1
|
Usman M, Yuyan L, Husnain M, Akhtar MW. COVID-19, travel restrictions and environmental consequences. ENVIRONMENT, DEVELOPMENT AND SUSTAINABILITY 2023:1-21. [PMID: 37363034 PMCID: PMC10024297 DOI: 10.1007/s10668-023-03146-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/10/2023] [Indexed: 06/28/2023]
Abstract
The component of human life that has been most significantly altered by the COVID-19 epidemic is travel. Due to the upheaval produced by the pandemic breakout, countries are becoming increasingly avaricious and are scrambling to stockpile vaccines. The world has been locked down to reduce/control the pandemic outbreak, driving countries to shut their doors to other people from countries. The recent pandemic has had a short-term, positive effect on the environment, but travel restrictions have caused problems for the common person and are expected to deteriorate more soon, necessitating longer quarantines, vaccination requirements, vaccine passports, and immunization certificates required by countries for safe travel. Thus, this study has three objectives. First, we investigate the impact of COVID-19 on travel and the environment, as well as the role that tourists play in the transmission of the virus. Second, we examine how countries are handling COVID-19 vaccines. Finally, we pinpoint differences in vaccination coverage.
Collapse
Affiliation(s)
- Muhammad Usman
- UE Business School, Division of Management and Administrative Sciences, University of Education Lahore, Lahore, Pakistan
| | - Li Yuyan
- Zhengzhou Shengda University, Zhengzhou, People’s Republic of China
| | - Mudassir Husnain
- UE Business School, Division of Management and Administrative Sciences, University of Education Lahore, Lahore, Pakistan
| | | |
Collapse
|
2
|
Chou OHI, Mui J, Chung CT, Radford D, Ranjithkumar S, Evbayekha E, Nam R, Pay L, Satti DI, Garcia-Zamora S, Bazoukis G, Çinier G, Lee S, Vassiliou VS, Liu T, Tse G, Wong ICK, Chou OHI, Liu T, Tse G. COVID-19 vaccination and carditis in children and adolescents: a systematic review and meta-analysis. Clin Res Cardiol 2022; 111:1161-1173. [PMID: 35906423 PMCID: PMC9361966 DOI: 10.1007/s00392-022-02070-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Coronavirus Disease-2019 (COVID-19) vaccination has been associated with the development of carditis, especially in children and adolescent males. However, the rates of these events in the global setting have not been explored in a systematic manner. The aim of this systematic review and meta-analysis is to investigate the rates of carditis in children and adolescents receiving COVID-19 vaccines. METHODS PubMed, Embase and several Latin American databases were searched for studies. The number of events, and where available, at-risk populations were extracted. Rate ratios were calculated and expressed as a rate per million doses received. Subgroup analysis based on the dose administered was performed. Subjects ≤ 19 years old who developed pericarditis or myocarditis following COVID-19 vaccination were included. RESULTS A total of 369 entries were retrieved. After screening, 39 articles were included. Our meta-analysis found that 343 patients developed carditis after the administration of 12,602,625 COVID-19 vaccination doses (pooled rate per million: 37.76; 95% confidence interval [CI] 23.57, 59.19). The rate of carditis was higher amongst male patients (pooled rate ratio: 5.04; 95% CI 1.40, 18.19) and after the second vaccination dose (pooled rate ratio: 5.60; 95% CI 1.97, 15.89). In 301 cases of carditis (281 male; mean age: 15.90 (standard deviation [SD] 1.52) years old) reported amongst the case series/reports, 261 patients were reported to have received treatment. 97.34% of the patients presented with chest pain. The common findings include ST elevation and T wave abnormalities on electrocardiography. Oedema and late gadolinium enhancement in the myocardium were frequently observed in cardiac magnetic resonance imaging (CMR). The mean length of hospital stay was 3.91 days (SD 1.75). In 298 out of 299 patients (99.67%) the carditis resolved with or without treatment. CONCLUSIONS Carditis is a rare complication after COVID-19 vaccination across the globe, but the vast majority of episodes are self-limiting with rapid resolution of symptoms within days. Central illustration. Balancing the benefits of vaccines on COVID-19-caused carditis and post-vaccination carditis.
Collapse
Affiliation(s)
- Oscar Hou In Chou
- Epidemiology Research Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
| | - Jonathan Mui
- Epidemiology Research Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
| | - Cheuk To Chung
- Epidemiology Research Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
| | - Danny Radford
- Epidemiology Research Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
- Kent and Medway Medical School, Canterbury Christ Church University, Canterbury, UK
- Kent and Medway Medical School, University of Kent, Canterbury, United Kingdom
| | - Simon Ranjithkumar
- Faculty of Health and Life Sciences, Aston University Medical School, Birmingham, B4 7ET, UK
| | - Endurance Evbayekha
- Epidemiology Research Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
| | - Ronald Nam
- Epidemiology Research Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
- Faculty of Health and Life Sciences, Aston University Medical School, Birmingham, B4 7ET, UK
| | - Levent Pay
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, 34668, Istanbul, Turkey
| | - Danish Iltaf Satti
- Epidemiology Research Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
| | - Sebastian Garcia-Zamora
- Cardiac Intensive Care Unit, Department of Cardiology, Delta Clinic, Rosario, Santa Fe, Argentina
| | - George Bazoukis
- Department of Cardiology, Medical School, University of Nicosia, 2408, Nicosia, Cyprus
| | - Göksel Çinier
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, 34668, Istanbul, Turkey
| | - Sharen Lee
- Epidemiology Research Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
| | - Vassilios S Vassiliou
- Department of Medicine, Bob Champion Research and Education, Norwich Medical School, University of East Anglia and Norfolk and Norwich University Hospital, Rosalind Franklin Rd, Norwich, NR4 7UQ, UK.
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK.
- Kent and Medway Medical School, University of Kent, Canterbury, United Kingdom.
| | - Ian Chi Kei Wong
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | | | | | | |
Collapse
|
3
|
Willis KD, Rao SR, Normen M, de Groot J, Calman L, Bahcivan O, Centeno I, Fehon DC. Same storm, different boat: The global impact of COVID-19 on palliative care. Psychooncology 2022; 32:148-154. [PMID: 35793431 PMCID: PMC9350379 DOI: 10.1002/pon.5995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/25/2022] [Accepted: 06/29/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has had a complex and profound impact on the provision of palliative care globally. To support learning from palliative care providers and researchers worldwide, the Education Subcommittee of International Psycho-Oncology Society (IPOS) Palliative Care Special Interest Group developed a webinar with presentations by and discussion with eight international palliative care leaders. METHODS Presentations were content rich; the speakers used both quantitative (e.g., sharing recent statistical findings) and qualitative (e.g., narrative storytelling, anecdotal experiences) approaches to portray the effect of COVID-19 in their region. Subsequent to the webinar, the committee collectively identified five themes conveyed by the presenters through consensus. RESULTS The themes included: (1) altered accessibility to palliative care, with socio-economic status impacting virtual health availability; (2) reduced opportunities to preserve dignity, as survival has been prioritized over preserving the humanity of patients and their loved ones; (3) complicated grief and bereavement arising from social distancing requirements; (4) greater awareness of the importance of sustaining health provider well-being; and (5) the development of valuable innovations across nations, institutions, disciplines, and communities. CONCLUSIONS Overall, the webinar facilitated valuable connection for global learning and identified opportunities for research and clinical interventions. In an ongoing crisis that has exacerbated isolation, we will need to continue to learn and lean on one another as a global community to navigate ongoing challenges of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Kelcie D. Willis
- Department of PsychologyVirginia Commonwealth UniversityRichmondVirginiaUSA,Massey Cancer CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Seema Rajesh Rao
- Department of Research & EducationBangalore Hospice Trust—KarunashrayaBangaloreIndia
| | - Michelle Normen
- Department of Research & EducationBangalore Hospice Trust—KarunashrayaBangaloreIndia
| | - Janet de Groot
- Departments of Psychiatry and OncologyCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Lynn Calman
- School of Health SciencesCentre for Psychosocial Research in CancerUniversity of SouthamptonSouthamptonUK
| | - Ozan Bahcivan
- Psiko‐Onkologlar Dernegi (Psycho‐Oncological Association)IzmirTurkiye,Ozel Oz Psikoloji Aile Danisma Merkezi (Oz Psychology Family Counselling Centre)IzmirTurkiye
| | - Isabel Centeno
- Breast Cancer CenterHospital Zambrano HellionMonterreyMexico
| | - Dwain C. Fehon
- Department of PsychiatryYale School of MedicineNew HavenConnecticutUSA,Smilow Cancer HospitalNew HavenConnecticutUSA
| |
Collapse
|
4
|
Freise NF, Kivel M, Grebe O, Meyer C, Wafaisade B, Peiper M, Zeus T, Schmidt J, Neuwahl J, Jazmati D, Luedde T, Bölke E, Feldt T, Jensen BEO, Bode J, Keitel V, Haussmann J, Tamaskovics B, Budach W, Fischer JC, Knoefel WT, Schneider M, Gerber PA, Pedoto A, Häussinger D, van Griensven M, Rezazadeh A, Flaig Y, Kirchner J, Antoch G, Schelzig H, Matuschek C. Acute cardiac side effects after COVID-19 mRNA vaccination: a case series. Eur J Med Res 2022; 27:80. [PMID: 35655235 PMCID: PMC9160507 DOI: 10.1186/s40001-022-00695-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/27/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Vaccination against SARS-CoV-2 has been the main tool to contain the pandemic. The rush development of the 3 vaccines and their expedited approval have led to inoculation of millions of patients around the world, leading to a containment of the disease. Despite continuous viral mutations and the identification of weaker variants, the severity of the infections has been mild, with many patients being either asymptomatic or recovering at home. Currently the focus has shifted from the host of organ damage related to the infection to potential side effects of the vaccine. Myocarditis has been reported as one of the potential side effects from the mRNA vaccine, affecting young healthy individuals. Up to September 30, 2021, 1.243 cases of myocarditis after vaccination with BNT162b2 Comirnaty© were registered in young adults by the Paul-Ehrlich-Institute in Germany alone. The exact pathophysiology and the risk factors for myocarditis following vaccination remain unclear. We present a case series of eight patients with cardiac symptom shortly after SARS-CoV-2 mRNA vaccination (BNT162b6, Biontech, Comirnaty© or mRNA-1237 Moderna, Spikevax©). PATIENTS AND METHODS Eight patients between 13 and 56 years of age, vaccinated with either BNT162b2 or mRNA-1273 mRNA vaccine between January and August 2021 developed cardiac side effects shortly after either their first or second dose of the vaccine. Clinical data were retrieved from the clinical information system and analyzed. To support diagnosis of myocarditis or pericarditis, cardiac magnetic resonance imaging (MRI) was performed shortly after the onset of symptoms, with further investigations in severe cases. Symptoms were defined as dyspnea, chest pain and cardiac arrhythmia as determined by electrocardiography. RESULTS Eight patients (5 males and 3 females) developed cardiac symptoms compatible with myocarditis, according to the CDC criteria, shortly after SARS-CoV-2 mRNA vaccination. Three patients (2 males, 1 female) required hospitalization due to severe chest pain and elevated troponin levels. All patients recovered fully within 7 days from the symptom onset. CONCLUSIONS Our data suggest that cardiac adverse events such as myocarditis or pericarditis shortly after SARS-CoV-2 mRNA vaccination are rare but possible and occur particularly in male patients.
Collapse
Affiliation(s)
- Noemi F Freise
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Milena Kivel
- Department of Pediatric, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Olaf Grebe
- Department of Cardiology and Rhythmology, Petrus Hospital, Wuppertal, Germany
| | - Christian Meyer
- Department for Cardiology, Rhythmology, Angiology and Intensive Care Medicine, cNEP Research Consortium, EVK Düsseldorf, Düsseldorf, Germany
| | - Bahram Wafaisade
- Department for Cardiology, Rhythmology, Angiology and Intensive Care Medicine, cNEP Research Consortium, EVK Düsseldorf, Düsseldorf, Germany
| | - Matthias Peiper
- Department for Cardiology, Rhythmology, Angiology and Intensive Care Medicine, cNEP Research Consortium, EVK Düsseldorf, Düsseldorf, Germany
| | - Tobias Zeus
- Medical Faculty, Department of Cardiology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Jan Schmidt
- Medical Faculty, Department of Cardiology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Judith Neuwahl
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Danny Jazmati
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Tom Luedde
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Björn Erik Ole Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Johannes Bode
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Verena Keitel
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Medical Faculty of Otto Von Guericke University Magdeburg, Leipziger Str. 44, 39104, Magdeburg, Germany
| | - Jan Haussmann
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Balint Tamaskovics
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Wilfried Budach
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Johannes C Fischer
- Institute for Transplant Diagnostics and Cell Therapeutics, Heinrich Heine University, Düsseldorf, Germany
| | - Wolfram Trudo Knoefel
- Medical Faculty, Department of Surgery and Interdisciplinary Surgical Intensive Care Unit, Heinrich Heine University, Düsseldorf, Germany
| | - Marion Schneider
- Division of Experimental Anesthesiology, University Hospital Ulm, Ulm, Germany
| | - Peter Arne Gerber
- Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Alessia Pedoto
- Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Dieter Häussinger
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Martijn van Griensven
- Department cBITE, Maastricht University, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht, The Netherlands
| | - Amir Rezazadeh
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Yechan Flaig
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Julian Kirchner
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Hospital of Düsseldorf, Dusseldorf, Germany
| | - Gerald Antoch
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Hospital of Düsseldorf, Dusseldorf, Germany
| | - Hubert Schelzig
- Medical Faculty, Department of Vascular Surgery, University Hospital Heinrich Heine University, Düsseldorf, Germany
| | - Christiane Matuschek
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| |
Collapse
|
5
|
Wells CR, Pandey A, Fitzpatrick MC, Crystal WS, Singer BH, Moghadas SM, Galvani AP, Townsend JP. Quarantine and testing strategies to ameliorate transmission due to travel during the COVID-19 pandemic: a modelling study. THE LANCET REGIONAL HEALTH. EUROPE 2022; 14:100304. [PMID: 35036981 PMCID: PMC8743228 DOI: 10.1016/j.lanepe.2021.100304] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Numerous countries have imposed strict travel restrictions during the COVID-19 pandemic, contributing to a large socioeconomic burden. The long quarantines that have been applied to contacts of cases may be excessive for travel policy. METHODS We developed an approach to evaluate imminent countrywide COVID-19 infections after 0-14-day quarantine and testing. We identified the minimum travel quarantine duration such that the infection rate within the destination country did not increase compared to a travel ban, defining this minimum quarantine as "sufficient." FINDINGS We present a generalised analytical framework and a specific case study of the epidemic situation on November 21, 2021, for application to 26 European countries. For most origin-destination country pairs, a three-day or shorter quarantine with RT-PCR or antigen testing on exit suffices. Adaptation to the European Union traffic-light risk stratification provided a simplified policy tool. Our analytical approach provides guidance for travel policy during all phases of pandemic diseases. INTERPRETATION For nearly half of origin-destination country pairs analysed, travel can be permitted in the absence of quarantine and testing. For the majority of pairs requiring controls, a short quarantine with testing could be as effective as a complete travel ban. The estimated travel quarantine durations are substantially shorter than those specified for traced contacts. FUNDING EasyJet (JPT and APG), the Elihu endowment (JPT), the Burnett and Stender families' endowment (APG), the Notsew Orm Sands Foundation (JPT and APG), the National Institutes of Health (MCF), Canadian Institutes of Health Research (SMM) and Natural Sciences and Engineering Research Council of Canada EIDM-MfPH (SMM).
Collapse
Affiliation(s)
- Chad R. Wells
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, 06520, USA
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, 06520, USA
| | - Meagan C. Fitzpatrick
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, 06520, USA
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, 21201, USA
| | - William S. Crystal
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, 06520, USA
| | - Burton H. Singer
- Emerging Pathogens Institute, University of Florida, P.O. Box 100009, Gainesville, FL, 32610, USA
| | - Seyed M. Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada
| | - Alison P. Galvani
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, 06520, USA
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut, 06525, USA
| | - Jeffrey P. Townsend
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut, 06525, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, 06510, USA
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, Connecticut, 06511, USA
- Program in Microbiology, Yale University, New Haven, Connecticut, 06511, USA
| |
Collapse
|
6
|
Choong CKC, Belger M, Koch AE, Meyers KJ, Marconi VC, Abedtash H, Faries D, Krishnan V. Comparative Effectiveness of Dexamethasone in Hospitalized COVID-19 Patients in the United States. Adv Ther 2022; 39:4723-4741. [PMID: 35962234 PMCID: PMC9374287 DOI: 10.1007/s12325-022-02267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION To compare the mortality of hospitalized patients with COVID-19 between those that required supplemental oxygen and received dexamethasone with a comparable set of patients who did not receive dexamethasone. METHODS We utilized the Premier Health Database to identify hospitalized adult patients with COVID-19 from July 1, 2020-January 31, 2021. Index date was when patients first initiated oxygen therapy. The primary endpoint was in-hospital mortality for patients receiving dexamethasone versus those not receiving dexamethasone 1-day pre- to 1-day post-index period. Secondary endpoints included 28-day mortality, time to in-hospital mortality, progression to invasive mechanical ventilation or death, time to discharge, and proportion discharged alive by day 28. Twenty-three models using weighting, matching, stratification, and regression were deployed through the concept of frequentist model average (FMA) to estimate the effect of dexamethasone on all-cause mortality up to the 28-day hospitalization period. RESULTS A total of 1,208,881 patients with COVID-19 were screened; as an inpatient 255,216 used oxygen, and 251,536 were included in the analysis. In the dexamethasone group, odds of in-hospital mortality were higher than those of the comparator (FMA: odds ratio [OR] 1.15, 95% CI 1.08, 1.22). Using a best fit model, OR for in-hospital mortality was non-significant for the dexamethasone group compared with the comparator (OR 1.02, 95% CI 0.92, 1.14). Dexamethasone treatment was associated with poorer outcomes versus the comparator group across the majority of secondary endpoints, except for number of days in hospital, which was lower in the dexamethasone group versus the comparator group (mean difference - 2.14, 95% CI - 2.43, - 1.47). CONCLUSIONS Hospitalized adult patients with COVID-19 who required supplemental oxygen and received dexamethasone did not have a survival benefit versus similar patients not receiving dexamethasone. The dexamethasone group was not associated with favorable responses for outcomes such as progression to death or mechanical ventilation and time to in-hospital death.
Collapse
Affiliation(s)
| | - Mark Belger
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN 46225 USA
| | - Alisa E. Koch
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN 46225 USA
| | - Kristin J. Meyers
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN 46225 USA
| | - Vincent C. Marconi
- Rollins School of Public Health and the Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA USA
| | - Hamed Abedtash
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN 46225 USA
| | - Douglas Faries
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN 46225 USA
| | - Venkatesh Krishnan
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN 46225 USA
| |
Collapse
|
7
|
Wells CR, Pandey A, Fitzpatrick MC, Crystal WS, Singer BH, Moghadas SM, Galvani AP, Townsend JP. Quarantine and testing strategies to ameliorate transmission due to travel during the COVID-19 pandemic: a modelling study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.04.25.21256082. [PMID: 34729563 PMCID: PMC8562544 DOI: 10.1101/2021.04.25.21256082] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Numerous countries imposed strict travel restrictions, contributing to the large socioeconomic burden during the COVID-19 pandemic. The long quarantines that apply to contacts of cases may be excessive for travel policy. METHODS We developed an approach to evaluate imminent countrywide COVID-19 infections after 0-14-day quarantine and testing. We identified the minimum travel quarantine duration such that the infection rate within the destination country did not increase compared to a travel ban, defining this minimum quarantine as "sufficient." FINDINGS We present a generalised analytical framework and a specific case study of the epidemic situation on November 21, 2021, for application to 26 European countries. For most origin-destination country pairs, a three-day or shorter quarantine with RT-PCR or antigen testing on exit suffices. Adaptation to the European Union traffic-light risk stratification provided a simplified policy tool. Our analytical approach provides guidance for travel policy during all phases of pandemic diseases. INTERPRETATION For nearly half of origin-destination country pairs analysed, travel can be permitted in the absence of quarantine and testing. For the majority of pairs requiring controls, a short quarantine with testing could be as effective as a complete travel ban. The estimated travel quarantine durations are substantially shorter than those specified for traced contacts. FUNDING EasyJet (JPT and APG), the Elihu endowment (JPT), the Burnett and Stender families' endowment (APG), the Notsew Orm Sands Foundation (JPT and APG), the National Institutes of Health (MCF), Canadian Institutes of Health Research (SMM) and Natural Sciences and Engineering Research Council of Canada EIDM-MfPH (SMM).
Collapse
Affiliation(s)
- Chad R. Wells
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut 06520, USA
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut 06520, USA
| | - Meagan C. Fitzpatrick
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut 06520, USA
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, 21201, USA
| | - William S. Crystal
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut 06520, USA
| | - Burton H. Singer
- Emerging Pathogens Institute, University of Florida, P.O. Box 100009, Gainesville, FL 32610, USA
| | | | - Alison P. Galvani
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut 06520, USA
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut 06525, USA
| | - Jeffrey P. Townsend
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut 06525, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut 06510, USA
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, Connecticut 06511, USA
- Program in Microbiology, Yale University, New Haven, Connecticut 06511, USA
| |
Collapse
|
8
|
Somerville M, Curran JA, Dol J, Boulos L, Saxinger L, Doroshenko A, Hastings S, Reynolds B, Gallant AJ, Shin HD, Wong H, Crowther D, Macdonald M, Martin-Misener R, Comeau J, McCulloch H, Tricco AC. Public health implications of SARS-CoV-2 variants of concern: a rapid scoping review. BMJ Open 2021; 11:e055781. [PMID: 34857582 PMCID: PMC8640198 DOI: 10.1136/bmjopen-2021-055781] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/22/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The four SARS-CoV-2 variants of concern (VOC; Alpha, Beta, Gamma and Delta) identified by May 2021 are highly transmissible, yet little is known about their impact on public health measures. We aimed to synthesise evidence related to public health measures and VOC. DESIGN A rapid scoping review. DATA SOURCES On 11 May 2021, seven databases (MEDLINE, Embase, the Cochrane Database of Systematic Reviews, Central Register of Controlled Trials, Epistemonikos' L-OVE on COVID-19, medRxiv, bioRxiv) were searched for terms related to VOC, public health measures, transmission and health systems. No limit was placed on date of publication. ELIGIBILITY CRITERIA Studies were included if they reported on any of the four VOCs and public health measures, and were available in English. Only studies reporting on data collected after October 2020, when the first VOC was reported, were included. DATA EXTRACTION AND SYNTHESIS Titles, abstracts and full-text articles were screened by two independent reviewers. Data extraction was completed by two independent reviewers using a standardised form. Data synthesis and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. RESULTS Of the 37 included studies, the majority assessed the impact of Alpha (n=32) and were conducted in Europe (n=12) or the UK (n=9). Most were modelling studies (n=28) and preprints (n=28). The majority of studies reported on infection control measures (n=17), followed by modifying approaches to vaccines (n=13), physical distancing (n=6) and either mask wearing, testing or hand washing (n=2). Findings suggest an accelerated vaccine rollout is needed to mitigate the spread of VOC. CONCLUSIONS The increased severity of VOC requires proactive public health measures to control their spread. Further research is needed to strengthen the evidence for continued implementation of public health measures in conjunction with vaccine rollout. With no studies reporting on Delta, there is a need for further research on this and other emerging VOC on public health measures.
Collapse
Affiliation(s)
- Mari Somerville
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pediatrics, IWK Health, Halifax, Nova Scotia, Canada
| | - Janet A Curran
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pediatrics, IWK Health, Halifax, Nova Scotia, Canada
| | - Justine Dol
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Leah Boulos
- Maritime SPOR SUPPORT Unit, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Lynora Saxinger
- Division of Infectious Diseases, Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Alexander Doroshenko
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Stephanie Hastings
- Health Systems Evaluation and Evidence, Alberta Health Services, Calgary, Alberta, Canada
| | - Bearach Reynolds
- Department of Infectious Diseases, St Vincents Hospital, Dublin, Leinster, UK
- Evidence Synthesis Ireland, National University of Ireland, Galway, UK
| | - Allyson J Gallant
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Helen Wong
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Daniel Crowther
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marilyn Macdonald
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Jeannette Comeau
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Infectious Diseases, IWK Health, Halifax, Nova Scotia, Canada
| | - Holly McCulloch
- Department of Pediatrics, IWK Health, Halifax, Nova Scotia, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, School of Nursing, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|