increased from 9.8% to 47.0% in rural areas between April-May 2020 and June-July 2020, and from 11.4% to 59.4% in urban areas. The percentage of respondents who reported wearing a facial mask to prevent the spread of SARS-CoV-2 also increased, reaching 67.7% among rural residents in August-September 2020, and 89.6% among urban residents. The pace at which these behaviors were adopted varied between population groups, with early adopters of mask use more commonly found among more educated office workers, residing in urban areas. The adoption of mask use was also initially slower among women, but later caught up with mask use among men. These findings stress the importance of behavioral changes in containing future SARS-CoV-2 outbreaks in settings where access to vaccination remains low. They also highlight the need for targeted outreach to members of socioeconomic groups in which the adoption of protective behaviors, such as mask use, might be delayed.

Factors Associated with Stress among Healthcare Personnel after COVID-19 in Northeast Thailand: A Cross-sectional Study

Background

The coronavirus disease (COVID-19) has affected people psychologically worldwide, particularly healthcare personnel. Even though the COVID-19 pandemic situation has eased, healthcare personnel must still perform their duties, which has resulted in psychological impacts, particularly stress.

Objectives

This study aimed to examine the risk factors associated with stress among healthcare personnel post-COVID-19 pandemic in northeast Thailand.

Methods

A cross-sectional analytic design was conducted from January to April 2023. One thousand and three hundred healthcare workers were selected from primary, secondary, and tertiary hospitals across 16 districts within Chaiyaphum province. The questionnaires were used to collect data, and the stress test 5 (ST-5) questionnaire was used to investigate stress among healthcare personnel.

Results

The overall stress rate for healthcare workers was 15.47%, including very severe (8.85%) and severe (6.62%). The factors associated with stress consisted of work position, environment of work, personal life such as education level and income, and responsibility for taking care of family members, in addition to experiencing quarantine from COVID-19 were more likely to have a high risk of stress problems among healthcare workers.

Conclusion

This result highlighted that the mental health of personnel should be in critical situations, and those found severely afflicted should undergo professional care. To prevent psychological issues, particularly stress, health organizations should be concerned with strong organizational management, which includes supporting bonuses and providing high-quality personal protective equipment (PPE) to healthcare staff.

Unspoken Consequences of Structural Racism in the USA: Diabetes and COVID-19

OBJECTIVES

Black, Indigenous, and People of Color (BIPOC) are disproportionately impacted by the diabetes epidemic. This health inequity, aggravated by environmental, lifestyle, and genetic factors, has been further exacerbated by the COVID-19 pandemic. The increased risk of severe complications due to COVID-19 in BIPOC communities speaks to the importance of understanding the impacts of social and structural factors on health. This report aims to outline the connection between diabetes and vulnerability to COVID-19 through the lens of racism.

STUDY DESIGN

Review of original report and subsequent modeling and interpretations.

METHODS

We reviewed and analyzed original data in relation to health inequity, diabetes, COVID-19, and BIPOC.

RESULTS

This holistic approach framed the disproportionate prevalence of diabetes and vulnerability to COVID-19 not just as a health disparity, but as a health inequity.

CONCLUSION

Defining the relationship between diabetes, vulnerability to COVID-19, and systems of advantage, such as racism, can further support the design of health interventions and policies that reduce the disproportionate impact of these diseases on the health of BIPOC communities.

Mortality and morbidity in critically ill COVID-19 patients: A systematic review and meta-analysis

BACKGROUND

The COVID-19 pandemic has caused 14.83 million deaths globally. This systematic review and meta-analysis aimed to provide a pooled estimate of the overall mortality and morbidity of critically ill COVID-19 patients.

METHOD

Four electronic databases, Medline/PubMed, the Cochrane Library, the WHO COVID-19 database, and the Web of Science, were used to identify relevant studies. Two authors independently screened the studies, evaluated the eligibility criteria and resolved discrepancies through discussion with the third author. The pooled effect size was computed using STATA software version 14. The Cochran Q test and I2 test were utilized to assess heterogeneity across the studies. Additionally, subgroup analysis, sensitivity analysis, and publication bias were evaluated. It is registered in Prospero with Prospero ID CRD42020212146.

RESULTS

A total of 1003 published articles were screened from various databases, and 24 studies involving a total of 142,291 critically ill COVID-19 participants were selected for inclusion in the review. Among the participants, 67 % were male, and the mean age was 63.43 + SD3.33 years. The mortality rate reported in the individual studies ranged from 4.5 % to 69.5 %. The findings from the analysis revealed that the overall pooled mortality rate was 34 % (95 % confidence interval: 31 %-37 %). Additionally, the findings showed that 62 % of critically ill COVID-19 patients required mechanical ventilation, while 68.7 % of these patients had chronic disease comorbidities.

CONCLUSION

Critically ill COVID-19 patients face a high-risk risk of death, with an estimate of about one in three patients dying from the virus. Notably, a substantial portion of critically ill COVID-19 patients (62 %) require mechanical ventilation; surprisingly, more than two-thirds of patients with COVID-19 have chronic disease comorbidities, highlighting the importance of managing comorbidities in this population.

Capsule Endoscopy for the Risk Stratification and Management of Acute Upper Gastrointestinal Bleeding in Emergency Departments: A Systematic Review on Triage, Risk Stratification, and Management

Gastrointestinal bleeding is a common occurrence in emergency departments. The standard of care for it is an esophagogastroduodenoscopy within 24 hours to diagnose and potentially treat the bleeding. Several tools and pre-endoscopic risk assessment scores are used to help evaluate and manage upper gastrointestinal bleeding. Additionally, capsule endoscopy provides a non-invasive method to visualize the gastrointestinal tract and identify lesions.  The aim of this review was to explore the role of capsule endoscopy in the triage, stratification, and management of upper gastrointestinal bleeding patients in the emergency department. Four databases, PubMed, Scopus, Embase, and the Cochrane Library, were searched using keywords related to capsule endoscopy and gastrointestinal bleeding in the emergency department. Studies were included if they assessed the use of capsule endoscopy in emergency settings for managing upper gastrointestinal bleeding. After screening titles, abstracts, and full texts and reviewing bibliographies for relevant articles, data on study design, participant demographics, capsule endoscopy procedure description, and outcomes were collected into a pre-designed spreadsheet. The review focused on the triage, risk stratification, management impact, and safety of capsule endoscopy. The literature search identified 712 records, with 37 studies screened for full-text review, resulting in nine studies included in the review. These studies involved 634 patients and primarily compared capsule endoscopy with standard care in emergency settings. Capsule endoscopy demonstrated potential advantages, including improved identification of high-risk lesions and reduced hospital admissions. Capsule endoscopy effectively detected bleeding and reduced the need for invasive procedures compared to standard practices. Capsule endoscopy also had lower costs relative to traditional triaging methods. The use of capsule endoscopy in the risk stratification and management of upper gastrointestinal bleeding in emergency settings is promising. Its high diagnostic accuracy can enhance patient outcomes by enabling timely and precise diagnosis, reducing the need for invasive procedures. Future research should focus on larger randomized trials to validate capsule endoscopy's efficacy and explore its cost-effectiveness.

Clinical and epidemiological characteristics of COVID-19 mortality in Saudi Arabia: A retrospective multi-center study

Background/Aim

Coronavirus disease 2019 (COVID-19) increased morbidity and mortality in health institutions worldwide. The present study describes the epidemiological and clinical characteristics of COVID-19 mortality rates. Investigating the factors that affect COVID-19 mortality will be helpful in reducing the burden of morbidity and mortality in healthcare systems.

Materials and Methods

The current retrospective observational study was carried out in the Kingdom of Saudi Arabia. COVID-19 cases resulting in death were admitted to hospitals from March 2020 to June 2020. The epidemiological and clinical characteristics of these cases of COVID-19-related death were collected and evaluated.

Results

A total of 3260 COVID-19 death cases were included. The mean age of the subjects was 55 years. COVID-19 deaths more frequently in patients aged 50-59 years, 60-69 years, and 40-49 years (26%, 22%, and 17%, respectively). A greater percentage of COVID-19-related deaths (47%) was observed in June than in March (>1%), April (15%), and May (37%). Men accounted for most death cases (76%) compared to women. The COVID-19 mortality rate was higher among non-Saudi (71%) than Saudis (29%). The highest COVID-19 mortality was observed in Tabuk Region, whereas the lowest was observed in Najran. The mean stay duration of COVID-19 cases in the intensive care unit (ICU) was 11 days. The independent t-test indicated a statistically significant increase in the life expectancy (6 days) of ICU cases compared to non-ICU cases.

Conclusion

The findings suggest that older age, male gender, and non-Saudi are risk factors that enhance COVID-19 mortality rates, while medical care increases the life expectancy of COVID-19 cases.

Synthetic vs. natural antimicrobial agents for safer textiles: a comparative review

Textiles in all forms act as carriers in transmitting pathogens and provide a medium of microbial growth, especially in those fabrics which are used in sports, medical and innerwear clothing. More attention towards hygiene and personal healthcare made it a necessity to develop pathogen-free textiles. Synthetic and natural antimicrobial compositions are used to control and reduce microbial activity by killing or inhibiting microbial growth on textiles. Synthetic metallic nanoparticles of Ag, Zn, Cu Ti and Ga are the most commonly and recently used advanced nanocomposites. Synthetic organic materials such as triclosan, quaternary ammonium compounds, polyhexamethylene biguanide, and N-halamines have proven antimicrobial activity. Carbon quantum dots are one of the advanced nanomaterials prepared from different kinds of organic carbon material with photoluminescence efficiency also work efficiently in antimicrobial textiles. A greener approach for producing natural antimicrobial textiles has gained significant importance and demand for personal care due to their less toxic effects on health and the environment In comparison to synthetic. The naturally existing materials including extracts and essential oils of plants have significant applications for antimicrobial textiles. Additionally, a number of animal extracts are also used as antimicrobial agents include chitosan, alginate, collagen hydrolysate to prepare naturally treated antimicrobial textiles. This review focuses on the comparative performance of antimicrobial fabrics between synthetic and natural materials. Textiles with synthetic substances cause health and environmental concerns whereas textiles treated with natural compositions are more safe and eco-friendly. Finally, it is concluded that textiles modified with natural antimicrobial compositions may be a better alternative and option as functional textiles.

The Prevalence and Clinical Features of Co-Infection with SARS-CoV-2 and Influenza Virus during the COVID-19 Pandemic in Semnan, Iran

Background

COVID-19 and influenza are both contagious respiratory diseases. Influenza virus can increase the severity of COVID-19 infection in the cold months of the year through damage to respiratory ciliated cells, which may cause an increase in hospitalization, disease symptoms and mortality rate. Therefore, the purpose of this study was to ascertain the frequency of co-infection with the influenza virus and SARS-CoV-2, as well as the impact of co-infection on clinical outcomes in hospitalized patients suffering from respiratory problems within Semnan City, Iran.

Methods

In this cross-sectional descriptive study, we investigated 1267 hospitalized patients with respiratory problems between September 2021 and March 2022. Two nasopharyngeal and oropharyngeal throat swab samples were collected from each patient and tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza A, and influenza B viruses using real-time reverse-transcriptase- polymerase-chain-reaction (RT-PCR). The collected data were analyzed with χ² test, ANOVA, paired Student's t-test, and Pearson's correlation coefficient test in different groups. Analyzes were done with SPSS 26.0 software.

Results

In total, 29.6% (n = 375) of patients had confirmed positive results for SARS-CoV-2, and their median age was 55.4 ± 24.63 years. It was found that 1.9% (n = 7) and 0.5% (n = 2) of COVID-19 patients had co-infections with influenza viruses A and B, respectively. In 2.4% of the cases, co-infection with COVID-19 and influenza was found. 8 out of 9 patients (88.8%) recovered, while one patient (11.1%) died. Co-infection did not significantly correlate with cancer (P = 0.588), diabetes (P = 0.202), hypertension (P = 0.530), or any other illness. Also, Associations of death and co-infection with diabetes, cardiovascular disease, or CKD showed that a statistically significant correlation was present only between diabetes and death. Based on the ANOVA test to look at associations of death and co-infection with diabetes, cardiovascular disease, or CKD, it showed that there was no significant association of co-infection with diabetes (P = 0.202), hypertension (P = 0.530), cancer (P = 0.588), and other diseases.

Conclusion

Although a low proportion of COVID-19 patients have influenza co-infection, the importance of such co-infection, especially in high-risk individuals and the elderly, cannot be ignored. Given the prevalence of influenza co-infection, increased coverage of flu vaccination is encouraged to mitigate the transmission of the influenza virus during the ongoing COVID-19 pandemic and reduce the risk of severe outcomes and mortality.

Comprehensive Analysis of COVID-19 Symptomatology among Healthcare Workers: Insights from a Tertiary Hospital

This paper presents a thorough examination of COVID-19 symptomatology among healthcare workers from All India Institute of Medical Sciences (AIIMS), Nagpur, India. Through meticulous analysis spanning from May 2020 to October 2020, we enrolled 73 healthcare workers engaged in COVID-19 screening, care and testing. Our study aimed to elucidate the spectrum of symptoms, adherence to protective measures and implications for early detection and intervention. Key findings revealed a diverse range of symptoms, including body ache, fatigue, headache, sore throat, fever, cough and loss of taste, among others. Notably, 21% of all positive cases were asymptomatic, underscoring the variability in clinical presentation. Adherence to personal protective measures varied across work areas, highlighting the importance of stringent compliance. Our discussion emphasizes the significance of early identification and tailored monitoring systems for mitigating transmission risks and ensuring healthcare worker safety. Additionally, addressing the mental health needs of healthcare workers is crucial for comprehensive pandemic management. Overall, this study contributes essential insights into COVID-19 symptomatology among healthcare workers, offering valuable guidance for infection control and prevention strategies in the pandemic.

Unravelling the diagnostic methodologies for SARS-CoV-2; the Indispensable need for developing point-of-care testing

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-caused COVID-19 pandemic that continues to be a global menace and since its emergence in the late 2019, SARS-CoV-2 has been vigorously spreading throughout the globe putting the whole world into a multidimensional calamity. The suitable diagnosis strategies are on the front line of the battle against preventing the spread of infections. Since the clinical manifestation of COVID-19 is shared between various diseases, detection of the unique impacts of the pathogen on the host along with the diagnosis of the virus itself should be addressed. Employing the most suitable approaches to specifically, sensitively and effectively recognize the infected cases may be a real game changer in controlling the outbreak and the crisis management. In that matter, point-of-care assays (POC) appears to be the potential option, due to sensitivity, specificity, affordable, and availability. Here we brief the most recent findings about the virus, its variants, and the conventional methods that have been used for its detection, along with the POC strategies that have been applied to the virus diagnosis and the developing technologies which can accelerate the diagnosis procedure yet maintain its efficiency.

Nanoscale hyperthermia mesostructures for sustainable antimicrobial design

Sustainability is critical in addressing global challenges posed by prolonged pandemics that impact health, economies, and the environment. Here, we introduce a molecular engineering approach for thermoregulated antimicrobial management inspired by firewalking rituals. The study uses in situ spectroscopy and multi-scale modeling to validate a hierarchical design. Efficient light-to-thermal energy conversion is achieved by engineering the molecular band structure. Rapid nanoscale hyperthermia is facilitated through thermal engineering. This approach significantly reduces the half-life of pathogens such as Escherichia coli, influenza A, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to 1.4 min while maintaining a low perceived temperature on human skin. Standard disease infection and epidemic models show this technology's potential to flatten outbreak curves and delay peak infection rates, which is crucial during the early stages of pandemics when developing vaccines and antiviral drugs takes time. The scalable manufacturing and broad antimicrobial applicability hold great promise for controlling emerging infectious diseases and diverse bioprotective applications.

Aerosol and Droplet Generation from Open Rhinoplasty: Surgical Risk in the Pandemic Era

Introduction: The coronavirus disease 2019 pandemic has led to concerns over transmission risk from head and neck operations including facial cosmetic surgeries. Objectives: To quantify droplet and aerosol generation from rhinoplasty techniques in a human anatomic specimen model using fluorescein staining and an optical particle sizer. Methods: Noses of human anatomic specimens were infiltrated using 0.1% fluorescein. Droplets and aerosols were measured during rhinoplasty techniques including opening the skin-soft tissue envelope, monopolar electrocautery, endonasal rasping, endonasal osteotomy, and percutaneous osteotomy. Results: No visible droplet contamination was observed for any rhinoplasty techniques investigated. Compared with the negative control of anterior rhinoscopy, total 0.300-10.000 μm aerosols were increased after monopolar electrocautery (p < 0.001) and endonasal rasp (p = 0.003). Opening the skin-soft tissue envelope, endonasal osteotomies, and percutaneous osteotomies did not generate a detectable increase in aerosols (p > 0.15). Discussion and Conclusions: In this investigation, droplets were not observed under ultraviolet light, and aerosol generation was noted only with cautery and endonasal rasping.

Nanomaterials-based electrochemical biosensors for diagnosis of COVID-19

Since the outbreak of corona virus disease 2019 (COVID-19), this pandemic has caused severe death and infection worldwide. Owing to its strong infectivity, long incubation period, and nonspecific symptoms, the early diagnosis is essential to reduce risk of the severe illness. The electrochemical biosensor, as a fast and sensitive technique for quantitative analysis of body fluids, has been widely studied to diagnose different biomarkers caused at different infective stages of COVID-19 virus (SARS-CoV-2). Recently, many reports have proved that nanomaterials with special architectures and size effects can effectively promote the biosensing performance on the COVID-19 diagnosis, there are few comprehensive summary reports yet. Therefore, in this review, we will pay efforts on recent progress of advanced nanomaterials-facilitated electrochemical biosensors for the COVID-19 detections. The process of SARS-CoV-2 infection in humans will be briefly described, as well as summarizing the types of sensors that should be designed for different infection processes. Emphasis will be supplied to various functional nanomaterials which dominate the biosensing performance for comparison, expecting to provide a rational guidance on the material selection of biosensor construction for people. Finally, we will conclude the perspective on the design of superior nanomaterials-based biosensors facing the unknown virus in future.

Factors Associated with Prolonged SARS-CoV-2 Viral Positivity in an Italian Cohort of Hospitalized Patients

Clinical or microbiological factors potentially associated with prolonged COVID-19 PCR positivity are still poorly underexplored, but they could be of importance for public-health and clinical reasons. The objective of our analysis is to explore demographic, clinical, and microbiological factors potentially associated with a prolonged positivity to SARS-CoV-2 among 222 hospitalized patients. Prolonged detection positivity for SARS-CoV-2 RNA in swap samples, defined as positivity more than 21 days, was the outcome of interest. The 56 cases with a prolonged positivity to SARS-CoV-2 were matched for age and sex with 156 controls. The cases reported a significantly higher presence of diabetes mellitus, autoimmune diseases, chronic kidney diseases, and acute coronary syndrome. Moreover, the viral load was significantly higher in a period of prolonged positivity compared to a normal period. In the multivariable analysis, the presence of autoimmune diseases and chronic kidney disease were significantly associated with an increased risk of prolonged positivity as well as medium viral load or high viral load, i.e., low Ct value ≤ 30 indicating high viral load. The results of this study confirmed that in a large population of hospitalized patients with COVID-19 manifestations, the prolonged positivity of SARS-CoV-2 detection with nasopharyngeal swab was mainly related to autoimmune diseases, chronic kidney disease, and to baseline viral load.

The determinants of COVID-19 case reporting across Africa

Background

According to study on the under-estimation of COVID-19 cases in African countries, the average daily case reporting rate was only 5.37% in the initial phase of the outbreak when there was little or no control measures. In this work, we aimed to identify the determinants of the case reporting and classify the African countries using the case reporting rates and the significant determinants.

Methods

We used the COVID-19 daily case reporting rate estimated in the previous paper for 54 African countries as the response variable and 34 variables from demographics, socioeconomic, religion, education, and public health categories as the predictors. We adopted a generalized additive model with cubic spline for continuous predictors and linear relationship for categorical predictors to identify the significant covariates. In addition, we performed Hierarchical Clustering on Principal Components (HCPC) analysis on the reporting rates and significant continuous covariates of all countries.

Results

21 covariates were identified as significantly associated with COVID-19 case detection: total population, urban population, median age, life expectancy, GDP, democracy index, corruption, voice accountability, social media, internet filtering, air transport, human development index, literacy, Islam population, number of physicians, number of nurses, global health security, malaria incidence, diabetes incidence, lower respiratory and cardiovascular diseases prevalence. HCPC resulted in three major clusters for the 54 African countries: northern, southern and central essentially, with the northern having the best early case detection, followed by the southern and the central.

Conclusion

Overall, northern and southern Africa had better early COVID-19 case identification compared to the central. There are a number of demographics, socioeconomic, public health factors that exhibited significant association with the early case detection.

Relationship between blood group (ABO) and risk of COVID-19 infection in a patient cohort in Tehran, Iran

Background and purpose. Coronavirus (COVID-19) is a contagious disease causing severe acute respiratory syndrome which had a catastrophic effect on the world population and resulted in more than 2.9 million deaths worldwide. Epidemiological investigations have recently announced blood type has an association with the incidence of COVID-19 infection. Consequently, research in this regard can be effective in determining a person's susceptibility to a viral infection. Therefore, we investigated the relationship between blood types and the risk of COVID-19 in patients admitted to Khorshid laboratory, Tehran, Iran. Materials and methods. From January to March 2020, 50 nasal and throat swapb samples of patients' secretions were obtained from patients who were admitted to Khorshid laboratory. They were confirmed to have COVID-19 virus RNA and real-time polymerase chain reaction (PCR)-ABI, and their blood type was determined simultaneously. After collecting data to determine the relationship between COVID-19 infection and blood type, a confidence interval of 90 % was considered using SPSS 16. Results. The mean age of the patients was measured at 38.4±6.3 years. According to PCR results, 100 % of the subjects with COVID-19 showed blood type A. In addition, the ratio of blood type A to the percentage of reference type O was higher (P=0.009). Conclusion. There was a significant relationship between ABO blood type and susceptibility to COVID-19. As the current study suggests, those with blood type A are at a higher COVID-19 infection risk than those with blood type O.

Bioengineered self-assembled nanofibrils for high-affinity SARS-CoV-2 capture and neutralization

The recent coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spurred intense research efforts to develop new materials with antiviral activity. In this study, we genetically engineered amyloid-based nanofibrils for capturing and neutralizing SARS-CoV-2. Building upon the amyloid properties of a short Sup35 yeast prion sequence, we fused it to SARS-CoV-2 receptor-binding domain (RBD) capturing proteins, LCB1 and LCB3. By tuning the reaction conditions, we achieved the spontaneous self-assembly of the Sup35-LCB1 fusion protein into a highly homogeneous and well-dispersed amyloid-like fibrillar material. These nanofibrils exhibited high affinity for the SARS-CoV-2 RBD, effectively inhibiting its interaction with the angiotensin-converting enzyme 2 (ACE2) receptor, the primary entry point for the virus into host cells. We further demonstrate that this functional nanomaterial entraps and neutralizes SARS-CoV-2 virus-like particles (VLPs), with a potency comparable to that of therapeutic antibodies. As a proof of concept, we successfully fabricated patterned surfaces that selectively capture SARS-CoV-2 RBD protein on wet environments. Collectively, these findings suggest that these protein-only nanofibrils hold promise as disinfecting coatings endowed with selective SARS-CoV-2 neutralizing properties to combat viral spread or in the development of sensitive viral sampling and diagnostic tools.

Glucose Tolerance and the Risk Factors for Transmission in Japanese SARS-CoV-2/WA-1/2020 Epicenter: A Retrospective Study

Purpose

The severe pathogenic ancient-type COVID-19, SARS-CoV-2/WA-1/2020 was the predominant gene variant in early 2020 in Japan, however, its transmissibility was uncertain. The period before the public commenced using any personal protective equipment (PPE) was evaluating to describe the transmissibility of the SARS-CoV-2/WA-1/2020. We analyzed the secondary attack rate (SAR) among close contacts and the risk factor for SAR.

Methods

This retrospective cohort study included a total of 539 patients who were anticipated for the SARS-CoV-2/WA-1/2020 infection at Toho University Medical Center Omori Hospital from February to May 2020. We selected 54 patients with 1) exclude other pathogens infection, 2) include "Three Cs" condition: crowded places between distance< 6 feet, closed spaces indoor and close contact settings involving contact >15min with a person tested positive for SARS-CoV-2/WA-1/2020 without PPE. We evaluated alternative infection risks: the body mass index (BMI) and diabetes (DM) status (non-DM, pre-DM, and DM) as demographic determinants of transmissibility and infectivity of SARS-CoV2/WA-1/2020 cases during the incubation period.

Results

The calculated SAR was 79.3%. BMI was significantly associated with the PCR positivity rate, which was significant in the univariate (CI 95%, 1.02-1.51; P = 0.03) and multivariate (CI 95%, 1.02-1.60; P = 0.03) analyses. Comparing the different BMI groups, the highest BMI group (25.5-35.8 kg/m2) had an elevated risk of SAR compared to the lowest BMI group (14.0-22.8 kg/m2), with an odds ratio of 1.41 (95% CI, 1.02-1.59; P = 0.03). There were no significant differences in the risk of SAR among different DM statuses.

Conclusion

The transmissibility of SARS-CoV2/WA-1/2020 was high (79.3%) among household members without PPE who had "Three Cs" exposure. Although pre-DM and established DM did not confer a risk for transmissibility, higher BMI was associated with an increased risk of SAR.

Trial Registration

UMIN Clinical Trials Registry, UMIN0000 50905.

Exploring the protective association between COVID-19 infection and laryngeal cancer: insights from a Mendelian randomization study

Introduction

Viral infections have been implicated as a risk factor for laryngeal cancer. Given the possible effects of Corona virus disease 2019 (COVID-19) on the laryngeal tissue, we investigated the causal link between COVID-19 and laryngeal cancer using a two-sample Mendelian randomization (MR) approach.

Methods

We utilized genetic data from the 5th Genome-wide association studies (GWAS) edition of the COVID-19 Host Genetics Initiative (published on January 18, 2021) and a large-scale laryngeal cancer GWAS comprising 180 cases and 218,612 controls of European ancestry. We applied inverse variance weighting, MR Egger, and weighted median methods to infer causality. We performed sensitivity analysis using the "leave-one-out" method to verify robustness.

Results

We found no evidence of a causal association between gene-predicted COVID-19 and laryngeal cancer [Odds ratio (OR)=0.24 (95% Confidence intervals (CI), 0.05-1.26), P=0.09]. However, we observed significant inverse associations between gene-predicted COVID-19 hospitalization [OR=0.51 (95% CI, 0.28-0.95), P=0.03] and severe patients [OR=0.62 (95% CI, 0.43-0.90), P=0.01] and laryngeal cancer. Notably, the study detected important genetic variants, such as rs13050728, that modulate the expression of interferon alpha receptor 2 (IFNAR2), indicating possible roles for immune response pathways in both COVID-19 and cancer.

Discussion

This study reveals a potential interaction between COVID-19 severity, genetic factors, and laryngeal cancer, underscoring the importance of investigating the immune response mechanisms in both conditions. These findings contribute to the understanding of the complex interactions between COVID-19 and laryngeal cancer and may guide future research on the role of immune response, particularly involving IFNAR2.

The role of asymptomatic infections in influenza transmission: what do we really know

Before the COVID-19 pandemic, the role of asymptomatic influenza virus infections in influenza transmission was uncertain. However, the importance of asymptomatic infection with SARS-CoV-2 for onward transmission of COVID-19 has led experts to question whether the role of asymptomatic influenza virus infections in transmission had been underappreciated. We discuss the existing evidence on the frequency of asymptomatic influenza virus infections, the extent to which they contribute to infection transmission, and remaining knowledge gaps. We propose priority areas for further evaluation, study designs, and case definitions to address existing knowledge gaps.

Improved SARS-CoV-2 RNA recovery in wastewater matrices using a CTAB-based extraction method

Wastewater-based epidemiology has allowed tracking the magnitude and distribution of SARS-CoV-2 in communities, allowing public health officials to prepare for impending outbreaks. While many factors influence recovery of SARS-CoV-2 from wastewater, proper extraction, concentration, and purification of RNA are key steps to ensure accurate detection of viral particles. The aim of this study was to compare the efficiency of four commonly used RNA extraction methods for detection of the SARS-CoV-2 RNA genome in sewage samples artificially inoculated with the virus, in order to identify a protocol that improves viral recovery. These methods included CTAB-based, TRIzol-based, and guanidinium thiocyanate (GTC)-based extraction procedures coupled with silica spin column-based purification, and an automated extraction/purification protocol using paramagnetic particles. Following RNA extraction, virus recovery rates were compared using RT-qPCR-based detection. The CTAB-based approach yielded the highest recovery rates and was the only method to consistently demonstrate stable virus recovery percentages regardless of the specific physicochemical characteristics of the samples tested. The TRIzol method proved to be the second most effective, yielding significantly higher recovery rates compared to both the GTC-based and the automated extraction methods. These results suggest that the CTAB-based approach could be a useful tool for the recovery of viral RNA from complex wastewater matrices.

Retrospective estimation of the time-varying effective reproduction number for a COVID-19 outbreak in Shenyang, China: An observational study

The time-varying effective reproduction number Re(t) is essential for designing and adjusting public health responses. Retrospective analysis of Re(t) helps to evaluate health emergency capabilities. We conducted this study to estimate the Re(t) of the Corona Virus Disease 2019 (COVID-19) outbreak caused by SARS-CoV-2 Omicron in Shenyang, China. Data on the daily incidence of this Corona Virus Disease 2019 outbreak between March 5, 2022, and April 25, 2022, in Shenyang, China, were downloaded from the Nationwide Notifiable Infectious Diseases Reporting Information System. Infector-infectee pairs were identified through epidemiological investigation. Re(t) was estimated by R-studio Package "EpiEstim" based on Bayesian framework through parameter and nonparametric method, respectively. About 1134 infections were found in this outbreak, with 20 confirmed cases and 1124 asymptomatic infections. Fifty-four infector-infectee pairs were identified and formed a serial interval list, and 15 infector-infectee pairs were included in the generation time table. Re(t) calculated by parameter and nonparametric method all peaked on March 17, 2022, with a value of 2.58 and 2.54 and decreased to <1 after March 28, 2022. There was no statistical difference in the Re(t) distribution calculated using the 2 methods (t = 0.001, P > .05). The present study indicated that the decisive response of Shenyang, China, played a significant role in preventing the spread of the epidemic, and the retrospective analysis provided novel insights into the outbreak response to future public health emergencies.

Comparison of inflammatory markers, coagulation indicators and outcomes between influenza and COVID-19 infection amongst children: A systematic review and meta-analysis

Background

Influenza and COVID-19 patients share similar features and outcomes amongst adults. However, the difference between these diseases is not explored in paediatric age group especially in terms of inflammatory markers, coagulation profile and outcomes. Hence, we did this review to compare the inflammatory, coagulation features and outcomes between influenza and COVID-19 infected children.

Methods

Literature search was done in PubMed Central, Scopus, EMBASE, CINAHL, Cochrane library, Google Scholar & ScienceDirect from November 2019 to May 2022. Risk of bias assessment was done through Newcastle Ottawa scale. Meta-analysis was done using random-effects model and the final pooled estimate was reported as pooled odds ratio (OR) or standardized mean difference (SMD) along with 95 % confidence interval (CI) depending on the type of outcome.

Results

About 16 studies were included with most studies having higher risk of bias. Influenza paediatric patients had significantly higher erythrocyte sedimentation rate (ESR) (pooled SMD = 0.60; 95%CI: 0.30-0.91; I2 = 0 %), lactate dehydrogenase (LDH) (pooled SMD = 2.01; 95%CI: 0.37-3.66; I2 = 98.4 %) and prothrombin time (PT) (pooled SMD = 2.12; 95%CI: 0.44-3.80; I2 = 98.3 %) when compared to paediatric COVID-19 patients. There was no significant difference in terms of features like CRP, procalcitonin, serum albumin, aPTT, mortality and need for mechanical ventilation.

Conclusion

Inflammatory markers like ESR, LDH and PT was significantly higher in influenza patients when compared to COVID-19 in children, while rest of the markers and adverse clinical outcomes were similar between both the groups. Identification of these biomarkers has helped in understanding the distinctness of COVID-19 and influenza virus and develop better management strategies.

Clinical Course and Factors Associated With Hospital Admission and Mortality among Sars-Cov 2 Patients within Nairobi Metropolitan Area

This study aims to investigate the clinical course and factors associated with hospital admission and mortality among SARS-CoV-2 patients within the Nairobi Metropolitan Area. The study utilizes a multicenter retrospective cohort design, collecting clinical characteristics and laboratory parameters of hospitalized patients from March 2020 to May 2022. Data analysis includes percentages, frequencies, chi-square tests, Kaplan-Meier analysis, pairwise comparisons, and multivariate regression models. Ethical considerations are observed throughout the research process. The study findings highlight significant associations between comorbidities, such as hypertension, and increased mortality risk due to COVID-19. Symptoms including fever, cough, dyspnea, chest pain, sore throat, and loss of smell/taste are also identified as predictors of mortality. Abnormal laboratory parameters, such as oxygen saturation, procalcitonin, glucose levels, serum creatinine, and gamma-glutamyl transpeptidase, are associated with mortality. However, demographic factors and certain vital signs do not exhibit significant associations. Recommendations based on this study suggest increased monitoring and management of comorbidities, early identification and management of symptoms, regular monitoring of laboratory parameters, continued research and collaboration, and implementation of preventive measures. Overall, a multidisciplinary approach involving healthcare professionals, researchers, policymakers, and the public is crucial to improve COVID-19 outcomes and reduce mortality rates. Adaptation of strategies based on emerging evidence and resource allocation is essential for effective management of the pandemic.

Evaluation of dental emergency during the COVID-19 pandemic in the Social Rehabilitation Centre of San Francisco Kobén (Campeche, Mexico)

INTRODUCTION

During the COVID-19 pandemic, access to dental treatment by persons deprived of their liberty (PPL) was affected due to dentist-patient proximity and the risk of generation of aerosols in dental procedures and treatments. The risks of infection for oral health personnel are considered high, mainly from cross-infection between patients.

OBJECTIVES

Differentiate between a true and false dental consultation emergency during the SARS-CoV-2 outbreak for a better and effective screening of inmates of the Social Rehabilitation Center (CERESO) of San Francisco Kobén (Campeche, Mexico).

MATERIAL AND METHOD

An observational, cross-sectional, descriptive, and prospective study was designed for a sample of 100 inmates of the CERESO San Francisco Kobén, the data was collected in the prison's dental office, the participants signed a letter of informed consent to be voluntarily included in the study during the SARS-CoV-2 outbreak. The questionnaire "Assessment of a true Dental Emergency" previously validated for the Mexican population was applied, the personnel was standardized and an intra- examiner and inter-examiner reliability of k = 0.98 was obtained. To prepare the database and the analysis of the information collected, the Statistical Package for Social Science v. 21 (SPSS v.21) was used.

RESULTS

When evaluating emergencies at the dental clinic, 84% were determined according to the instrument as a false emergency and 16% were a true emergency.

DISCUSSION

In the population of CERESO of San Francisco Kobén, the figures for medical-dental care show that inmates face a proportionally low dental morbidity-mortality.

Seroprevalence of SARS-CoV-2 and Hepatitis B Virus Coinfections among Ethiopians with Acute Leukemia

SARS-CoV-2 and blood-borne viral coinfections are well reported. Nevertheless, little is known regarding the seroprevalence of SARS-CoV-2 and coinfection with blood-borne viruses in hematologic malignancy patients in Ethiopia. We aimed to assess the seroprevalence of SARS-CoV-2 and associated infections with hepatitis B and other viruses among adolescent and adult acute leukemia patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. A cross-sectional study was conducted from July 2020 to June 2021. Blood samples were tested for the presence of anti-SARS-CoV-2, HBV, HCV, and HIV with ELISA kits and occult hepatitis B infection with a real-time polymerase chain reaction assay. Out of a total 110 cases, the SARS-CoV-2 seroprevalence was 35.5%. The prevalence showed a significant increment from July 2020 to the end of June 2021 (p = 0.015). In 22.7% and 2.7% of leukemia cases, HBV and HIV, respectively, were detected. No HCV was identified. The rate of SARS-CoV-2 coinfection with HBV and HIV was 28% (11/39) and 2.6% (1/39), respectively; however, there was no statistically significant association between SARS-CoV-2 seropositivity with HBV and HIV (p > 0.05). There is a need for viral screening in leukemia cases to monitor infections and inform management.

Evaluation the frequencies of HLA alleles in moderate and severe COVID-19 patients in Iran: A molecular HLA typing study

Background

Severe acute respiratory syndrome coronavirus 2 was first reported in December 2019 and it has spread globally ever since. The HLA system is crucial in directing anti-viral immunity and recent studies are investigating the possible involvement of the HLA genes on the severity of immune inflammation in different phases of COVID-19.

Methods

In this cross-sectional study, peripheral blood-extracted genomic DNAs of 109 COVID-19 patients and 70 healthy controls were genotyped for different alleles of HLA-A, HLA-B, and HLA-DRB1 loci using sequence-specific primer PCR method.

Results

The results indicated that frequencies of HLA-DRB1*11:01 and HLA-DRB1*04:03 were significantly higher in severe patients rather than moderates (p: <0.001 and 0.004, respectively). Also, it was observed that HLA-DRB1*04:01 was more frequent in moderate patients and healthy controls (p:0.002). In addition, HLA-B*07:35, and HLA-DRB1*07:01 showed higher frequencies in patients compared with controls (p: 0.031 and 0.003 respectively). Inversely, due to the higher frequencies of HLA-B*51:01 (p:0.027), HLA-DRB1*11:05 (p:0.003), HLA-DRB1*13:05 (p:0.022), and HLA-DRB1*14:01 (p:0.006) in healthy individuals rather than patients, they may be associated with COVID-19 resistance.

Conclusion

The results show that, based on the population differences, the type of alleles related to the severity of COVID-19 is different, which should be clarified by designing large-scale studies in order to develop HLA-based treatments and vaccines.

Bluff Indicators in Medical and Dental Tele-Consultation: A Review

The global lockdowns have resulted in the popularisation of tele-consultation. Also the anxiety about dental visits and hospital-acquired infections in patients and incidences of dishonesty are increased. Tele-consultation includes patient data collected on phone calls, text messages, and video calls. Bluffing or providing false information is one of the dark realities of clinical practice. Dishonesty might affect the treatment success and spread of contamination. During normal and epidemic eras, skills for honesty and bluff identification are required during tele-consultation to protect patients and doctors from hospital-acquired infection in further one-to-one treatment meetings.

Belief, knowledge, attitude and practices towards COVID-19 amongst residents of Abuja, Nigeria: implications for pandemic preparedness

Introduction

coronavirus disease, (COVID-19), was a pandemic with high global morbidity and mortality, partly due to a lack of preparedness. People´s knowledge, belief, attitude, and perception of disease outbreaks may affect their response, and this may impact their health-related behavior. This study was designed to determine the pattern of belief, knowledge, attitude, and practices (BKAP) of residents of Abuja, Nigeria, towards the COVID-19 pandemic. The outcome of the study may help to make informed decisions on future pandemic preparedness.

Methods

a cross-sectional study with data collected online about the local perceptions and common concerns, beliefs, misconceptions, attitudes, and conspiracy theories amongst residents of the FCT. A self-reported validated e-questionnaire prepared on Google Forms was used. The obtained data was downloaded on Excel sheet and then exported to SPSS for analysis.

Results

there were one thousand eight hundred and seventy-three (1,873) respondents, 1017 (54.3%) females and 856 (45.7%) males. Participants were majorly knowledgeable, the majority (31.2%) were in the 41-50 years age group. Surprisingly, about 17% did not know that wearing a face mask could prevent COVID-19. About 25% still met in crowded places, and slightly more than 33% did not wear outdoor masks. The highest knowledge of COVID-19 was found among people in the age range 41-50 years, females, University graduates, married people, and healthcare personnel, particularly doctors.

Conclusion

our study concludes that the overall population of Abuja had good knowledge and, a positive attitude, with pockets of poor attitudes and bad practices born out of misconceptions and infodemics.

COVID-19 Detection From Respiratory Sounds With Hierarchical Spectrogram Transformers

Monitoring of prevalent airborne diseases such as COVID-19 characteristically involves respiratory assessments. While auscultation is a mainstream method for preliminary screening of disease symptoms, its utility is hampered by the need for dedicated hospital visits. Remote monitoring based on recordings of respiratory sounds on portable devices is a promising alternative, which can assist in early assessment of COVID-19 that primarily affects the lower respiratory tract. In this study, we introduce a novel deep learning approach to distinguish patients with COVID-19 from healthy controls given audio recordings of cough or breathing sounds. The proposed approach leverages a novel hierarchical spectrogram transformer (HST) on spectrogram representations of respiratory sounds. HST embodies self-attention mechanisms over local windows in spectrograms, and window size is progressively grown over model stages to capture local to global context. HST is compared against state-of-the-art conventional and deep-learning baselines. Demonstrations on crowd-sourced multi-national datasets indicate that HST outperforms competing methods, achieving over 90% area under the receiver operating characteristic curve (AUC) in detecting COVID-19 cases.

Sarcopenic patients "get even": The impact of COVID-19 vaccination on mortality

BACKGROUND

Coronavirus Disease-2019 (COVID-19), driven by the SARS-CoV-2 virus, has disproportionately affected the elderly, with comorbidities like sarcopenia worsening prognosis. Considering the significant impact of RNA vaccines on survival rates in this population, our objective is to investigate the impact of vaccination on the survival of hospitalized elderly patients with COVID-19, considering the presence or absence of sarcopenia.

METHODS

Prospective study conducted on 159 patients aged>65 years from September 2021 to March 2022. Data about clinical and body composition, and mortality at 12-months after discharge were recorded. Sarcopenia was diagnosed according to the 2019 European Consensus criteria.

RESULTS

At the twelfth month post-discharge, vaccinated sarcopenic individuals exhibited a mortality risk similar to vaccinated non-sarcopenic individuals, and lower than unvaccinated non-sarcopenic patients. Cox regression analysis, adjusted for age, gender, comorbidity, functional and vaccinal status, showed that the presence of sarcopenia did not significantly impact the risk of death within 12-months post-discharge.

DISCUSSION

Vaccination emerges as a protective measure for sarcopenic patients, countering the potential adverse effects of sarcopenia on COVID-19 outcomes, underscoring the importance of immunization in the frail elderly with a call for meticulous monitoring of its benefits.

CONCLUSIONS

Our study represents the first attempt to analyze the vaccine's effect on survival in sarcopenic hospitalized older adults with COVID-19. The administration of vaccination to sarcopenic patients proves pivotal, as its omission could lead to notably unfavorable outcomes within this specific population.

Heat inactivation of SARS-CoV 2 enabled the measurement of salivary cortisol during COVID-19 pandemic

BACKGROUND AND AIM

Salivary cortisol has become an essential tool in the management of cortisol-related disease. In 2020 the sudden outbreak of COVID-19 pandemic caused several concerns about the use of saliva, due to the risk of contamination, and a European consensus further discourage using salivary cortisol. To decrease infectious risk, we handled specimens by applying a heat treatment to inactivate viral particles, further evaluating the impact of the COVID-19 pandemic on the use of salivary cortisol in clinical practice.

MATERIAL AND METHODS

Saliva samples were exposed for 10 min at 70 °C, then cortisol was measured using LC-MS/MS. The number of salivary cortisol examinations from 2013 to 2022 was extracted from the local electronic database: those performed in 2019, 2020, and 2021 were analyzed and compared with the historical data.

RESULTS

During 2020 we observed a decrease of 408 (-20%) examinations (p = 0.05) compared to 2019; especially in salivary cortisol daily rhythm and salivary cortisol/cortisone ratio (respectively reduction of 47% and 88%, p = 0.003 and p = 0.001). Analyzing year 2021 compared with 2020 we reported an increase of 420 examinations (+20%, p = 0.01), with a complete recovery of salivary cortisol measurement (considering 2019: p = 0.71). Major differences were observed between morning salivary cortisol (-20%, p = 0.017), LNSC (-21%, p = 0.012) and salivary cortisol rhythm (-22%, p = 0.056). No Sars-Cov2 infections related to working exposure were reported among laboratory's employers.

CONCLUSIONS

We speculate that the adoption of an appropriate technique to inactivate viral particles in saliva specimens allowed the safety maintenance of salivary collections, also during the Sars-CoV-2 outbreak.

Analysis of the COVID-19 model with self-protection and isolation measures affected by the environment

Since the global outbreak of COVID-19, the virus has continuously mutated and can survive in the air for long periods of time. This paper establishes and analyzes a model of COVID-19 with self-protection and quarantine measures affected by viruses in the environment to investigate the influence of viruses in the environment on the spread of the outbreak, as well as to develop a rational prevention and control measure to control the spread of the outbreak. The basic reproduction number was calculated and Lyapunov functions were constructed to discuss the stability of the model equilibrium points. The disease-free equilibrium point was proven to be globally asymptotically stable when $ R_0 < 1 $, and the endemic equilibrium point was globally asymptotically stable when $ R_0 > 1 $. The model was fitted using data from COVID-19 cases in Chongqing between November 1 to November 25, 2022. Based on the numerical analysis, the following conclusion was obtained: clearing the virus in the environment and strengthening the isolation measures for infected people can control the epidemic to a certain extent, but enhancing the self-protection of individuals can be more effective in reducing the risk of being infected and controlling the transmission of the epidemic, which is more conducive to the practical application.

Exploring the Midwives' Experiences of Providing Delivery Care for Women with Suspected or Confirmed COVID-19 Infection: A Qualitative Study

Introduction

Midwives were at the forefront of caring for pregnant women during the COVID-19 pandemic, therefore, the present study was conducted with the purpose of exploring midwives' experiences of providing delivery care for women with suspected or confirmed COVID-19 infection.

Methods

In this qualitative study, 18 midwives working in the public hospitals affiliated with Guilan University of Medical Sciences (Iran). Who had experience in providing delivery care to women with suspected or confirmed COVID-19 infection were selected using purposive sampling. Data were collected via individual semi-structured interviews until reaching data saturation, and analyzed through conventional content analysis.

Results

Data analysis led to the extraction of three main categories and six sub-categories. The main categories included "COVID-19 and organizational support" with two sub-categories including lack of resources/neglecting the role of midwives, "COVID-19 and positive achievements" with two sub-categories including professional resilience/turning threats into opportunities, "COVID-19 and informational support" with two sub-categories, including up-to-date training/empowering pregnant women.

Conclusion

According to the findings, to realize and guarantee the provision of high-quality maternity care to pregnant women in dealing with epidemic diseases such as COVID-19 in the future, the attention of policymakers and healthcare service officials to the physical and psychological needs of midwives is necessary. Also, organizational and informational support, improving job satisfaction, and paying attention to the importance of midwives' role in the medical team are recommended. Moreover, empowering pregnant women during epidemic diseases is essential.

Association of Inflammatory Markers With Disease Progression and the Severity of COVID-19

Introduction In December 2019, there was a massive outbreak of viral pneumonia, which had a high case fatality rate. Genetic sequencing of the virus showed similarity with severe acute respiratory syndrome coronavirus (SARS-CoV). It was later named novel coronavirus 2019 while the disease it caused was given the nomenclature of COVID-19. This deadly pneumonia outbreak was declared a pandemic by the World Health Organization (WHO). Aim To derive the strength of the correlation between blood levels of various inflammatory markers with the severity of COVID-19 pneumonia in patients affected with novel coronavirus 2019. Materials and methodology A prospective study was conducted on 300 confirmed cases of COVID-19 infection from August 2020 to July 2021 in SSG Hospital, Vadodara. Diagnosis of patients as confirmed cases of COVID-19 infection was done according to the WHO interim guidance for COVID-19. Their inflammatory markers were done for this study. All COVID-19-positive patients who had given negative consent for enrollment were excluded from the study. Patients were classified based on the severity of acute respiratory distress syndrome (ARDS). Comprehensive medical record information, encompassing biodata, clinical symptoms, comorbidities, and laboratory investigations, was systematically collected. Patients were given the standard treatment protocol as per guidelines. Patients were subjected to detailed investigations comprising complete blood counts and inflammatory markers like C-reactive protein (CRP), lactate dehydrogenase (LDH), serum ferritin, and D-dimer. Patients were further investigated by chest X-ray (posteroanterior view) or high-resolution computed tomography of the thorax. Results A total of 300 confirmed cases of COVID-19 infection were included in this study. Most of them were males (52%) with a mean age of 51 years and 48% were females with a mean age of 55 years. The majority of patients (40%) did not have ARDS, 23.3% of patients had mild, 16.7% of patients had moderate, and 20% of patients had severe ARDS. Higher CRP levels, serum ferritin, and serum D-dimer were significantly associated with the severity of COVID-19 infection as compared to those having no symptoms (p < 0.05). Increased levels were associated with severe clinical manifestations of COVID-19. The sensitivity of CRP is 69% and specificity is 100% as a diagnostic marker for COVID-19 pneumonia in terms of ARDS. The sensitivity of ferritin is 88% and specificity is 81% as a diagnostic marker for COVID-19 pneumonia in terms of ARDS. The sensitivity of D-dimer is 94% and specificity is 89% as a diagnostic marker for COVID-19 pneumonia in terms of ARDS. The sensitivity of LDH is 93% and specificity is 84% as a diagnostic marker for COVID-19 pneumonia in terms of ARDS. Conclusions Current evidence from our study showed that higher levels of inflammatory markers such as CRP, LDH, D-dimer, and ferritin are associated with the severity of COVID-19 in terms of ARDS and thus could be used as significant prognostic factors of the disease. These indicators might support clinical decisions to identify high fatality cases and poor diagnosis in the initial admission phase.