Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission

Occurrence and clinical correlates of SARS-CoV-2 viremia in two German patient cohorts

Viremia defined as detectable SARS-CoV-2 RNA in the blood is a potential marker of disease severity and prognosis in COVID-19 patients. Here, we determined the frequency of viremia in serum of two independent COVID-19 patient cohorts within the German National Pandemic Cohort Network (German: Nationales Pandemie Kohorten Netzwerk, NAPKON) with diagnostic RT-PCR against SARS-CoV-2. A cross-sectional cohort with 1122 COVID-19 patients (German: Sektorenuebergreifende Platform, SUEP) and 299 patients recruited in a high-resolution platform with patients at high risk to develop severe courses (German: Hochaufloesende Plattform, HAP) were tested for viremia. Our study also involved a comprehensive analysis and association of serological, diagnostic, and clinical parameters of the NAPKON medical dataset. Prevalence of viremia at the recruitment visit was 12.8% (SUEP) and 13% (HAP), respectively. Serological analysis revealed that viremic patients had lower levels of SARS-CoV-2 specific antibodies as well as lower neutralizing antibodies compared to aviremic patients. Viremia was associated with severity (<0.0001 SUEP; 0.002 HAP) and mortality of COVID-19 (both cohorts <0.0001) compared to aviremic patients. While rare, viremia was also detected in patients with mild disease (0.7%). In patients of the SUEP cohort with acute kidney disease (p = 0.0099) and hematooncological conditions (p = 0.0091), viremia was detected more frequently. Compared to the aviremic group, treatment with immunomodulating drugs as well as elevated levels of inflammatory markers in the blood was more frequent in the viremic group. In conclusion, our analysis revealed that detectable viremia correlates with hyperinflammatory conditions and higher risk for severe COVID-19 disease.

Significant Alterations of Colorectal Cancer Care in the COVID-19 Pandemic With High Adherence to Quality Criteria in German Cancer Centers (CC) ‒ Data From the AIO CancerCOVID Consortium (AIO-YMO/KRK 520/ass)

BACKGROUND

Colorectal cancer (CRC) remains a leading cause of death despite notable advancements through guideline-based management. We present data on changes of CRC care during the COVID-19 pandemic in Germany.

METHODS

Retrospective data from 22 AIO CCs and an academic Institute of Pathology compared the first (fw, 03-05.2020) and second wave (sw, 11-12.2020) of the pandemic with corresponding 2019 periods. Parameters were: number of cases diagnosed, age, sex, tumor stage, surgical procedures, quality criteria of CRC care (presentation in multidisciplinary tumor boards (MTB), psychological or social consultation), number of precancerous and malignant colorectal lesions (CRL). Data points were compared as mean values with confidence intervals estimated according to Clopper and Pearson (1934). Hypothesis tests were conducted using Poisson regression models that included interaction terms (year*sex or year*age over70). Statistical significance was considered at P < .05.

RESULTS

A total of 4316 cases diagnosed (AIO CC) revealed a substantial reduction (fw -20.58%; sw -23.48%). Hypothesis test showed a significant decline in incidence due to the fw and sw of the pandemic. Quality criteria of cancer care remained stable except for trial participation. Analysis from 60,695 CRL detected a decrease in precancerous (fw: -16 %/sw: -4 %) and malignant (fw: -18 %) lesions while malignant CRL increased in the sw (+8 %). Hypothesis test revealed a significant decline only for the fw 2020 and detected age > 70 as independent risk factor in both waves.

CONCLUSION

We detected substantial alterations in cancer care during the pandemic, including detected precancerous CRL. CCs showed high resilience in quality criteria for CRC care.

Remote patient monitoring for managing acute COVID-19, and mortality and hospital use in Sydney, New South Wales, 2021-22: a retrospective observational cohort study

OBJECTIVES

To evaluate the influence of remote patient monitoring (RPM) for managing people with acute coronavirus disease 2019 (COVID-19) on 28-day mortality and hospital use in Australia.

STUDY DESIGN

Retrospective observational cohort study; analysis of deterministically linked NSW Notifiable Conditions Information Management System and hospital, emergency department, and non-admitted patient data.

SETTING, PARTICIPANTS

South Eastern Sydney Local Health District catchment area residents aged 15 years or older for whom positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test results (polymerase chain reaction or rapid antigen testing) during 26 November 2021 - 30 June 2022 were recorded.

MAIN OUTCOME MEASURES

Primary outcome: All-cause mortality within 28 days of positive SARS-CoV-2 test result.

SECONDARY OUTCOMES

Hospital length of stay, and numbers of emergency department presentations, hospital admissions, and intensive care unit admissions within 14 days of positive test results. All analyses were undertaken for the unadjusted data (original cohort analysis) and after propensity score matching and inverse probability treatment weighting.

RESULTS

Of 276 236 people aged 15 years or older with positive SARS-CoV-2 test results and complete demographic information, 4399 (1.6%) participated in RPM. Twenty-eight-day mortality was lower for the RPM group than the usual care group (propensity score-matched: adjusted odds ratio [aOR], 0.19; 95% confidence interval [CI], 0.08-0.43; inverse probability treatment-weighted: aOR, 0.21; 95% CI, 0.10-0.46). The 14-day likelihood of intensive care unit admission and emergency department presentation was similar for both groups; the likelihood of hospital admission was higher for the RPM group (propensity score-matched: aOR, 1.42; 95% CI, 1.12-1.78; inverse probability treatment-weighted: aOR, 1.51; 95% CI, 1.28-1.78), but the mean hospital length of stay was shorter (adjusted mean difference, original cohort: -2.01 [95% CI, -2.81 to -1.21] days; propensity score-matched: -3.54 [95% CI, -6.39 to -0.69] days; inverse probability treatment-weighted: -3.26 [95% CI, -6.01 to -0.50] days).

CONCLUSION

RPM was associated with greater 14-day likelihood of hospital admission, but also with shorter mean length of stay and lower 28-day mortality, which may indicate that clinical deterioration was detected and treated earlier than with usual care. The benefit of RPM for managing other acute health conditions in the community, particularly infectious diseases, should be examined.

Occupational differences in COVID-19 hospital admission and mortality risks between women and men in Scotland: a population-based study using linked administrative data

OBJECTIVES

Occupations vary with respect to workplace factors that influence exposure to COVID-19, such as ventilation, social contacts and protective equipment. Variations between women and men may arise because they have different occupational roles or behavioural responses. We estimated occupational differences in COVID-19 hospital admission and mortality risks by sex.

METHODS

We combined (1) individual-level data from 2011 Census with (2) health records and (3) household-level information from residential identifiers, using a Scottish cohort of 1.7 million adults aged 40-64 years between 1 March 2020 and 31 January 2021. We estimated age-standardised COVID-19 hospital admission and mortality rates, stratified by sex and occupation. Cox proportional hazards models were adjusted for pre-pandemic health and occupational exposure factors, including interaction effects between occupation and sex.

RESULTS

Women had lower age-standardised COVID-19 hospital admission and mortality rates than men. Among women, adjusted death risks were lowest for health professionals, and those in associate professional and technical occupations (paramedics and medical technicians), with the latter supported by results from the interaction model. Among men, elevated adjusted admission and death risks were observed for large vehicle and taxi drivers. Additionally, admission risks remained high among men in caring personal services (including home and care workers), while elevated risks were observed among women in customer service occupations (call centre operators) and process, plant and machine operative roles (assemblers and sorters).

CONCLUSIONS

Occupational differences in COVID-19 hospital admission and mortality risks between women and men highlight the need to account for sex differences when developing interventions to reduce infections among vulnerable occupational groups.

Sex differences in adenosine deaminase activity associate with disparities in SARS-CoV-2 innate immunity

Females demonstrate elevated type-I interferon production and a stronger antiviral immune response; however, the mechanisms underlying sex-based differences in antiviral immunity are incompletely understood. We previously reported that low adenosine deaminase (ADA) activity perturbs the methylation-based transcriptional silencing of endogenous retroviral elements (hERV), which stimulates IFN-Stimulated Genes (ISG) and primes antiviral immunity. Here we demonstrate lower ADA activity in females compared to their male counterparts, which correlated with higher hERV and ISG expression in female lungs. Sex differences in ADA2 were linked to the number and expression profiles of blood and lung-derived monocyte populations. Single-cell RNA sequencing of respiratory cells from patients with COVID-19 showed a significant female bias in hERV-ISG signatures, and implicated IL-18 as a driver of sex-specific ADA2 expression. Observations in healthy and COVID-19 cohorts indicate that higher ADA activity is associated with suppressed antiviral innate immunity in the male respiratory tract, which may drive adverse COVID-19 outcomes.

Elevated Plasma Levels of NET Components in Men with Severe COVID-19 Correlates to Increased Amounts of IL-18

Severe COVID-19 disease is accompanied by high plasma levels of proinflammatory, prothrombotic NETs, and NET-inducing cytokine IL-18. We found that both, IL-18 and NETs, are elevated in men with severe disease, but not in women of the same category. Our findings warrant further investigation of sex-related differences in SARS-CoV-2 infection.

Do genetic variants of the Y chromosome affect mortality from COVID-19

AIMS

During the early stages of the COVID-19 pandemic, significant differences in mortality patterns emerged based on sex and geographical regions. While we were studying on the heredity of variants of the Y chromosome, we observed that regional variations in mortality rates appeared to correlate with the geographical distribution of certain variants of the Y chromosome. This observation led us to propose that some genes on the Y chromosome, with an influence on immune responses, may represent a confounding factor in the observed geographical mortality differences.

METHODS

In this analysis, we investigate the potential associations between COVID-19 morbidity and disease-specific mortality and specific Y chromosome variants. The study is based on publicly available pandemic data validated by state authorities or presented in scientific literature documented in PubMed and Medline.

RESULTS

We find that Y chromosome haplogroups in different populations exhibit wave-like patterns corresponding with persistent global disparities in COVID-19-related mortality.

CONCLUSIONS

These findings warrant further research to uncover possible new pathophysiological mechanisms.

Estrogen influences class-switched memory B cell frequency only in humans with two X chromosomes

Sex differences in immunity are well-documented, though mechanisms underpinning these differences remain ill-defined. Here, in a human-only ex vivo study, we demonstrate that postpubertal cisgender females have higher levels of CD19+CD27+IgD- class-switched memory B cells compared with age-matched cisgender males. This increase is only observed after puberty and before menopause, suggesting a strong influence for sex hormones. Accordingly, B cells express high levels of estrogen receptor 2 (ESR2), and class-switch-regulating genes are enriched for ESR2-binding sites. In a gender-diverse cohort, blockade of natal estrogen in transgender males (XX karyotype) reduced class-switched memory B cell frequency, while gender-affirming estradiol treatment in transgender females (XY karyotype) did not increase these levels. In postmenopausal cis-females, class-switched memory B cells were increased in those taking hormone replacement therapy (HRT) compared with those who were not. These data demonstrate that sex hormones and chromosomes work in tandem to impact immune responses, with estrogen only influencing the frequency of class-switched memory B cells in individuals with an XX chromosomal background.

Increased pathogenicity and transmissibility in hamsters of all age groups reveal an underestimated perniciousness of severe acute respiratory syndrome coronavirus 2 EG.1 variant

The evolution and mutation of SARS-CoV-2 is elusive. However, the diverse in vivo pathogenicity and transmissibility of different SARS-CoV-2 Omicron/XBB variants are not well understood. We compared virological attributes of two XBB variants, XBB.1.16 and XBB.1.9.2.1 (EG.1) in new-born, juvenile, adult, middle-aged and senescent Syrian hamsters. In particular, EG.1 has a specific Q613H mutation and causes fatal severe pneumonia in hamsters of all ages. In contrast, all hamsters infected with XBB.1.16 survived and showed milder symptoms. The XBB.1.16 infected hamsters lost significantly less body weight and exhibited lower respiratory viral loads, pro-inflammatory cytokines and lung injury than those with EG.1 infection. In addition, EG.1 is more transmissible than XBB.1.16 in close contact co-housing. Both EG.1 and XBB.1.16 are highly resistant to therapeutic antibodies and convalescent serum. Overall, the unpredictable evolution, global transmission and potential threat of emerging SARS-CoV-2 variants necessitate the updating of prophylactic and therapeutic countermeasures in all age groups.

Gut Microbiome dysbiosis and immune activation correlate with somatic and neuropsychiatric symptoms in COVID-19 patients

BACKGROUND

Infection with SARS-CoV-2, the virus responsible for COVID-19, can lead to a range of physical symptoms and mental health challenges, including stress, anxiety, and depression. These effects are particularly pronounced in hospitalized patients, likely due to the virus's direct and indirect impact on the nervous system. Gut dysbiosis, an imbalance in the gut microbiome, has been implicated in immune dysfunction and chronic inflammation in COVID-19 patients. However, the interactions between gut microbiome composition and the physical and mental symptoms of COVID-19 remain incompletely understood.

METHODS

We investigated the association between physical and mental symptoms, cytokine profiles, and gut microbiota composition in 124 hospitalized COVID-19 patients. We collected data on demographics, COVID-19 severity, and mental health indicators (stress, anxiety, and depression). Gut microbiome profiling was performed using full-length 16 S rRNA gene sequencing to evaluate microbial diversity and composition.

RESULTS

COVID-19 severity was categorized as low (27.4%), moderate (29.8%), or critical (42.8%). Common symptoms included fever (66.1%) and cough (55.6%), while somatic symptoms (27.3%), anxiety (27.3%), depressive symptoms (39%), and stress (80.5%) were frequently self-reported. Elevated interleukin-6 levels in severe cases highlighted systemic inflammation, reduced gut bacterial diversity, particularly among women and obese patients, correlated with higher disease severity. Notably, the genus Mitsuokella was associated with increased physical symptoms and mental distress, while Granulicatella was linked to critical illness.

CONCLUSIONS

Our findings reveal significant associations between mental health status, systemic inflammation, and gut dysbiosis in hospitalized COVID-19 patients. These results indicate the potential for microbiome-targeted therapies to mitigate psychological and physical complications and improve recovery outcomes in this population.

Incidence of Scrub Typhus in Rural South India

BACKGROUND

Hospital studies suggest that scrub typhus is a leading cause of severe undifferentiated fever in regions across Asia where the disease is endemic, but the population-based incidence of infection and illness has been little studied.

METHODS

We conducted a population-based cohort study to assess epidemiologic and clinical characteristics of scrub typhus in 37 villages in Tamil Nadu, India, where the disease is highly endemic. Study participants were visited every 6 to 8 weeks over a period of 2 years; a venous blood sample was obtained from those who had had fever since the last visit. A subcohort of participants underwent blood sampling to estimate the incidence of serologically confirmed Orientia tsutsugamushi infection.

RESULTS

We systematically assessed 32,279 participants from 7619 households for acute febrile illness. During 54,588 person-years of follow-up, we observed 6175 episodes of fever. A blood sample was obtained in 4474 episodes (72.5%), of which 328 (7.3%) met the clinical case definition of scrub typhus (detection of IgM against O. tsutsugamushi on enzyme-linked immunosorbent assay [ELISA] or detection of O. tsutsugamushi on polymerase-chain-reaction assay). The incidence of clinical infection was 6.0 cases per 1000 person-years (95% confidence interval [CI], 4.8 to 7.5). A total of 71 clinical cases (21.6%) resulted in hospitalization (incidence, 1.3 events per 1000 person-years; 95% CI, 1.0 to 1.7). A total of 29 clinical cases (8.8%) were severe, as indicated by the presence of organ dysfunction or adverse pregnancy outcomes (incidence, 0.5 cases per 1000 person-years; 95% CI, 0.4 to 0.8). Among 2128 participants in the subcohort who provided samples at the beginning and end of a study year, the incidence of seroconversion independent of any symptoms was 81.2 events per 1000 person-years (95% CI, 70.8 to 91.6). The incidence of clinical infection was higher in older age groups than in younger age groups and higher among female participants than among male participants. By contrast, the age-adjusted rate of severe infection was similar among male and female participants. Among 5602 participants assessed at the start of the first year of the study, the seroprevalence of IgG as assessed with ELISA was 42.8% (95% CI, 35.8 to 50.2). IgG seropositivity at the beginning of years 1 or 2 did not protect against clinical illness during the subsequent year but was associated with less severe disease than IgG seronegativity.

CONCLUSIONS

We describe the burden of scrub typhus, including the incidence of asymptomatic infection, in a region of Asia where the disease is endemic. (Funded by the U.K. Medical Research Council; ClinicalTrials.gov number, NCT04506944.).

Robust COVID-19 Vaccine Responses Despite Filarial Co-Infection: Insights from a Lymphatic Filariasis Cohort in Ghana

BACKGROUND/OBJECTIVES

Although the COVID-19 pandemic has largely concluded, the varied trajectories it has followed in different regions of the world remain incompletely understood. Intensive research is needed to fully grasp its course and the implications for future global health challenges. Notably, the milder trajectory of the COVID-19 pandemic in Sub-Saharan Africa has defied initial predictions. An emerging body of evidence suggests that, in addition to the continent's younger average age and the lower prevalence of relevant comorbidities, co-infections with helminths may have also impressively shaped the pandemic's milder trajectory in the region. Indeed, helminths are renowned for their ability to modulate human immune responses, which, while potentially beneficial in limiting excessive inflammation, could also diminish vaccine efficacy and impede viral clearance. This study investigated different aspects of the intricate interactions between COVID-19 and Lymphatic Filariasis (LF), a helminth infection caused by parasitic worms such as Wuchereria bancrofti, Brugia malayi, and Brugia timori and endemic to various regions in Sub-Saharan Africa and the tropics.

METHODS

For this purpose, samples of a larger and ongoing clinical trial (ethical approval codes: CHRPE/AP/525/17 and 325/21; trial registration number ISRCTN14042737) were collected from 222 individuals from endemic areas of Ghana, along with comprehensive clinical and demographic data. The samples include LF patients (n = 222) grouped according to their Lymphoedema (LE) stages, as well as COVID-19 vaccinated (n = 81) and non-vaccinated individuals (n = 141). All vaccinated participants received the COVID-19 vaccine ChAdOx1-S (also known as Vaxzevria) developed by the University of Oxford and AstraZenca. The expressions of SARS-CoV-2 and filarial-specific antibodies (IgG, IgA) were accessed using ELISA, while Luminex-based immunoassays were employed to measure the expression of SARS-CoV-2 variant-specific neutralizing antibodies. The interplay between vaccine responses and demographic factors was analyzed using group comparisons with the Kruskal-Wallis or Mann-Whitney U tests.

RESULTS

The results indicate that a remarkable portion of unvaccinated individuals (56% IgA seropositive, 39% IgG seropositive) developed antibodies against SARS-CoV-2 despite no confirmed infection. Notably, the study identified a robust antibody response to COVID-19 vaccination, which was independent of the degree of LF pathology or parasitic status. An important observation was the reduced SARS-CoV-2 antibody response in individuals seropositive for Ascaris lumbricoides (p = 0.0264), highlighting an interaction between roundworm infection and COVID-19.

CONCLUSIONS

The study concludes that the ChAdOx1-S COVID-19 vaccine (AstraZeneca) triggers a strong immune response in LF patients; however, filarial and/or soil-transmitted helminth seropositivity might influence the COVID-19 infection-induced response. These findings emphasize the complexity of infectious disease dynamics in co-infected populations and the need to decipher parasite-induced immunomodulatory mechanisms on COVID-19 vaccination.

COVID-19 related complications

The COVID-19 pandemic has significantly impacted global healthcare systems, revealed vulnerabilities and prompted a re-evaluation of medical practices. Acute complications from the virus, including cardiovascular and neurological issues, have underscored the necessity for timely medical interventions. Advances in diagnostic methods and personalized therapies have been pivotal in mitigating severe outcomes. Additionally, Long COVID has emerged as a complex challenge, affecting various body systems and leading to respiratory, cardiovascular, neurological, psychological, and musculoskeletal problems. This broad spectrum of complications highlights the importance of multidisciplinary management approaches that prioritize therapy, rehabilitation, and patient-centered care. Vulnerable populations such as paediatric patients, pregnant women, and immunocompromised individuals face unique risks and complications, necessitating continuous monitoring and tailored management strategies to reduce morbidity and mortality associated with COVID-19.

Biochemical differences based on sex and clusters of biomarkers in patients with COVID-19: analysis from the CARDIO COVID 19-20 registry

BACKGROUND

The inflammatory response associated with COVID-19 varies with sex, potentially affecting disease outcomes. Males have a higher risk of complications compared to females, requiring an evaluation of differences in inflammatory response severity based on sex.

OBJECTIVE

To compare clinical data, biochemical biomarkers, and outcomes among hospitalized COVID-19 patients in Latin America and the Caribbean (LA&C) based on sex and to perform a cluster analysis of biomarker profiles for both sexes.

METHODS

This prospective, multicenter observational registry made by the Inter-American Council of Heart Failure and Pulmonary Hypertension of the Inter-American Society of Cardiology included hospitalized COVID-19 patients from 44 hospitals in 14 countries in LA&C between May 1, 2020, and June 30, 2021.

RESULTS

Of 3,260 patients (1,201 females and 2,059 males), males had higher C-reactive protein and ferritin levels, while females had higher natriuretic peptides and d-dimer levels. Males had more cardiovascular complications (acute coronary syndrome [3.3% vs. 2.2%], decompensated heart failure [8.9% vs. 7.8%], pulmonary embolism [4.4% vs. 2.9%]), intensive care unit (ICU) admissions (56.9% vs. 47.7%), and overall mortality (27.5% vs. 22.1%). Cluster analysis identified three groups: one with normal-range biomarkers but elevated ferritin, one with coagulation abnormalities, and one with an inflammatory profile linked to renal injury and increased non-cardiovascular mortality.

CONCLUSIONS

In the LA&C population hospitalized with COVID-19, males had higher inflammatory biomarker levels, correlating with increased cardiovascular complications and mortality. The cluster with an inflammatory profile showed higher non-cardiovascular mortality, while clusters with elevated ferritin levels were associated with increased ICU admissions.

Overlooked and underserved: how healthcare fails men in the pursuit of equity

PURPOSE OF REVIEW

Men face distinctive health-related challenges as a result of biological, behavioral, and sociocultural factors. In addition, the modern healthcare system does not offer men equal opportunities and options to ensure sex-specific access and delivery to health services. Men's health concerns are, indeed, often not addressed or even forgotten. In this review, we wanted to assess the impact of biology and sociocultural effects on sex-specific life-expectancy.

RECENT FINDINGS

Globally, men have a shorter life expectancy than women. With a 5.8 years gender gap in the USA and 5.4 in the EU-27 (both in 2022). Cardiovascular disease, cancer, and accidents continue to represent the primary causes of mortality for both genders with all having disproportional preponderance in men. In recent years, there has been a notable decline in age-adjusted mortality rates related to cancer, while there has been an increase in deaths from accidental and intentional self-harm. Moreover, in the United States, men are more likely than women to develop and die from nonsex-specific cancers. As a result, men's poor health affects productivity, absenteeism, and employment.

SUMMARY

The status of men in healthcare is complex. It is rooted in history, culture, and institutions. To address disparities, we need a comprehensive approach that includes policy reforms, sociocultural changes, and a fair and equitable public discourse. Grassroots and top-down strategies are needed to ensure a value-based societal healthcare system acknowledging the unique health needs of men.

Glycemic Control Status After Six Months in Post-COVID-19 Patients

Background Despite being typically a viral respiratory disease, COVID-19 has harmful effects that go beyond the respiratory system. The endocrine system is particularly susceptible to damage due to the high expression of angiotensin-converting enzyme-2 receptors. This study evaluates glycemic status in survivors of COVID-19. Methodology In this prospective, observational study, 96 individuals were enrolled from the COVID-19 unit of Bangabandhu Sheikh Mujib Medical University (BSMMU). Mild and moderate COVID-19 patients were classified as non-severe, whereas severe and critical cases were classified as severe, following the WHO disease severity classification. Follow-ups were conducted at the post-COVID-19 clinic at BSMMU one and six months after diagnosis. Blood samples for fasting blood sugar and glycated hemoglobin measurements were collected within 24 hours of initial diagnosis and during each follow-up at the first and sixth months. Results Of the 96 participants, the non-severe and severe groups consisted of 49 (51%) and 47 (49%) participants, respectively. Among the participants, 62 (63.9%) were men, the mean age was 54.2 (15.9) years, and hypertension was the most common comorbidity (37, 38.5%). After six months, 12 new cases of diabetes (15.4%) were observed, with a male predominance (10, 62%). After adjusting for potential confounders, we found that severe COVID-19 was substantially linked to a higher risk of diabetes at six months (odds ratio = 5.5, 95% confidence interval, 1.1-27.7, p = 0.03). Conclusions The study findings showed a significant association between a higher frequency of diabetes and severe COVID-19.

Respiratory long COVID in aged hamsters features impaired lung function post-exercise with bronchiolization and fibrosis

Long-term consequences of SARS-CoV-2 infection affect millions of people and strain public health systems. The underlying pathomechanisms remain unclear, necessitating further research in appropriate animal models. This study aimed to characterize the trajectory of lung regeneration over 112 days in the male hamster model by combining morphological, transcriptomic and functional readouts. We demonstrate that in the acute phase, SARS-CoV-2 Delta-infected, male, aged hamsters show a severe impairment of lung function at rest. In the chronic phase, similar impairments persisted up to 7 weeks post-infection but were only evident after exercise on a rodent treadmill. The male hamster model recapitulates chronic pulmonary fibrotic changes observed in many patients with respiratory long COVID, but lacks extra-pulmonary long-term lesions. We show that sub-pleural and interstitial pulmonary fibrosis as well as alveolar bronchiolization persist until 112 dpi. Interestingly, CK8+ alveolar differentiation intermediate (ADI) cells are becoming less prominent in the alveolar proliferation areas from 28 dpi on. Instead, CK14+ airway basal cells and SCGB1A1+ club cells, expressing cell proliferation markers, mainly populate alveolar bronchiolization areas at later time-points. We postulate that pulmonary fibrosis and SCGB1A1+ club cell-rich areas of alveolar bronchiolization represent potential risk factors for other diseases in long-COVID survivors.

New mouse model for inducible hACE2 expression enables to dissect SARS-CoV-2 pathology beyond the respiratory system

The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection is not limited to the respiratory tract as receptors, including the angiotensin-converting enzyme 2 (ACE2), are expressed across many tissues. This study employed a new conditional mouse model, Rosa26creERT2/chACE2, which expresses human ACE2 (hACE2) across multiple organs, to investigate the effects of SARS-CoV-2 infection beyond the respiratory system. This strain demonstrated susceptibility to SARS-CoV-2 infection in a dose and sex-dependent manner, showing that infected male mice exhibited more severe disease outcomes, including significant weight loss, pronounced lung pathology and dysfunction, and increased mortality, compared to females. In contrast to intratracheal infection, intranasal virus administration facilitated viral spread to the brain, thereby underscoring the nasal route's role in the pathogenesis of neurological manifestations. Intranasal infection also led to increased innate immune system activation as compared to intratracheal virus administration, even though both routes activated the adaptive immune response. This model provides a valuable tool to study SARS-CoV-2 in individual tissues or use a multisystemic approach, and it also advances possibilities for preclinical evaluation of antiviral therapies and vaccine strategies.

Stratified analysis of health and gender-affirming care among Italian transgender and gender diverse adults

PURPOSE

This study aimed to provide the first comprehensive analysis of the health status of transgender and gender-diverse (TGD) adults in Italy, addressing disparities in physical and mental health and access to gender-affirming care. By combining self-reported health data with clinical evaluations and incorporating demographic and clinical variables, the research offers a robust and previously unavailable health profile of this population.

METHODS

An anonymous online survey targeting TGD adults across Italy was conducted from June 2020 to June 2021. The survey consisted of self-reported health assessments and clinician-conducted evaluations, collecting data on chronic physical conditions, mental health disorders, infectious diseases, and gender-affirming care. Statistical analyses, including chi-square tests and logistic regression, identified associations between demographics and health outcomes.

RESULTS

Among 959 participants, mental health disorders were prevalent, with over half experiencing depression and/or anxiety. Non-binary individuals reported poorer health compared to binary individuals. Chronic conditions such as thyroid disorders were more common in individuals assigned female at birth (AFAB), whereas those assigned male at birth (AMAB) had higher rates of osteoporosis and sexually transmitted infections. Key health predictors included age, education, employment, and engagement in gender-affirming hormone therapy.

CONCLUSION

The study reveals stark health disparities among TGD individuals in Italy, emphasizing the need for targeted health policies, expanded mental health services, and specialized healthcare provider training.

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.

Testosterone Replacement Therapy and Risk of COVID-19 and Effect of COVID-19 on Testosterone's Treatment Effect

Context

Whether circulating testosterone, dihydrotestosterone, and estradiol levels or testosterone replacement therapy (TRT) affects the risk of COVID-19 and whether COVID-19 affects response to TRT remains unknown.

Objective

The study evaluated whether baseline testosterone, dihydrotestosterone, and estradiol levels or TRT are associated with risk of developing COVID-19 and whether COVID-19 affects treatment response to TRT.

Methods

Among 5204 men, aged 45 to 80 years, with hypogonadism in the TRAVERSE trial, 379 developed COVID-19. We compared baseline and on-treatment hormone levels, and safety and efficacy in participants with and without COVID-19 diagnosis.

Results

Neither baseline nor on-treatment testosterone, estradiol, and dihydrotestosterone levels prior to COVID-19 differed significantly between men with and without COVID-19 diagnosis. Incidence of COVID-19 was similar in participants randomized to TRT or placebo groups (3-year Kaplan-Meier incidence 8.0% in TRT and 8.6% in placebo group, P = .823). Incidences of COVID-19-related hospitalizations (38.5% vs 32.8%, P = .222) and deaths (12.8% vs 8.9%, P = .247) were similar in the TRT and placebo groups. Changes in hypogonadal symptoms, libido, energy, and hemoglobin/hematocrit in response to TRT were attenuated in testosterone-treated men who developed COVID-19. Incidences of major adverse cardiovascular events, venous thromboembolism, and acute kidney injury were similar in those with COVID-19 diagnosis and those without.

Conclusion

In men with hypogonadism and cardiovascular disease (CVD) or increased risk of CVD, baseline and pre-COVID-19 on-treatment testosterone, dihydrotestosterone, and estradiol levels were similar in those who developed COVID-19 and those who did not. TRT did not affect the risk of COVID-19. COVID-19 attenuated the treatment response to TRT.

Disparities in response to mRNA SARS-CoV-2 vaccines according to sex and age: A systematic review

Background

The rapid development and distribution of mRNA COVID-19 vaccines has been essential in containing the SARS-CoV-2 epidemic around the globe. For ongoing and future immunization campaigns globally, there is a need to evaluate the impact of population demographics such as age and sex, on vaccine efficacy and safety.

Methods

This systematic review (PROSPERO ID CRD42023328245) conducted according to PRISMA guidelines evaluates the impact of age and sex on the safety and efficacy of the mRNA COVID-19 vaccinations administrated in 15 studies that were chosen according to strict criteria. The ROBIS tool was applied to evaluate the robustness and the quality of the studies included in the review.

Results

After screening, 15 studies satisfied the inclusion criteria. The results showed that the COVID-19 mRNA vaccines typically elicit robust immune responses, and that younger people have higher antibody levels. Comparing the sexes reveals that higher immunological responses were induced in females, and mild to moderate adverse effects (such as injection site discomfort, exhaustion, and headaches) were also more frequently reported in women. Despite these variations, COVID-19 vaccines have been found to be safe to use across diverse populations, which supports their extensive use in public health initiatives.

Conclusion

Our results suggests that tailored vaccination may achieve maximum effectiveness and better tolerability depending on age and sex. Currently study results are rarely stratified by age and sex and this is a deficit in clinical trial publications. More research is needed to elucidate the biological mechanisms underlying the variations in vaccine responses according to age and sex.

Clinical aspects and characterization of Pseudomonas aeruginosa isolated from patients infected with SARS-CoV-2

AIMS

This study aimed to identify and characterize Pseudomonas aeruginosa isolates from patients infected and uninfected with SARS-CoV-2, focusing on their phenotypic characteristics and antimicrobial resistance profiles.

MAIN METHODS

A total of 100 P. aeruginosa isolates were obtained from patients admitted to a hospital in Presidente Prudente, SP, in 2021. The isolates were assessed for antimicrobial resistance, pyocyanin, lipase and phospholipase C production, biofilm formation, and the presence of virulence factor genes, including those associated with metallo-β-lactamase (MBL) production.

KEY FINDINGS

Among the isolates, 58 were from patients infected with SARS-CoV-2 and 42 from non-infected patients. P. aeruginosa was predominantly isolated from tracheal secretion samples in infected patients, while urine samples were more common in non-infected patients. Notably, patients with SARS-CoV-2 exhibited a higher rate of resistance to aztreonam and used a wider range of antibiotics. Isolates from infected patients demonstrated higher phospholipase C production and a greater number classified as strong biofilm formers. Virulence factor genes were present in at least 70 % of the isolates, while only three isolates showed genes for MBL production.

SIGNIFICANCE

The findings of this study indicate that the COVID-19 pandemic creates a favorable environment for the increase of secondary infections by P. aeruginosa. Understanding the characteristics and resistance profiles of these isolates is crucial for improving treatment strategies and patient outcomes.

Prior vaccination prevents overactivation of innate immune responses during COVID-19 breakthrough infection

At this stage in the COVID-19 pandemic, most infections are "breakthrough" infections that occur in individuals with prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure. To refine long-term vaccine strategies against emerging variants, we examined both innate and adaptive immunity in breakthrough infections. We performed single-cell transcriptomic, proteomic, and functional profiling of primary and breakthrough infections to compare immune responses from unvaccinated and vaccinated individuals during the SARS-CoV-2 Delta wave. Breakthrough infections were characterized by a less activated transcriptomic profile in monocytes and natural killer cells, with induction of pathways limiting monocyte migratory potential and natural killer cell proliferation. Furthermore, we observed a female-specific increase in transcriptomic and proteomic activation of multiple innate immune cell subsets during breakthrough infections. These insights suggest that prior SARS-CoV-2 vaccination prevents overactivation of innate immune responses during breakthrough infections with discernible sex-specific patterns and underscore the potential of harnessing vaccines in mitigating pathologic immune responses resulting from overactivation.

Risk factors for disease progression and clinical outcomes in patients with COVID-19 in Taiwan: a nationwide population-based cohort study

BACKGROUND

Since 2021, COVID-19 has had a substantial impact on global health and continues to contribute to serious health outcomes. In Taiwan, most research has focused on hospitalized patients or mortality cases, leaving important gaps in understanding the broader effects of the disease and identifying individuals at high risk. This study aims to investigate the risk factors for disease progression through a nationwide population-based cohort study on COVID-19 in Taiwan.

METHODS

This study included 15,056 patients diagnosed with COVID-19 between January 1, 2021, and December 31, 2021, using the Taiwan National Health Insurance Research Database. Baseline and clinical characteristics were collected to verify the association with progression to severity outcomes, including hospital admission, intensive care unit (ICU) admission, invasive ventilatory support, fatal outcome, and the composite outcome of these four events. Patients were observed for 30 days for disease progression. Multivariable logistic regression models were used to calculate odd ratios and 95% confidence intervals (CIs) for each outcome, adjusting for age, sex, region, risk factors, and vaccination status.

RESULTS

Overall, 8,169 patients diagnosed during outpatient visits and 6,887 patients diagnosed during hospitalization were analyzed. Adjusting for age, sex, region, risk factors, and vaccination status, elderly patients had higher risks of hospital admission, ICU admission, invasive ventilatory support, fatal outcome, and composite outcome. Specifically, the risk of the fatal outcome was significantly higher for patients aged 75-84 (odds ratio: 6.11, 95% CI: 4.75-7.87) and those aged 85 years and older (12.70, 9.48-17.02). Patients with cardiovascular disease exhibited higher risks of hospital admission (1.60, 1.31-1.96), ICU admission (1.52, 1.31-1.78), invasive ventilatory support (1.57, 1.26-1.96), and fatal outcomes (1.26, 1.03-1.54) and the composite outcome (1.66, 1.20-1.54). Diabetes mellitus was identified as a significant risk factor for all clinical outcomes (hospital admission: 1.89, 1.53-2.35; ICU admission: 1.53, 1.30-1.79; invasive ventilatory support: 1.27, 1.01-1.60; the composite outcome: 1.45, 1.28-1.66), except for the fatal outcome.

CONCLUSIONS

This study indicated the impact of sex, age, and risk factors on the clinical outcomes of COVID-19 patients in Taiwan. Elderly patients and those with cardiovascular disease or diabetes mellitus had higher risks for severe outcomes, including hospitalization, ICU admission, invasive ventilatory support, and mortality. These findings can provide evidence for a better understanding of risk factors for disease progression and inform targeted intervention.

Analysis of the immune response in COVID-19

The COVID-19 pandemic, instigated by the novel coronavirus SARS-CoV-2, has emerged as a significant global health challenge, demanding a profound grasp of the immune response. The innate immune system, a multifaceted network encompassing pattern recognition receptors (PRRs) and effector cells, assumes a pivotal function in detecting and countering this viral assailant. Toll-like receptors (TLRs), situated on immune cell surfaces and within endosomes, play a central role in recognizing SARS-CoV-2. TLR-2 and TLR-4 discern specific viral constituents, such as the spike (S) protein, setting off inflammatory signaling cascades and catalyzing the generation of type I interferons. Intracellular PRRs, including the RIG-I-like receptors (RLRs), RIG-I and MDA5, detect viral RNA within the cytoplasm of infected cells, provoking antiviral responses by initiating the synthesis of type I interferons. The equilibrium between interferons and pro-inflammatory cytokines dictates the outcomes of the disease. Interferons play an indispensable role in governing viral replication, while unregulated cytokine production can result in tissue harm and inflammation. This intricate dynamic underpins therapeutic strategies aimed at regulating immune responses in individuals grappling with COVID-19. Natural killer (NK) cells, with their capacity to recognize infected cells through the "missing self" phenomenon and activating receptors, make significant contributions to the defense against SARS-CoV-2. NK cells play a pivotal role in eliminating infected cells and boosting immune responses through antibody-dependent cell-mediated cytotoxicity (ADCC). In conclusion, comprehending the interplay among PRRs, interferons, and NK cells within innate immunity is paramount for discerning and combatting SARS-CoV-2. This comprehension illuminates therapeutic interventions and vaccine development, casting light on our endeavors to confront this worldwide health crisis.

Utilizing machine learning to predict hospital admissions for pediatric COVID-19 patients (PrepCOVID-Machine)

The COVID-19 pandemic has burdened healthcare systems globally. To curb high hospital admission rates, only patients with genuine medical needs are admitted. However, machine learning (ML) models to predict COVID-19 hospitalization in Asian children are lacking. This study aimed to develop and validate ML models to predict pediatric COVID-19 hospitalization. We collected secondary data with 2200 patients and 65 variables from Malaysian aged 0 to 12 with COVID-19 between 1st February 2020 and 31st March 2022. The sample was partitioned into training, internal, and external validation groups. Recursive Feature Elimination (RFE) was employed for feature selection, and we trained seven supervised classifiers. Grid Search was used to optimize the hyperparameters of each algorithm. The study analyzed 1988 children and 30 study variables after data were processed. The RFE algorithm selected 12 highly predicted variables for COVID-19 hospitalization, including age, male sex, fever, cough, rhinorrhea, shortness of breath, vomiting, diarrhea, seizures, body temperature, chest indrawing, and abnormal breath sounds. With external validation, Adaptive Boosting was the highest-performing classifier (AUROC = 0.95) to predict COVID-19 hospital admission in children. We validated AdaBoost as the best to predict COVID-19 hospitalization among children. This model may assist front-line clinicians in making medical disposition decisions.

Barcoded SARS-CoV-2 viruses define the impact of duration and route of exposure on the transmission bottleneck in a hamster model

The transmission bottleneck, defined as the number of viruses shed from one host to infect another, is an important determinant of the rate of virus evolution and the level of immunity required to protect against virus transmission. Despite its importance, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission bottleneck remains poorly characterized. We adapted a SARS-CoV-2 reverse genetics system to generate a pool of >200 isogenic SARS-CoV-2 viruses harboring specific 6-nucleotide barcodes, infected donor hamsters with this pool, and exposed contact hamsters to paired infected donors, varying the duration and route of exposure. Following exposure, the nasal turbinates, trachea, and lungs were collected and the number of barcodes in each tissue was enumerated. We found that longer and more direct exposures increased the transmission bottleneck and that the upper airway is the primary source of transmitted virus in this model. Together, these findings highlight the utility of barcoded viruses as tools to rigorously study virus transmission.

Investigating the relationship between the immune response and the severity of COVID-19: a large-cohort retrospective study

The COVID-19 pandemic has left an indelible mark globally, presenting numerous challenges to public health. This crisis, while disruptive and impactful, has provided a unique opportunity to gather precious clinical data extensively. In this observational, case-control study, we utilized data collected at the Azienda Sanitaria Universitaria Friuli Centrale, Italy, to comprehensively characterize the immuno-inflammatory features in COVID-19 patients. Specifically, we employed multicolor flow cytometry, cytokine assays, and inflammatory biomarkers to elucidate the interplay between the infectious agent and the host's immune status. We characterized immuno-inflammatory profiles within the first 72 hours of hospital admission, stratified by age, disease severity, and time elapsed since symptom onset. Our findings indicate that patients admitted to the hospital shortly after symptom onset exhibit a distinct pattern compared to those who arrive later, characterized by a more active immune response and heightened cytokine activity, but lower markers of tissue damage. We used univariate and multivariate logistic regression models to identify informative markers for outcome severity. Predictors incorporating the immuno-inflammatory features significantly outperformed standard baselines, identifying up to 59% of patients with positive outcomes while maintaining a false omission rate as low as 4%. Overall, our study sheds light on the immuno-inflammatory aspects observed in COVID-19 patients prior to vaccination, providing insights for guiding the clinical management of first-time infections by a novel virus.

The comparative effectiveness of methylprednisolone versus dexamethasone on in-hospital mortality in patients with severe or critical COVID-19: a retrospective observational study

Background

Studies comparing the effectiveness of dexamethasone versus methylprednisolone for treating severe-to-critical COVID-19 have produced conflicting results. This study aimed to evaluate the impact of dexamethasone compared with methylprednisolone on in-hospital mortality among patients with severe or critical COVID-19.

Objectives

The objective of this study was to assess the effectiveness of dexamethasone in comparison to methylprednisolone in reducing in-hospital mortality in patients suffering from severe-to-critical COVID-19 pneumonia.

Design

This was a retrospective observational study conducted at a tertiary care academic medical center.

Methods

Clinical data from 706 hospitalized patients with severe or critical COVID-19 in Karachi, Pakistan, were reviewed. Of these patients, 217 received either oral or intravenous dexamethasone, and 393 were treated with methylprednisolone. The primary outcome was in-hospital mortality, while secondary outcomes included the length of hospitalization and the need for mechanical ventilation.

Results

The methylprednisolone group had a male predominance (74% vs 54%; p < 0.001). However, there was no significant difference in median age between the dexamethasone group (55 years) and the methylprednisolone group (57 years) (p = 0.09). Mortality was significantly higher in the methylprednisolone group compared to the dexamethasone group (13.7% vs 3.2%, p < 0.001). Multivariable analysis showed that dexamethasone was associated with lower in-hospital mortality (adjusted odds ratio (aOR): 0.24; 95% CI: 0.09-0.62; p = 0.003). Furthermore, patients in the dexamethasone group had a shorter length of hospital stay (aOR: 0.87 (95% CI: 0.82-0.92)) compared to the methylprednisolone group. A higher proportion of patients required invasive mechanical ventilation in the methylprednisolone group compared to the dexamethasone group (13.7% vs 3.2%; p < 0.001).

Conclusion

Dexamethasone was associated with lower mortality and a reduced length of hospital stay and a lower proportion of patients required mechanical ventilation compared to methylprednisolone in patients with severe-to-critical COVID-19.

ACE2 and TMPRSS2 in human kidney tissue and urine extracellular vesicles with age, sex, and COVID-19

SARS-CoV-2 virus infects cells by engaging with ACE2 requiring protease TMPRSS2. ACE2 is highly expressed in kidneys. Predictors for severe disease are high age and male sex. We hypothesized that ACE2 and TMPRSS2 proteins are more abundant (1) in males and with increasing age in kidney and (2) in urine and extracellular vesicles (EVs) from male patients with COVID-19 and (3) SARS-CoV-2 is present in urine and EVs during infection. Kidney cortex samples from patients subjected to cancer nephrectomy (male/female; < 50 years/˃75 years, n = 24; ˃80 years, n = 15) were analyzed for ACE2 and TMPRSS2 protein levels. Urine from patients hospitalized with SARS-CoV-2 infection was analyzed for ACE2 and TMPRSS2. uEVs were used for immunoblotting and SARS-CoV-2 mRNA and antigen detection. Tissue ACE2 and TMPRSS2 protein levels did not change with age. ACE2 was not more abundant in male kidneys in any age group. ACE2 protein was associated with proximal tubule apical membranes in cortex. TMPRSS2 was observed predominantly in the medulla. ACE2 was elevated significantly in uEVs and urine from patients with COVID-19 with no sex difference compared with urine from controls w/wo albuminuria. TMPRSS2 was elevated in uEVs from males compared to female. ACE2 and TMPRSS2 did not co-localize in uEVs/apical membranes. SARS-CoV-2 nucleoprotein and mRNA were not detected in urine. Higher kidney ACE2 protein abundance is unlikely to explain higher susceptibility to SARS-CoV-2 infection in males. Kidney tubular cells appear not highly susceptible to SARS-CoV-2 infection. Loss of ACE2 into urine in COVID could impact susceptibility and angiotensin metabolism.

[How did men report their long COVID experience? Health-Disease socio-anthropological meaning]

The study aims to explain the discourse of the collective subject of adult and elderly men about the experience of long COVID. Qualitative research, derived from a national multicenter clinical-virtual observatory involving 92 adult men, between 2022 and 2023 in Brazil. IRaMuTeQ software was used (data processing), the Collective Subject Discourse technique (analysis) and socio-anthropological references of the disease experience (interpretation). The results showed that the long COVID experience was marked by the prolongation of respiratory symptoms characteristic of COVID-19; systemic symptomatology in the physical-psychic body; and severe clinical complications. The experience of the long COVID-19 disease was shaped by gender relations and masculinities, constructed notions of health-disease, imaginaries about the capacity of the disease in the context of vaccination, the systemic character of syndromic events understood as sequelae left by the disease, resonating the sense of incapacity and stigmatization.

Long COVID-19 outcomes of patients with pre-existing dementia

BACKGROUND

Although COVID-19 has been linked to worse acute outcomes in patients with some neurodegenerative disorders, its long-term impact on dementia remains unclear.

OBJECTIVE

To investigate the outcomes of COVID-19 survivors with dementia.

METHODS

This retrospective study evaluated 9806 patients with dementia in the Montefiore Health System (January 2016 to July 2023). Comparisons were made between dementia patients with and without a positive SARS-CoV-2 polymerase-chain-reaction test who had a follow-up at least two weeks post-infection. Outcomes included all-cause mortality, major adverse cardiovascular events (MACE), new-onset dysphagia, dyspnea, fatigue, new-onset sleep disturbances, altered mental status, first-time fall, headache, new-onset depression, and new-onset anxiety. Adjusted hazard ratios (aHR) were computed adjusting for age, sex, race, ethnicity, and pre-existing comorbidities.

RESULTS

Dementia patients with COVID-19 were younger, more likely to be male, and had a higher prevalence of major pre-existing comorbidities compared to those without COVID-19. Patients who survived acute COVID-19 were more likely to die than non-COVID controls after adjusting for covariates (aHR = 1.65 [1.43, 1.91]). COVID-19 was significantly associated with higher risk of MACE (aHR = 1.58 [1.41, 1.78]), new-onset dysphagia (aHR = 1.64 [1.42, 1.91]), dyspnea (aHR = 1.27 [1.12, 1.44]), fatigue (aHR = 1.42 [1.22, 1.65]), new-onset sleep disturbances (aHR = 1.36 [1.15, 1.60]), altered mental status (aHR = 1.36 [1.16, 1.59]), and first-time fall (aHR = 1.34 [1.09, 1.65]).

CONCLUSIONS

COVID-19 increases the risk of mortality and other adverse health outcomes in dementia patients. These findings highlight the need for closer follow-up and management strategies for dementia patients post-COVID-19.

Targeted and untargeted cross-sectional study for sex-specific identification of plasma biomarkers of COVID-19 severity

Coronavirus disease 2019 is a highly contagious respiratory illness caused by the coronavirus SARS-CoV-2. Symptoms can range from mild to severe and typically appear 2-14 days after virus exposure. While vaccination has significantly reduced the incidence of severe complications, strategies for the identification of new biomarkers to assess disease severity remains a critical area of research. Severity biomarkers are essential for personalizing treatment strategies and improving patient outcomes. This study aimed to identify sex-specific biomarkers for COVID-19 severity in a Chilean population (n = 123 female, n = 115 male), categorized as control, mild, moderate, or severe. Data were collected using clinical biochemistry parameters and mass spectrometry-based metabolomics and lipidomics to detect alterations in plasma cytokines, metabolites, and lipid profiles related to disease severity. Principal component analysis (PCA) and orthogonal partial least squares discriminant analysis (OPLS-DA) were performed to select significant characteristic features for each group. The results revealed distinct biomarkers for males and females. In males, COVID-19 severity of was associated with inflammation parameters, triglycerides content, and phospholipids profiles. For females, liver damage parameters, triglycerides content, cholesterol derivatives, and phosphatidylcholine were identified as severity biomarkers. For both sexes, most of the biomarker combinations evaluated got areas under the ROC curve greater than 0.8 and low prediction errors. These findings suggest that sex-specific biomarkers can help differentiate the levels of COVID-19 severity, potentially aiding in the development of tailored treatment approaches.

Outcomes of Patients with Heart Failure Hospitalized for COVID-19-A Study in a Tertiary Italian Center

Background: Coronavirus Disease 2019 (COVID-19), triggered by SARS-CoV-2, has represented a global pandemic associated with an elevated rate of mortality, mainly among older individuals. The extensive pulmonary involvement by the viral infection might have precipitated pre-existing chronic conditions in this vulnerable population, including heart failure (HF). Materials and Methods: The aim of this retrospective, observational study was to assess the impact of COVID-19 in patients with a prior diagnosis of HF referred to the Emergency Department of the Agostino Gemelli University Hospital between March 2020 and January 2023. A total of 886 HF patients (444 men and 442 women, mean age of 80 ± 10 years) were identified. Patients were matched in a 1:1 ratio by gender, age, number of comorbidities (excluding HF), and vaccination status, using a propensity score matching (PSM) procedure. We compared the outcomes of 189 patients with a concomitant diagnosis of HF with those of 189 matched controls without HF. Results: Among patients with HF, there was a significantly higher prevalence of valvular disease (p = 0.004), atrial fibrillation (p = 0.003), use of anticoagulants (p = 0.001), chronic obstructive pulmonary diseases (p = 0.03), and chronic kidney disease (p = 0.001). In contrast, hypertension was more prevalent among controls than HF patients (p = 0.04). In addition, controls exhibited higher lymphocytes counts and a higher PaO2/FiO2 ratio compared to HF patients. During hospitalization, patients with HF were more frequently treated with high-flow nasal cannulas (p = 0.01), required more frequent admission to an intensive care unit (ICU) (p = 0.04), and showed a significantly higher mortality rate (p 0.0001) than controls. Conclusions: HF is an independent risk factor for ICU admission and death in COVID-19 patients.

The immune-endocrine interplay in sex differential responses to viral infection and COVID-19

Men are at higher risk for developing severe COVID-19 than women, while women are at higher risk for developing post-acute sequelae of COVID-19 (PASC). This highlights the impact of sex differences on immune responses and clinical outcomes of acute COVID-19 or PASC. A dynamic immune-endocrine interface plays an important role in the development of effective immune responses impacting the control of viral infections. In this opinion article we discuss mechanisms underlying the transcriptional and epigenetic regulation of immune responses by sex hormones during viral infections. We propose that disruption of this delicate immune-endocrine interplay can result in worsened outcomes of viral disease. We also posit that insights into these immune mechanisms can propel the development of novel immunomodulatory interventions that leverage immune-endocrine pathways to treat viral infections.

Impact of COVID-19 on the time to counseling and treatment of prostate cancer

PURPOSE

This study investigates how the COVID-19 pandemic (CP) impacted the timeline between initial diagnosis (ID) of prostate carcinoma and subsequent therapy consultation (TC) or radical prostatectomy (RP) due to the implementation of a "minimal contact concept," which postponed clinical examinations until the day of admission.

METHODS

We analyzed patient data from a tertiary care center from 2018 to September 2021. The focus was on comparing the time intervals from ID to TC and from ID to RP before and during the CP.

RESULTS

Of 12,255 patients, 6,073 (61.6%) were treated before and 3,791 (38.4%) during the CP. The median time from ID to TC reduced from 37 days (IQR: 21 - 58d) pre-CP to 32 days (IQR: 20 - 50d) during CP (p < 0.001). Similarly, the time from ID to RP decreased from 98 days (IQR: 70 - 141d) to 75 days (IQR: 55 - 108d; p < 0.001) during the CP. There was a significant decrease in low-risk tumor cases at ID (18.9% vs. 21.4%; p = 0.003) and post-RP (4% vs. 6.7%; p < 0.001) during the CP.

CONCLUSION

Our findings suggest that the COVID-19 pandemic facilitated more timely treatment of prostate cancer, suggesting potential benefits for both low-risk and aggressive tumor management through expedited clinical procedures.

Hypopituitarism and COVID-19

PURPOSE

This review aims to collect and examine recent research findings regarding hypopituitarism and COVID-19, focusing on the virus's impact on the pituitary gland and the outcomes for infected patients with hormonal deficiencies.

METHODS

Literature review using PubMed (pubmed.ncbi.nlm.nih.gov). The search included the following terms: "COVID19" in combination with "Pituitary" and "Hypopituitarism".

RESULTS

Many studies have aimed to evaluate the function of the pituitary gland in infected patients, revealing variable degrees of deficiencies. The results are very heterogenous mostly because many different tests and hormonal cut-off have been adopted. It is unclear whether primary virus damage or the inflammatory response is responsible for these hormonal alterations. Interestingly, pituitary defects may persist long after the initial infection, possibly contributing to the "Long COVID syndrome". However, data on the recovery of pituitary function and long-term follow-up are not yet available. On the other hand, although findings are not consistent, patients with hypopituitarism may be at a higher risk for COVID-19 infection rate, complications, and mortality.

CONCLUSION

The COVID-19 pandemic presented challenges for endocrinologists. The endocrine system appears to be involved in both the acute phase of infection and the recovery period. Hypopituitarism can be a consequence of SARS-COV-2 infection, and patients with existing hypopituitarism may face higher risks of complications. It is advisable to educate these patients on how to adjust their replacement therapies. Long-term follow-up data on pituitary function after recovery from COVID-19 are needed.

Retrospective analysis of COVID-19 clinical and laboratory data: Constructing a multivariable model across different comorbidities

BACKGROUND

The clinical pathogenesis of COVID-19 necessitates a comprehensive and homogeneous study to understand the disease mechanisms. Identifying clinical symptoms and laboratory parameters as key predictors can guide prognosis and inform effective treatment strategies. This study analyzed comorbidities and laboratory metrics to predict COVID-19 mortality using a homogeneous model.

METHOD

A retrospective cohort study was conducted on 7500 COVID-19 patients admitted to Rasoul Akram Hospital between 2022 and 2022. Clinical and laboratory data, along with comorbidity information, were collected and analyzed using advanced coding, data alignment, and regression analyses. Machine learning algorithms were employed to identify relevant features and calculate predictive probability scores.

RESULTS

The frequency and mortality rates of COVID-19 among males (19.3 %) were higher than those among females (17 %) (p = 0.01, OR = 0.85, 95 % CI = 0.76-0.96). Cancer (p < 0.05, OR = 1.9, 95 % CI = 1.48-2.4) and Alzheimer's (p < 0.05, OR = 2.36, 95 % CI = 1.89-2.9) were the two most common comorbidities associated with long-term hospitalization (LTH). Kidney disease (KD) was identified as the most lethal comorbidity (45 % of KD patients) (OR = 5.6, 95 % CI = 5.05-6.04, p < 0.001). Age > 55 was the most predictive parameter for mortality (p < 0.001, OR = 6.5, 95 % CI = 1.03-1.04), and the CT scan score showed no predictive value for death (p > 0.05). WBC, Cr, CRP, ALP, and VBG-HCO3 were the most significant critical data associated with death prediction across all comorbidities (p < 0.05).

CONCLUSION

COVID-19 is particularly lethal for elderly adults; thus, age plays a crucial role in disease prognosis. Regarding death prediction, various comorbidities rank differently, with KD having a significant impact on mortality outcomes.

Effects of COVID-19 virus-like particles on the behavioral and cognitive performance of human apolipoprotein E targeted replacement mice

Introduction

The effects of viral infections might be apolipoprotein E (apoE) isoform-dependent. In humans, there are three major apoE isoforms, E2, E3, and E4. E4 is associated with the enhanced entry of several viruses into the brain and their disease progression. A concern of infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the development of post-acute COVID-19 syndrome, also known as long COVID. Genetic risk factors for developing long COVID were reported.

Methods

In this study, we used virus-like particles (VLPs) that include expression of the SARS-CoV-2 nucleocapsid (N), membrane (M), and envelope (E) structural proteins together with S. In the current study, we used human E2, E3, and E4 targeted replacement mice to assess whether these VLPs affect body weight, behavioral and cognitive performance, and circadian body temperatures. Using VLPs allow working outside an ABSL-3 facility.

Results

The effects of VLPs on some behavioral measures were apoE isoform-dependent, with the E2 mice being more affected than E3 or E4 mice. The overall decreased activity in the open field containing objects in week 2 indicate that VLPs can also reduce activity levels in an apoE isoform-independent fashion.

Discussion

The results of the current study indicate that even in the absence of viral replication, detrimental effects of VLPs on behavioral measures and circadian body temperatures are seen.

The impact of COVID-19 on women's reproductive system

The coronavirus disease 2019 (COVID-19) pandemic has been a major global focus since 2019. However, drug development and vaccination have been unable to stop the rise in the number of COVID-19 infections. As a result, almost everyone has been infected with COVID-19. As the COVID-19 pandemic nears its end, it is important to explore whether contracting COVID-19 has any irreversible effects on the female reproductive system. This article aims to review the effects of COVID-19 on the female ovary and reproductive system and examine whether these effects are permanent. In conclusion, we can state that COVID-19 has not caused any long-lasting effects on the reproductive health of most women, with the exception of a few cases where premature ovarian failure has been observed. These temporary effects, such as menstrual disturbances and temporary fertility loss, tend to diminish and eventually disappear over time.

Gut microbiome dysbiosis and immune activation correlate with somatic and neuropsychiatric symptoms in COVID-19 patients: Microbiome dysbiosis linked to COVID-19 symptoms

COVID-19 patients often exhibit altered immune responses and neuropsychiatric symptoms during hospitalization. However, the potential interactions with gut microbiome profiles have not been fully characterized. Here, COVID-19 disease severity was classified as low (27.4%), moderate (29.8%), and critical (42.8%). Fever (66.1%) and cough (55.6%) were common symptoms. Additionally, 27.3% reported somatic symptoms, 27.3% experienced anxiety, 39% had depressive symptoms, and 80.5% reported stress. Gut microbiome profiling was performed using full-length 16S rRNA gene sequencing. Elevated interleukin-6 levels were observed in the most severe cases, indicating systemic inflammation. Reduced gut bacterial diversity was more pronounced in women and obese patients and correlated with higher disease severity. The presence of the genus Mitsuokella was significantly associated with increased physical, stress, anxiety, and depressive symptoms, and Granulicatella with critically ill patients. These findings suggest a link between mental health status, systemic inflammation, and gut dysbiosis in COVID-19 patients, emphasizing the potential of microbiome-targeted therapies to improve recovery and reduce severe complications.

Delineating sex-specific circulating host response signatures associated with COVID-19 severity and mortality

Male SARS-CoV-2-infected patients have higher hospitalization rates, ICU admissions, and mortality compared to females, yet with unclear underlying mechanisms. We investigated the influence of biological sex on COVID-19 severity and patient outcomes. We profiled 41 circulating host response markers and identified differentially regulated proteins based on disease severity using covariates, such as sex, age, BMI, diabetes, and corticosteroid administration. IL-8, D-dimer, S100B, IL-6, Angpt-2, MMP-8, TNF-R1, u-PAR, u-PA, osteopontin, IL-13, TNF-α, pentraxin-3, P-selectin, fractalkine, and SP-D levels were elevated in critically ill COVID-19 males compared to severe cases. In contrast, IL-8, D-dimer, IL-6, Angpt-2, Tie-2, uPAR, and SP-D were higher in females with critical-COVID-19 than in severe cases. Notably, D-dimer, IL-6, pentraxin-3, and S100B were associated with male mortality, yet none of the measured plasma proteins associated with female mortality. Our study delineated distinct sex-specific plasma protein signatures linked to the severity and mortality of COVID-19 patients.

CT pulmonary angiography in the inpatients: A 5-year retrospective view at the end of COVID-19 public health emergency

To retrospectively evaluate the trends in utilization and results of computed tomography pulmonary angiography (CTPA study) for detection of acute pulmonary embolism (PE) in the hospital inpatients during different phases of COVID-19 public health emergency. We conducted an Institutional Review Board (IRB)-approved retrospective review of CTPA studies for our hospital inpatients in the years from 2019 to 2023, ranging from the prepandemic year (2019) to the year coinciding with the end of public health declarations (2023). Collected characteristics included patient age, patient sex, and result of the study. The utilization of CTPA studies for inpatients was higher in 2020 to 2023, compared to 2019 (3.8% in 2023 compared to 2.4% in 2019, P < .001). The increase in utilization was also statistically significant in each group, when stratified by age and sex (OR = 1.46 for female, OR = 1.71 for male, OR = 1.93 for elderly, and OR = 1.29 for non-elderly inpatients in 2023, compared to 2019). The positivity rate of acute PE in the inpatients was overall higher in 2021, 2022, and 2023, compared to 2019 (for example, 18.5% in 2023 compared to 14.3% in 2019, P = .01). When stratified by age and sex, only the non-elderly patients continued to have a significantly higher rate of acute PE in 2023, compared to 2019 (OR = 1.39). While studies spanning longer time frames and involving multiple institutions are needed to understand and generalize this conclusion, we conclude that the utilization and positivity rates of CTPA studies in inpatients remains high at the end of the COVID-19 pandemic public health emergency.

Prospective clinical surveillance for severe acute respiratory illness and COVID-19 vaccine effectiveness in Kenyan hospitals during the COVID-19 pandemic

BACKGROUND

There are limited data from sub-Saharan Africa describing the demographic characteristics, clinical features and outcome of patients admitted to public hospitals with severe acute respiratory infections during the COVID-19 pandemic.

METHODS

We conducted a prospective longitudinal hospital-based sentinel surveillance between May 2020 and December 2022 at 16 public hospitals in Kenya. All patients aged above 18 years admitted to adult medical wards in the participating hospitals were included. We collected data on demographic and clinical characteristics, SARS-CoV-2 infection and COVID-19 vaccination status and, admission episode outcomes. We determined COVID-19 vaccine effectiveness (VE) against admission with SARS-CoV-2 positive severe acute respiratory illness (SARI) (i.e., COVID-19) and progression to inpatient mortality among patients admitted with SARI, using a test-negative case control design.

RESULTS

Of the 52,636 patients included in the study, 17,950 (34.1%) were admitted with SARI. The median age was 50 years. Patients were equally distributed across sexes. Pneumonia was the most common diagnosis at discharge. Hypertension, Human Immunodeficiency Virus (HIV) infection and Diabetes Mellitus were the most common chronic comorbidities. SARS-CoV-2 test results were positive in 2,364 (27.9%) of the 8,471 patients that underwent testing. After adjusting for age, sex and presence of a chronic comorbidity, SARI patients were more likely to progress to inpatient mortality compared to non-SARI patients regardless of their SARS-CoV-2 infection status (adjusted odds ratio (aOR) for SARI and SARS-CoV-2 negative patients 1.22, 95% CI 1.10-1.37; and aOR for SARI and SARS-CoV-2 positive patients 1.32, 95% CI 1.24-1.40). After adjusting for age, sex and presence of a chronic comorbidity, COVID-19 VE against progression to inpatient mortality following admission with SARI for those with a confirmed vaccination status was 0.59 (95% CI 0.27-0.77).

CONCLUSION

We have provided a comprehensive description of the demographic and clinical pattern of admissions with SARI in Kenyan hospitals during the COVID-19 pandemic period as well as the COVID-19 VE for these patients. These data were useful in providing situational awareness during the first three years of the pandemic in Kenya and informing national response measures.

Sex Differences in Long-Term Cardiovascular Outcomes and Mortality After COVID-19 Hospitalization During Alpha, Delta and Omicron Waves

Background: Increased mortality and occurrence of cardiovascular (CV) outcomes during hospitalization and in short-term follow-up for moderate to severe SARS-CoV-2 infection have been associated with male sex, yet data regarding long-term outcomes by sex and COVID-19 variant (Alpha, Delta, and Omicron) are limited. Methods: This prospective study of 4882 patients examines potential differences by sex in the occurrence of primary combined cardiovascular outcomes (CV death, CV hospitalization, myocardial infarction (MI), stroke, pulmonary embolism) as well as secondary outcomes (CV death, cardiovascular hospitalizations, myocardial infarction, stroke, pulmonary embolism) at 18-month follow-up after urgent hospitalization for SARS-CoV-2-associated pneumonia, as well as evaluating for differences during the three COVID-19 waves. Survival rate was analyzed for the entire cohort by sex and SARS-CoV-2 variant and adjusted for age using the multiple Kaplan-Meier method. To compare survival in groups of men and women for each wave, the Gehan-Wilcoxon test was applied with significance p < 0.05. Univariate Cox proportional hazards models were used to search for potential risk factors of CV death at 18-months follow-up separately for men and women in each COVID-19 wave. Results: Men had significantly higher 18-month CV mortality compared to women in the Delta wave (6.13% men vs. 3.62% women, p = 0.017). Although men had higher percentages of all other CV endpoints (excepting pulmonary embolism) at follow-up during the Delta wave, none were significant compared with women, except for the combined CV endpoint (16.87% men vs. 12.61% women, p = 0.017). No significant differences by sex in CV outcomes were seen during the Alpha and Omicron variants. Discrepancies in CV outcomes in demographical data and concomitant disease between the COVID-19 variants of concern existed. Conclusions: Higher male mortality and higher but non-significant incidences of CV outcomes occurred during the Delta wave of the COVID-19 pandemic, with the lowest incidence of CV outcomes observed during the Omicron variant.

The impact of sex/gender-specific funding and editorial policies on biomedical research outcomes: a cross-national analysis (2000-2021)

Reflecting sex and gender characteristics in biomedical research is critical to improving health outcomes and reducing adverse effects from medical treatments. This study investigates the impact of sex/gender-specific funding policies and journal editorial standards on the integration of sex/gender analysis in biomedical research publications. Using data from the United States, Canada, the United Kingdom, and other countries between 2000 and 2021, we assessed how these policies influenced research output in the fields of medicine and life sciences. Our findings show that countries with progressive funding policies and journals promoting sex/gender-based reporting have significantly improved research quality and publication rates. This highlights the importance of coordinated policy efforts and editorial practices in advancing integrated sex/gender research. We recommend continued global efforts from policymakers, funding bodies, and journals to embed sex/gender perspectives in scientific inquiry, ensuring more effective and equitable biomedical advancements.

Relationships Between Polymorphisms in HLA-G 3'UTR Region and COVID-19 Disease Severity

The objective of this study is to investigate the the relationships between HLA-G gene variants and sHLA-G with susceptibility to SARS-CoV-2 infection. In this case-control study, 65 Patients with COVID-19 were and 67 healthy controls were genotyped for their main functional polymorphisms namely, the 14-bp Ins/Del (rs371194629), +3003C/T (rs1707), +3010C/G (rs1710), +3027A/C (rs17179101), +3035C/T (rs17179108), +3142C/G (rs1063320), +3187A/G (rs9380142) and +3196C/G (rs1610696) in the exon 8 of the 3' untranslated regions (3' UTRs) using sanger sequencing method. Associations were assessed for five inheritance models (codominant, dominant, recessive, over-dominant and log-additive). Moreover, the levels of plasma soluble HLA-G (sHLA-G) were explored using ELISA method. Our results revealed that the 14-bp INS/DEL polymorphism was strongly associated with COVID-19 symptoms development for almost all tested inheritance models (p < 0.001). Inversely, the (+3196C/G) polymorphism exhibited a protective effect against COVID-19. In addition, three haplotypes; UTR-1, UTR-3, and UTR-5 were found associated with COVID-19 symptoms (p < 0.05), The level of HLA-G in the serum was significantly higher in COVID-19 individuals than in healthy individuals (p < 0.001).These findings suggest that HLA-G gene polymorphisms in the regulatory 3'UTR region of the HLA-G gene may influence the host immune response to SARS-CoV-2 infection. A deeper comprehension of the functional effect of these associated polymorphisms could be useful in identifying high-risk individuals and in developing adaptive treatments for patients.

Comorbid burden at ICU admission in COVID-19 compared to sepsis and acute respiratory distress syndrome

BACKGROUND

Comorbidities are similarly associated with short-term mortality for COVID-19, acute respiratory distress syndrome (ARDS) and sepsis in intensive care unit (ICU) patients, but their adjusted frequencies at admission are unknown. Thus, we aimed to evaluate the adjusted distribution, reported as odds ratios, of known risk factors (i.e., age, sex and comorbidities) for ICU admission between COVID-19, sepsis and ARDS patients in this nationwide registry-based study.

METHODS

In this cohort study, we included adult patients admitted to Swedish ICUs with COVID-19 (n = 7382) during the pandemic and compared them to patients admitted to ICU with sepsis (n = 22,354) or ARDS (n = 2776) during a pre-COVID-19 period. The main outcomes were the adjusted odds for comorbidities, sex, and age in multivariable logistic regression on diagnostic categories in patients admitted to ICU, COVID-19 or sepsis and COVID-19 or ARDS.

RESULTS

We found that most comorbidities, as well as age, had a stronger association with sepsis admission than COVID-19 admission with the exception of male sex, type 2 diabetes mellitus, and asthma that were more strongly associated with COVID-19 admission, while no difference was seen for chronic renal failure and obesity. For COVID-19 and ARDS admission most risk factors were more strongly associated with ARDS admission except for male sex, type 2 diabetes mellitus, chronic renal failure, and obesity which were more strongly associated with COVID-19 admission, whereas hypertension, chronic obstructive pulmonary disease and asthma were not different.

CONCLUSIONS

Patients admitted to ICU with sepsis or ARDS carry a heavier burden of comorbidity and high age than patients admitted with COVID-19. This is likely caused by a combination of: (1) respiratory failure in COVID-19 being less dependent on comorbidities than in other forms of ARDS, and the cause of critical illness in other infections causing sepsis and (2) COVID-19 patients being deferred admission in situations where patients with the other syndromes were admitted.

COVID-19 increased existing gender mortality gaps in high-income more than middle-income countries

OBJECTIVE

To analyze how patterns of excess mortality varied by sex and age groups across countries during the COVID-19 pandemic and their association with country income level.

METHODS

We used World Health Organization excess mortality estimates by sex and age groups for 75 countries in 2020 and 62 countries in 2021, restricting the sample to estimates based on recorded all-cause mortality data. We examined patterns across countries using country-specific Poisson regressions with observations consisting of the number of excess deaths by groups defined by sex and age.

FINDINGS

Men die at higher rates in nearly all places and at all ages beyond age 45. In 2020, the pandemic amplified this gender mortality gap for the world, but with variation across countries and by country income level. In high-income countries, rates of excess mortality were much higher for men than women. In contrast, in middle-income countries, the sex ratio of excess mortality was similar to the sex ratio of expected all-cause mortality. The exacerbation of the sex ratio of excess mortality observed in 2020 in high-income countries, however, declined in 2021.

CONCLUSION

The COVID-19 pandemic has killed men at much higher rates than women, as has been well documented, but these gender differences have varied by country income. These differences were the result of some combination of variation in gender patterns of infection rates and infection fatality rates across countries. The gender gap in mortality declined in high-income countries in 2021, likely as a result of the faster rollout of vaccination against COVID-19.