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Gutman EG, Salvio AL, Fernandes RA, Duarte LA, Raposo-Vedovi JV, Alcaraz HF, Teixeira MA, Passos GF, de Medeiros KQM, Hammerle MB, Pires KL, Vasconcelos CCF, Leon LAA, Figueiredo CP, Alves-Leon SV. Long COVID: plasma levels of neurofilament light chain in mild COVID-19 patients with neurocognitive symptoms. Mol Psychiatry 2024:10.1038/s41380-024-02554-0. [PMID: 38678084 DOI: 10.1038/s41380-024-02554-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/29/2024]
Abstract
It is well known the potential of severe acute respiratory coronavirus type 2 (SARS-CoV-2) infection to induce post-acute sequelae, a condition called Long COVID. This syndrome includes several symptoms, but the central nervous system (CNS) main one is neurocognitive dysfunction. Recently it has been demonstrated the relevance of plasma levels of neurofilament light chain (pNfL), as a biomarker of early involvement of the CNS in COVID-19. The aim of this study was to investigate the relationship between pNfL in patients with post-acute neurocognitive symptoms and the potential of NfL as a prognostic biomarker in these cases. A group of 63 long COVID patients ranging from 18 to 59 years-old were evaluated, submitted to a neurocognitive battery assessment, and subdivided in different groups, according to results. Plasma samples were collected during the long COVID assessment and used for measurement of pNfL with the Single molecule array (SIMOA) assays. Levels of pNfL were significantly higher in long COVID patients with neurocognitive symptoms when compared to HC (p = 0.0031). Long COVID patients with cognitive impairment and fatigue symptoms presented higher pNfL levels when compared to long COVID patients without these symptoms, individually and combined (p = 0.0263, p = 0.0480, and 0.0142, respectively). Correlation analysis showed that levels of cognitive lost and exacerbation of fatigue in the neurocognitive evaluation had a significative correlation with higher pNfL levels (p = 0.0219 and 0.0255, respectively). Previous reports suggested that pNfL levels are related with higher risk of severity and predict lethality of COVID-19. Our findings demonstrate that SARS-CoV-2 infection seems to have a long-term impact on the brain, even in patients who presented mild acute disease. NfL measurements might be useful to identify CNS involvement in long COVID associated with neurocognitive symptoms and to identify who will need continuous monitoring and treatment support.
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Affiliation(s)
- Elisa Gouvea Gutman
- Translational Neuroscience Laboratory (LabNet), Biomedical Institute, Federal University of the State of Rio de Janeiro/UNIRIO, Rio de Janeiro, RJ, ZIP CODE 20211-040, Brazil
- Clinical Medicine post-graduation program, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Andreza Lemos Salvio
- Translational Neuroscience Laboratory (LabNet), Biomedical Institute, Federal University of the State of Rio de Janeiro/UNIRIO, Rio de Janeiro, RJ, ZIP CODE 20211-040, Brazil
| | - Renan Amphilophio Fernandes
- Translational Neuroscience Laboratory (LabNet), Biomedical Institute, Federal University of the State of Rio de Janeiro/UNIRIO, Rio de Janeiro, RJ, ZIP CODE 20211-040, Brazil
| | - Larissa Araujo Duarte
- Translational Neuroscience Laboratory (LabNet), Biomedical Institute, Federal University of the State of Rio de Janeiro/UNIRIO, Rio de Janeiro, RJ, ZIP CODE 20211-040, Brazil
- Clinical Medicine post-graduation program, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Jessica Vasques Raposo-Vedovi
- Translational Neuroscience Laboratory (LabNet), Biomedical Institute, Federal University of the State of Rio de Janeiro/UNIRIO, Rio de Janeiro, RJ, ZIP CODE 20211-040, Brazil
| | - Helena França Alcaraz
- Translational Neuroscience Laboratory (LabNet), Biomedical Institute, Federal University of the State of Rio de Janeiro/UNIRIO, Rio de Janeiro, RJ, ZIP CODE 20211-040, Brazil
| | - Milene Ataíde Teixeira
- Translational Neuroscience Laboratory (LabNet), Biomedical Institute, Federal University of the State of Rio de Janeiro/UNIRIO, Rio de Janeiro, RJ, ZIP CODE 20211-040, Brazil
| | | | | | - Mariana Beiral Hammerle
- Division of Neurology, Gaffrée and Guinle University Hospital, Federal University of the State of Rio de Janeiro/UNIRIO, Rio de Janeiro, RJ, Brazil
| | - Karina Lebeis Pires
- Division of Neurology, Gaffrée and Guinle University Hospital, Federal University of the State of Rio de Janeiro/UNIRIO, Rio de Janeiro, RJ, Brazil
| | | | | | | | - Soniza Vieira Alves-Leon
- Translational Neuroscience Laboratory (LabNet), Biomedical Institute, Federal University of the State of Rio de Janeiro/UNIRIO, Rio de Janeiro, RJ, ZIP CODE 20211-040, Brazil.
- Department of Neurology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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Zhang J, Xu Z, Wei X, Fu Y, Zhu Z, Wang Q, Wang Q, Liu Q, Guo J, Hao Y, Yang L. Analysis of health service utilization and influencing factors due to COVID-19 in Beijing: a large cross-sectional survey. Health Res Policy Syst 2024; 22:31. [PMID: 38439096 PMCID: PMC10910832 DOI: 10.1186/s12961-024-01118-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/05/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND In the wake of China's relaxed zero-COVID policy, there was a surge in coronavirus disease 2019 (COVID-19) infections. This study aimed to examine the infection status and health service utilization among Beijing residents during a widespread outbreak, and to explore the factors that affected utilization of health services due to COVID-19. METHODS A cross-sectional survey was conducted among Beijing residents from 13 January to 13 February 2023, collecting information on socio-demographic characteristics, health behaviours, COVID-19 infection status, utilization of health services and depressive symptoms. Multivariate Tobit regression was used for data analysis. RESULTS Among the 53 924 participants, 14.7% were older than 60 years, 63.7% were female and 84.8% were married. In total, 44 992 of the 53 924 individuals surveyed (83.4%) contracted COVID-19 during 2020-2023, and 25.2% (13 587) sought corresponding health services. The majority of individuals (85.6%) chose in-person healthcare, while 14.4% chose internet-based healthcare. Among those who chose in-person healthcare, 58.6% preferred primary healthcare institutions and 41.5% were very satisfied with the treatment. Factors affecting health service utilization include being female (β = -0.15, P < 0.001), older than 60 years (β = 0.23, P < 0.01), non-healthcare workers (β = -0.60, P < 0.001), rich self-rated income level (β = 0.59, P < 0.001), having underlying disease (β = 0.51, P < 0.001), living alone (β = -0.19, P < 0.05), depressive symptoms (β = 0.06, P < 0.001) and healthy lifestyle habits, as well as longer infection duration, higher infection numbers and severe symptoms. CONCLUSION As COVID-19 is becoming more frequent and less severe, providing safe and accessible healthcare remains critical. Vulnerable groups such as the elderly and those with underlying conditions need reliable health service. Prioritizing primary healthcare resources and online medical services have played a vital role in enhancing resource utilization efficiency.
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Affiliation(s)
- Jiawei Zhang
- Department of Health Policy and Management, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Zhihu Xu
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Xia Wei
- Department of Health Policy and Management, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom
| | - Yaqun Fu
- Department of Health Policy and Management, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Zheng Zhu
- Department of Health Policy and Management, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Quan Wang
- Department of Health Policy and Management, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
- Brown School, Washington University in St. Louis, St. Louis, Missouri, 63130, United States of America
| | - Qingbo Wang
- Department of Health Policy and Management, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Qing Liu
- General Practice Department, Second Outpatient Section, Peking University Third Hospital, Xisanqi Street, Haidian District, Beijing, 100096, China
| | - Jing Guo
- Department of Health Policy and Management, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Yuantao Hao
- Center for Public Health and Epidemic Preparedness and Response, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Li Yang
- Department of Health Policy and Management, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
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3
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Kwok KO, Wei WI, Mcneil EB, Tang A, Tang JWT, Wong SYS, Yeoh EK. Comparative analysis of symptom profile and risk of death associated with infection by SARS-CoV-2 and its variants in Hong Kong. J Med Virol 2024; 96:e29326. [PMID: 38345166 DOI: 10.1002/jmv.29326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/19/2023] [Accepted: 12/07/2023] [Indexed: 02/15/2024]
Abstract
The recurrent multiwave nature of coronavirus disease 2019 (COVID-19) necessitates updating its symptomatology. We characterize the effect of variants on symptom presentation, identify the symptoms predictive and protective of death, and quantify the effect of vaccination on symptom development. With the COVID-19 cases reported up to August 25, 2022 in Hong Kong, an iterative multitier text-matching algorithm was developed to identify symptoms from free text. Multivariate regression was used to measure associations between variants, symptom development, death, and vaccination status. A least absolute shrinkage and selection operator technique was used to identify a parsimonious set of symptoms jointly associated with death. Overall, 70.9% (54 450/76 762) of cases were symptomatic with 102 symptoms identified. Intrinsically, the wild-type and delta variant caused similar symptoms among unvaccinated symptomatic cases, whereas the wild-type and omicron BA.2 subvariant had heterogeneous patterns, with seven symptoms (fatigue, fever, chest pain, runny nose, sputum production, nausea/vomiting, and sore throat) more frequent in the BA.2 cohort. With ≥2 vaccine doses, BA.2 was more likely than delta to cause fever among symptomatic cases. Fever, blocked nose, pneumonia, and shortness of breath remained jointly predictive of death among unvaccinated symptomatic elderly in the wild-type-to-omicron transition. Number of vaccine doses required for reducing occurrence varied by symptoms. We substantiate that omicron has a different clinical presentation compared to previous variants. Syndromic surveillance can be bettered with reduced reliance on symptom-based case identification, increased weighing on symptoms predictive of death in outcome prediction, individual-based risk assessment in care homes, and incorporating free-text symptom reporting.
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Affiliation(s)
- Kin On Kwok
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Institute of Asia-Pacific Studies, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Wan In Wei
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Edward B Mcneil
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Arthur Tang
- School of Science, Engineering and Technology, RMIT University, Ho Chi Minh City, Vietnam
| | - Julian W-T Tang
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
- Department of Clinical Microbiology, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Samuel Y S Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eng Kiong Yeoh
- Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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4
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Kang JY, Bae YS, Chie EK, Lee SB. Predicting Deterioration from Wearable Sensor Data in People with Mild COVID-19. SENSORS (BASEL, SWITZERLAND) 2023; 23:9597. [PMID: 38067970 PMCID: PMC10708735 DOI: 10.3390/s23239597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023]
Abstract
Coronavirus has caused many casualties and is still spreading. Some people experience rapid deterioration that is mild at first. The aim of this study is to develop a deterioration prediction model for mild COVID-19 patients during the isolation period. We collected vital signs from wearable devices and clinical questionnaires. The derivation cohort consisted of people diagnosed with COVID-19 between September and December 2021, and the external validation cohort collected between March and June 2022. To develop the model, a total of 50 participants wore the device for an average of 77 h. To evaluate the model, a total of 181 infected participants wore the device for an average of 65 h. We designed machine learning-based models that predict deterioration in patients with mild COVID-19. The prediction model, 10 min in advance, showed an area under the receiver characteristic curve (AUC) of 0.99, and the prediction model, 8 h in advance, showed an AUC of 0.84. We found that certain variables that are important to model vary depending on the point in time to predict. Efficient deterioration monitoring in many patients is possible by utilizing data collected from wearable sensors and symptom self-reports.
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Affiliation(s)
- Jin-Yeong Kang
- Department of Medical Informatics, Keimyung University, Daegu 42601, Republic of Korea;
- Department of Statistics and Data Science, Yonsei University, Seoul 03722, Republic of Korea
| | - Ye Seul Bae
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea;
- Department of Future Healthcare Planning, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
| | - Seung-Bo Lee
- Department of Medical Informatics, Keimyung University, Daegu 42601, Republic of Korea;
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5
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Banerjee U, Chunchanur S, R A, Balaji KN, Singh A, Chakravortty D, Chandra N. Systems-level profiling of early peripheral host-response landscape variations across COVID-19 severity states in an Indian cohort. Genes Immun 2023; 24:183-193. [PMID: 37438430 DOI: 10.1038/s41435-023-00210-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023]
Abstract
Host immune response to COVID-19 plays a significant role in regulating disease severity. Although big data analysis has provided significant insights into the host biology of COVID-19 across the world, very few such studies have been performed in the Indian population. This study utilizes a transcriptome-integrated network analysis approach to compare the immune responses between asymptomatic or mild and moderate-severe COVID-19 patients in an Indian cohort. An immune suppression phenotype is observed in the early stages of moderate-severe COVID-19 manifestation. A number of pathways are identified that play crucial roles in the host control of the disease such as the type I interferon response and classical complement pathway which show different activity levels across the severity spectrum. This study also identifies two transcription factors, IRF7 and ESR1, to be important in regulating the severity of COVID-19. Overall this study provides a deep understanding of the peripheral immune landscape in the COVID-19 severity spectrum in the Indian genetic background and opens up future research avenues to compare immune responses across global populations.
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Affiliation(s)
- Ushashi Banerjee
- Department of Biochemistry, Indian Institute of Science, Bengaluru, India
| | - Sneha Chunchanur
- Bangalore Medical College and Research Institute (BMCRI), Bengaluru, India
| | - Ambica R
- Bangalore Medical College and Research Institute (BMCRI), Bengaluru, India
| | | | - Amit Singh
- Department of Microbiology and Cell Biology, Indian Institute of Science, Bengaluru, India
- Center for Infectious Disease Research, Indian Institute of Science, Bengaluru, India
| | - Dipshikha Chakravortty
- Department of Microbiology and Cell Biology, Indian Institute of Science, Bengaluru, India
- Center for Infectious Disease Research, Indian Institute of Science, Bengaluru, India
| | - Nagasuma Chandra
- Department of Biochemistry, Indian Institute of Science, Bengaluru, India.
- Center for Biosystems Science and Engineering, Indian Institute of Science, Bengaluru, India.
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6
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Buttia C, Llanaj E, Raeisi-Dehkordi H, Kastrati L, Amiri M, Meçani R, Taneri PE, Ochoa SAG, Raguindin PF, Wehrli F, Khatami F, Espínola OP, Rojas LZ, de Mortanges AP, Macharia-Nimietz EF, Alijla F, Minder B, Leichtle AB, Lüthi N, Ehrhard S, Que YA, Fernandes LK, Hautz W, Muka T. Prognostic models in COVID-19 infection that predict severity: a systematic review. Eur J Epidemiol 2023; 38:355-372. [PMID: 36840867 PMCID: PMC9958330 DOI: 10.1007/s10654-023-00973-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 01/28/2023] [Indexed: 02/26/2023]
Abstract
Current evidence on COVID-19 prognostic models is inconsistent and clinical applicability remains controversial. We performed a systematic review to summarize and critically appraise the available studies that have developed, assessed and/or validated prognostic models of COVID-19 predicting health outcomes. We searched six bibliographic databases to identify published articles that investigated univariable and multivariable prognostic models predicting adverse outcomes in adult COVID-19 patients, including intensive care unit (ICU) admission, intubation, high-flow nasal therapy (HFNT), extracorporeal membrane oxygenation (ECMO) and mortality. We identified and assessed 314 eligible articles from more than 40 countries, with 152 of these studies presenting mortality, 66 progression to severe or critical illness, 35 mortality and ICU admission combined, 17 ICU admission only, while the remaining 44 studies reported prediction models for mechanical ventilation (MV) or a combination of multiple outcomes. The sample size of included studies varied from 11 to 7,704,171 participants, with a mean age ranging from 18 to 93 years. There were 353 prognostic models investigated, with area under the curve (AUC) ranging from 0.44 to 0.99. A great proportion of studies (61.5%, 193 out of 314) performed internal or external validation or replication. In 312 (99.4%) studies, prognostic models were reported to be at high risk of bias due to uncertainties and challenges surrounding methodological rigor, sampling, handling of missing data, failure to deal with overfitting and heterogeneous definitions of COVID-19 and severity outcomes. While several clinical prognostic models for COVID-19 have been described in the literature, they are limited in generalizability and/or applicability due to deficiencies in addressing fundamental statistical and methodological concerns. Future large, multi-centric and well-designed prognostic prospective studies are needed to clarify remaining uncertainties.
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Affiliation(s)
- Chepkoech Buttia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Emergency Department, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16C, 3010 Bern, Switzerland
- Epistudia, Bern, Switzerland
| | - Erand Llanaj
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
- ELKH-DE Public Health Research Group of the Hungarian Academy of Sciences, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Epistudia, Bern, Switzerland
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Hamidreza Raeisi-Dehkordi
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lum Kastrati
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mojgan Amiri
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Renald Meçani
- Department of Pediatrics, “Mother Teresa” University Hospital Center, Tirana, University of Medicine, Tirana, Albania
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Petek Eylul Taneri
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- HRB-Trials Methodology Research Network College of Medicine, Nursing and Health Sciences University of Galway, Galway, Ireland
| | | | - Peter Francis Raguindin
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences, University of Lucerne, Lucerne, Switzerland
| | - Faina Wehrli
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Farnaz Khatami
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Department of Community Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Octavio Pano Espínola
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Preventive Medicine and Public Health, University of Navarre, Pamplona, Spain
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain
| | - Lyda Z. Rojas
- Research Group and Development of Nursing Knowledge (GIDCEN-FCV), Research Center, Cardiovascular Foundation of Colombia, Floridablanca, Santander, Colombia
| | | | | | - Fadi Alijla
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Beatrice Minder
- Public Health and Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
| | - Alexander B. Leichtle
- University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, and Center for Artificial Intelligence in Medicine (CAIM), University of Bern, Bern, Switzerland
| | - Nora Lüthi
- Emergency Department, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16C, 3010 Bern, Switzerland
| | - Simone Ehrhard
- Emergency Department, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16C, 3010 Bern, Switzerland
| | - Yok-Ai Que
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurenz Kopp Fernandes
- Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Wolf Hautz
- Emergency Department, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16C, 3010 Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Epistudia, Bern, Switzerland
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7
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Badin RC, de Amorim RLO, Aguila A, Manaças LRA. Clinical and pharmacological factors associated with mortality in patients with COVID-19 in a high complexity hospital in Manaus: A retrospective study. PLoS One 2023; 18:e0280891. [PMID: 36763604 PMCID: PMC9916623 DOI: 10.1371/journal.pone.0280891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/10/2023] [Indexed: 02/11/2023] Open
Abstract
COVID-19 is a contagious infection caused by the SARS-CoV-2 virus, responsible for more than 5 million deaths worldwide, and has been a significant challenge for healthcare systems worldwide. Characterized by multiple manifestations, the most common symptoms are fever, cough, anosmia, ageusia, and myalgia. However, several organs can be affected in more severe cases, causing encephalitis, myocarditis, respiratory distress, hypercoagulable state, pulmonary embolism, and stroke. Despite efforts to identify appropriate clinical protocols for its management, there are still no fully effective therapies to prevent patient death. The objective of this study was to describe the demographic, clinical, and pharmacotherapeutic management characteristics employed in patients hospitalized for diagnosis of COVID-19, in addition to identifying predictive factors for mortality. This is a single-center, retrospective cohort study carried out in a reference hospital belonging to the Brazilian public health system, in Manaus, from March 2020 to July 2021. Data were obtained from analyzing medical records, physical and electronic forms, medical prescriptions, and antimicrobial use authorization forms. During the study period, 530 patients were included, 51.70% male, with a mean age of 58.74 ± 15.91 years. The overall mortality rate was 23.58%. The variables age, number of comorbidities, admission to the ICU, length of stay, oxygen saturation, serum aspartate transaminase, and use of mechanical ventilation showed a positive correlation with the mortality rate. Regarding pharmacological management, 88.49% of patients used corticosteroids, 86.79% used antimicrobials, 94.15% used anticoagulant therapy, and 3.77% used immunotherapy. Interestingly, two specific classes of antibiotics showed a positive correlation with the mortality rate: penicillins and glycopeptides. After multivariate logistic regression analysis, age, number of comorbidities, need for mechanical ventilation, length of hospital stay, and penicillin or glycopeptide antibiotics use were associated with mortality (AUC = 0.958).
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Affiliation(s)
- Rebeka Caribé Badin
- Department of Neurosurgery, Getúlio Vargas University Hospital, Manaus, Amazonas, Brazil
- * E-mail:
| | | | - Alian Aguila
- Department of Cardiology, Memorial Hospital System, Hollywood, Florida, United States of America
| | - Liliane Rosa Alves Manaças
- Department of Pharmacology, Brazilian National Cancer Institute José Alencar Gomes da Silva (INCA)/ Hospital II, Rio de Janeiro, Rio de Janeiro, Brazil
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8
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Hughes A, Ragonnet R, Jayasundara P, Ngo HA, de Lara-Tuprio E, Estuar MRJ, Teng TR, Boon LK, Peariasamy KM, Chong ZL, Ghazali IMM, Fox GJ, Nguyen TA, Le LV, Abayawardana M, Shipman D, McBryde ES, Meehan MT, Caldwell JM, Trauer JM. COVID-19 collaborative modelling for policy response in the Philippines, Malaysia and Vietnam. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 29:100563. [PMID: 35974800 PMCID: PMC9371475 DOI: 10.1016/j.lanwpc.2022.100563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Angus Hughes
- School of Public Health and Preventive Medicine, Monash University, Melbourne Australia
| | - Romain Ragonnet
- School of Public Health and Preventive Medicine, Monash University, Melbourne Australia
| | - Pavithra Jayasundara
- School of Public Health and Preventive Medicine, Monash University, Melbourne Australia
| | - Hoang-Anh Ngo
- Woolcock Institute of Medical Research, Hanoi, Viet Nam
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Timothy Robin Teng
- Department of Mathematics, Ateneo de Manila University, Manila, Philippines
| | - Law Kian Boon
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Kalaiarasu M. Peariasamy
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Zhuo-Lin Chong
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Izzuna Mudla M Ghazali
- Malaysian Health Technology Assessment Section, Medical Development Division, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Greg J. Fox
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Thu-Anh Nguyen
- Woolcock Institute of Medical Research, Hanoi, Viet Nam
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Linh-Vi Le
- WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Milinda Abayawardana
- School of Public Health and Preventive Medicine, Monash University, Melbourne Australia
| | - David Shipman
- School of Public Health and Preventive Medicine, Monash University, Melbourne Australia
| | - Emma S. McBryde
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Michael T. Meehan
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Jamie M. Caldwell
- High Meadows Environmental Institute, Princeton University, New Jersey, United States of America
| | - James M. Trauer
- School of Public Health and Preventive Medicine, Monash University, Melbourne Australia
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9
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Wong YP, Tan GC, Omar SZ, Mustangin M, Singh Y, Salker MS, Abd Aziz NH, Shafiee MN. SARS-CoV-2 Infection in Pregnancy: Placental Histomorphological Patterns, Disease Severity and Perinatal Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159517. [PMID: 35954874 PMCID: PMC9368100 DOI: 10.3390/ijerph19159517] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 12/12/2022]
Abstract
The association between maternal COVID-19 infection, placental histomorphology and perinatal outcomes is uncertain. The published studies on how placental structure is affected after SARS-CoV-2 virus in COVID-19-infected pregnant women are lacking. We investigated the effects of maternal SARS-CoV-2 infection on placental histomorphology and pregnancy outcomes. A retrospective cohort study on 47 pregnant women with confirmed SARS-CoV-2 infection, matched with non-infected controls, was conducted. Relevant clinicopathological data and primary birth outcomes were recorded. Histomorphology and SARS-CoV-2 immunohistochemistry analyses of placental tissues were performed. Only 1 of 47 cases showed SARS-CoV-2 immunoreactivity in the syncytiotrophoblasts. Histologically, decidual vasculopathy (n = 22/47, p = 0.004), maternal vascular thrombosis (n = 9/47, p = 0.015) and chronic histiocytic intervillositis (n = 10/47, p = 0.027) were significantly higher in the COVID-19-infected placentas when compared to the control group. Maternal vascular thrombosis was a significant feature in the active COVID-19 group. A significant lower gestational age (p < 0.001)) at delivery and a higher caesarean section rate (p = 0.007) were observed in the active SARS-CoV-2-infected cases, resulting in a significant lower fetal-placental weight ratio (p = 0.022) and poorer Apgar score (p < 0.001). Notably, active (p = 0.027), symptomatic (p = 0.039), severe-critical (p = 0.002) maternal COVID-19 infection and placental inflammation (p = 0.011) were associated with an increased risk of preterm delivery. Altered placental villous maturation and severe-critical maternal COVID-19 infection were associated with an elevated risk of poor Apgar scores at birth (p = 0.018) and maternal mortality (p = 0.023), respectively.
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Affiliation(s)
- Yin Ping Wong
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia;
- Correspondence: (Y.P.W.); (G.C.T.); Tel.: +60-3-91455364 (Y.P.W.); +60-3-91455362 (G.C.T.)
| | - Geok Chin Tan
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia;
- Correspondence: (Y.P.W.); (G.C.T.); Tel.: +60-3-91455364 (Y.P.W.); +60-3-91455362 (G.C.T.)
| | - Siti Zarqah Omar
- Department of Pathology, Hospital Sultanah Nur Zahirah, Kuala Terengganu 20400, Terengganu, Malaysia;
| | - Muaatamarulain Mustangin
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia;
| | - Yogesh Singh
- Institute of Medical Genetics and Applied Genomics, University of Tubingen, Calwerstrasse 7, 72076 Tubingen, Germany;
- Research Institute for Women’s Health, University of Tubingen, Calwerstrasse 7, 72076 Tubingen, Germany;
| | - Madhuri S. Salker
- Research Institute for Women’s Health, University of Tubingen, Calwerstrasse 7, 72076 Tubingen, Germany;
| | - Nor Haslinda Abd Aziz
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia; (N.H.A.A.); (M.N.S.)
| | - Mohamad Nasir Shafiee
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia; (N.H.A.A.); (M.N.S.)
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10
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Liang JB, Yuan HY, Li KK, Wei WI, Wong SYS, Tang A, Riley S, Kwok KO. Path to normality: Assessing the level of social-distancing measures relaxation against antibody-resistant SARS-CoV-2 variants in a partially-vaccinated population. Comput Struct Biotechnol J 2022; 20:4052-4059. [PMID: 35935805 PMCID: PMC9338450 DOI: 10.1016/j.csbj.2022.07.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 02/09/2023] Open
Abstract
Introduction Two years into the coronavirus 2019 (COVID-19) pandemic, populations with less built-up immunity continued to devise ways to optimize social distancing measures (SDMs) relaxation levels for outbreaks triggered by SARS-CoV-2 and its variants to resume minimal economics activities while avoiding hospital system collapse. Method An age-stratified compartmental model featuring social mixing patterns was first fitted the incidence data in second wave in Hong Kong. Hypothetical scenario analysis was conducted by varying population mobility and vaccination coverages (VCs) to predict the number of hospital and intensive-care unit admissions in outbreaks initiated by ancestral strain and its variants (Alpha, Beta, Gamma, Delta and Omicron). Scenarios were "unsustainable" if either of admissions was larger than the maximum of its occupancy. Results At VC of 65%, scenarios of full SDMs relaxation (mean daily social encounters prior to COVID-19 pandemic = 14.1 contacts) for outbreaks triggered by ancestral strain, Alpha and Beta were sustainable. Restricting levels of SDMs was required such that the optimal population mobility had to be reduced to 0.9, 0.65 and 0.37 for Gamma, Delta and Omicron associated outbreaks respectively. VC improvement from 65% to 75% and 95% allowed complete SDMs relaxation in Gamma-, and Delta-driven epidemic respectively. However, this was not supported for Omicron-triggered epidemic. Discussion To seek a path to normality, speedy vaccine and booster distribution to the majority across all age groups is the first step. Gradual or complete SDMs lift could be considered if the hybrid immunity could be achieved due to high vaccination coverage and natural infection rate among vaccinated or the COVID-19 case fatality rate could be reduced similar to that for seasonal influenza to secure hospital system sustainability.
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Affiliation(s)
- Jing-Bo Liang
- Department of Biomedical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong Special administrative regions, China
| | - Hsiang-Yu Yuan
- Department of Biomedical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong Special administrative regions, China
- Centre for Applied One Health Research and Policy Advice, City University of Hong Kong, Hong Kong Special administrative regions, China
| | - Kin-Kit Li
- Department of Social and Behavioral Sciences, City University of Hong Kong, Hong Kong Special administrative regions, China
| | - Wan-In Wei
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special administrative regions, China
| | - Samuel Yeung Shan Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special administrative regions, China
| | - Arthur Tang
- College of Computing and Informatics, Sungkyunkwan University, Seoul, Republic of Korea
| | - Steven Riley
- School of Public Health, Imperial College London, GB, UK
| | - Kin On Kwok
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special administrative regions, China
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Institute of Asia-Pacific Studies, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Shenzhen Research Institute of the Chinese University of Hong Kong, Shenzhen, China
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11
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Analyzing the Effect of Social Distancing Policies on Traffic at Sinchon Station, South Korea, during the COVID-19 Pandemic in 2020 and 2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148535. [PMID: 35886387 PMCID: PMC9318621 DOI: 10.3390/ijerph19148535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022]
Abstract
The COVID-19 pandemic is recognized as one of the most serious global health problems, and many countries implemented lockdown measures to mitigate the effects of the crisis caused by this respiratory infectious disease. In this study, we investigated the relationship between social distancing policies and changes in traffic volume in Sinchon Station, South Korea. We used an official COVID-19 report provided by the Korea Disease Control and Prevention Agency (KCDA) and Seoul Metropolitan Government (SMG) to review social distancing policies, and the changes in traffic patterns before and during the COVID-19 pandemic between January 2020 and November 2021 were analyzed. Our study reveals that the changes in the overall traffic patterns from acceleration phases to deceleration phases of COVID-19 were related to the alert levels of social distancing policies implemented to tackle the situation resulting from the COVID-19 pandemic. Herein, we found that a significant decline in traffic volume took place from August to September 2020 (13.5−19.7%, weekday; 19.4−31.7%, weekend), from December 2020 to January 2021 (20.0%−26.6%, weekday; 26.8−34.0%, weekend), and from July to September 2021 (3.2−13.1%, weekday; 38.3−44.7%, weekend) when compared to the corresponding periods in 2019 (paired t-test; p < 0.001). The results of this study provide strong support for the effectiveness of Seoul’s preemptive measures, namely, the central government’s intensive social distancing campaign, in managing and reducing the impact of the pandemic situation based on the precise analysis of 10 types of facilities.
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12
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Chan KKP, Hui DSC. Contemporary Concise Review 2021: COVID-19 and other respiratory infections. Respirology 2022; 27:661-668. [PMID: 35670259 PMCID: PMC9347613 DOI: 10.1111/resp.14305] [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: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 12/15/2022]
Abstract
Bats are likely the primary source of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Minks are highly susceptible to infection by SARS‐CoV‐2. Transmission from asymptomatic individuals was estimated to account for over 50% of all transmissions of coronavirus disease 2019 (COVID‐19) cases. SARS‐CoV‐2 is evolving towards more efficient aerosol transmission. Remdesivir, baricitinib, tocilizumab and dexamethasone are frequently used for the treatment of patients with respiratory failure due to COVID‐19. There is a rising incidence of non‐tuberculous Mycobacterium pulmonary disease globally, with a higher prevalence in Asian countries than in the Western world. Protracted bacterial bronchitis is a common cause of chronic productive cough in childhood. Re‐emergence of respiratory syncytial virus may occur after the relaxation of infection control measures and the reopening of borders during COVID‐19 pandemic.
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Affiliation(s)
- Ken K P Chan
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - David S C Hui
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.,Stanley Ho Center for Emerging Infectious Diseases, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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13
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Kwok KO, Wei WI, Ma BHM, Ip M, Cheung H, Hui E, Tang A, Mcneil EB, Wong SYS, Yeoh EK. Antibiotic use among COVID-19 patients in Hong Kong, January 2018 to March 2021. J Infect 2022; 84:e129-e132. [PMID: 35183606 PMCID: PMC8851745 DOI: 10.1016/j.jinf.2022.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/13/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Kin On Kwok
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Stanley Ho Center for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Asia-Pacific Studies, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Shenzhen Research Institute of the Chinese University of Hong Kong, Shenzhen, China.
| | - Wan In Wei
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Bosco Hon Ming Ma
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Margaret Ip
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Heidi Cheung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Elsie Hui
- Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong Special Administrative Region, China
| | - Arthur Tang
- Department of Software, Sungkyunkwan University, Seoul, Republic of Korea
| | - Edward B Mcneil
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Samuel Yeung Shan Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eng Kiong Yeoh
- Center for Health Systems and Policy Research, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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14
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Chung GKK, Strong C, Chan YH, Chung RYN, Chen JS, Lin YH, Huang RY, Lin CY, Ko NY. Psychological Distress and Protective Behaviors During the COVID-19 Pandemic Among Different Populations: Hong Kong General Population, Taiwan Healthcare Workers, and Taiwan Outpatients. Front Med (Lausanne) 2022; 9:800962. [PMID: 35242778 PMCID: PMC8885588 DOI: 10.3389/fmed.2022.800962] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/03/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The novel coronavirus disease 2019 (COVID-19) caused psychological distress and changed human living styles. However, rare studies have examined the psychological distress and protective behaviors across different populations. Therefore, the present study aimed to assess psychological distress, protective behaviors, and potential predictors of psychological distress and protective behaviors across the Hong Kong general population, Taiwan healthcare workers, and Taiwan outpatients. METHODS A cross-sectional design was used to recruit participants from Hong Kong and Taiwan. Telephone interviews were carried out for Hong Kong participants (n = 1,067; 30.2% male participants); online surveys were used for Taiwan healthcare workers (n = 500; 8.0% male participants) and Taiwan outpatients (n = 192; 32.8% male participants). All the participants completed questions on psychological distress and protective behaviors. Multiple linear regressions and multivariable logistic regressions were employed to explore the potential predictors of psychological distress and protective behaviors, respectively. RESULTS Hong Kong participants had significantly lower levels of psychological distress than Taiwan participants [mean (SD) = 0.16 (0.39) vs. 0.47 (0.59) in healthcare workers and 0.46 (0.65) in outpatients; p < 0.001]. Hong Kong participants (51.7%) and Taiwan outpatients had more people showing fear of COVID-19 (52.0%) than Taiwan healthcare providers (40.8%; p < 0.001). Moreover, Hong Kong participants engaged the most in protective behaviors, followed by Taiwan healthcare providers and Taiwan outpatients (p < 0.001). Moreover, being a female, fear of COVID-19 and worry about personal savings were associated with protective behaviors in general. CONCLUSIONS Despite the greater COVID-19 severity and fear of COVID-19 in Hong Kong, the general population in Hong Kong experienced less psychosocial distress with higher compliance to protective behaviors than the other groups in Taiwan.
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Affiliation(s)
- Gary Ka-Ki Chung
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Carol Strong
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yat-Hang Chan
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Roger Yat-Nork Chung
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jung-Sheng Chen
- Department of Medical Research, E-Da Hospital, Kaohsiung, Taiwan
| | - Yi-Hsuan Lin
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ru-Yi Huang
- Department of Family and Community Medicine, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chung-Ying Lin
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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15
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COVID-19 persists: Current risk of a recurrence of the epidemic in China. J Infect 2021; 84:579-613. [PMID: 34953902 PMCID: PMC8695321 DOI: 10.1016/j.jinf.2021.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/19/2021] [Indexed: 11/23/2022]
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16
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Jayaraj VJ, Rampal S, Ng CW, Chong DWQ. The Epidemiology of COVID-19 in Malaysia. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 17:100295. [PMID: 34704083 PMCID: PMC8529946 DOI: 10.1016/j.lanwpc.2021.100295] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND COVID-19 has rapidly spread across the globe. Critical to the control of COVID-19 is the characterisation of its epidemiology. Despite this, there has been a paucity of evidence from many parts of the world, including Malaysia. We aim to describe the epidemiology of COVID-19 in Malaysia to inform prevention and control policies better. METHODS Malaysian COVID-19 data was extracted from 16 March 2020 up to 31 May 2021. We estimated the following epidemiological indicators: 7-day incidence rates, 7-day mortality rates, case fatality rates, test positive ratios, testing rates and the time-varying reproduction number (Rt). FINDINGS Between 16 March 2020 and 31 May 2021, Malaysia has reported 571,901 cases and 2,796 deaths. Malaysia's average 7-day incidence rate was 26•6 reported infections per 100,000 population (95% CI: 17•8, 38•1). The average test positive ratio and testing rate were 4•3% (95% CI: 1•6, 10•2) and 0•8 tests per 1,000 population (95% CI: <0•1, 3•7), respectively. The case fatality rates (CFR) was 0•6% (95% CI: <0•1, 3•7). Among the 2,796 cases who died, 87•3% were ≥ 50 years. INTERPRETATION The public health response was successful in the suppression of COVID-19 transmission or the first half of 2020. However, a state election and outbreaks in institutionalised populations have been the catalyst for more significant community propagation. This rising community transmission has continued in 2021, leading to increased incidence and strained healthcare systems. Calibrating NPI based on epidemiological indicators remain critical for us to live with the virus. (243 words). FUNDING This study is part of the COVID-19 Epidemiological Analysis and Strategies (CEASe) Project with funding from the Ministry of Science, Technology and Innovation (UM.0000245/HGA.GV).
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Affiliation(s)
- Vivek Jason Jayaraj
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive, Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Sanjay Rampal
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive, Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Chiu-Wan Ng
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive, Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Diane Woei Quan Chong
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive, Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Ministry of Health Malaysia, Putrajaya, Malaysia
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17
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Kwok KO, Wan In W, Huang Y, Wong A, Tang A, Wong SYS. Estimation of early phase local-to-local transmissibility and importation hazard of Coronavirus Disease 2019 (COVID-19) epidemic under assorted containment measures in Hong Kong. Travel Med Infect Dis 2021; 45:102226. [PMID: 34861416 PMCID: PMC8629774 DOI: 10.1016/j.tmaid.2021.102226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Kin On Kwok
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Shenzhen Research Institute of the Chinese University of Hong Kong, Shenzhen, China; Hong Kong Institute of Asia-Pacific Studies, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Wei Wan In
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ying Huang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Angel Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Arthur Tang
- College of Computing and Informatics, Sungkyunkwan University, Seoul, South Korea.
| | - Samuel Yeung Shan Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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18
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Rowland R, Brandariz-Nuñez A. Analysis of the Role of N-Linked Glycosylation in Cell Surface Expression, Function, and Binding Properties of SARS-CoV-2 Receptor ACE2. Microbiol Spectr 2021; 9:e0119921. [PMID: 34494876 PMCID: PMC8557876 DOI: 10.1128/spectrum.01199-21] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/13/2021] [Indexed: 12/28/2022] Open
Abstract
Human angiotensin I-converting enzyme 2 (hACE2) is a type I transmembrane glycoprotein that serves as the major cell entry receptor for SARS-CoV and SARS-CoV-2. The viral spike (S) protein is required for the attachment to ACE2 and subsequent virus-host cell membrane fusion. Previous work has demonstrated the presence of N-linked glycans in ACE2. N-glycosylation is implicated in many biological activities, including protein folding, protein activity, and cell surface expression of biomolecules. However, the contribution of N-glycosylation to ACE2 function is poorly understood. Here, we examined the role of N-glycosylation in the activity and localization of two species with different susceptibility to SARS-CoV-2 infection, porcine ACE2 (pACE2) and hACE2. The elimination of N-glycosylation by tunicamycin (TM) treatment, or mutagenesis, showed that N-glycosylation is critical for the proper cell surface expression of ACE2 but not for its carboxiprotease activity. Furthermore, nonglycosylable ACE2 was localized predominantly in the endoplasmic reticulum (ER) and not at the cell surface. Our data also revealed that binding of SARS-CoV or SARS-CoV-2 S protein to porcine or human ACE2 was not affected by deglycosylation of ACE2 or S proteins, suggesting that N-glycosylation does not play a role in the interaction between SARS coronaviruses and the ACE2 receptor. Impairment of hACE2 N-glycosylation decreased cell-to-cell fusion mediated by SARS-CoV S protein but not that mediated by SARS-CoV-2 S protein. Finally, we found that hACE2 N-glycosylation is required for an efficient viral entry of SARS-CoV/SARS-CoV-2 S pseudotyped viruses, which may be the result of low cell surface expression of the deglycosylated ACE2 receptor. IMPORTANCE Understanding the role of glycosylation in the virus-receptor interaction is important for developing approaches that disrupt infection. In this study, we showed that deglycosylation of both ACE2 and S had a minimal effect on the spike-ACE2 interaction. In addition, we found that the removal of N-glycans of ACE2 impaired its ability to support an efficient transduction of SARS-CoV and SARS-CoV-2 S pseudotyped viruses. Our data suggest that the role of deglycosylation of ACE2 on reducing infection is likely due to a reduced expression of the viral receptor on the cell surface. These findings offer insight into the glycan structure and function of ACE2 and potentially suggest that future antiviral therapies against coronaviruses and other coronavirus-related illnesses involving inhibition of ACE2 recruitment to the cell membrane could be developed.
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Affiliation(s)
- Raymond Rowland
- Department of Pathobiology, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Alberto Brandariz-Nuñez
- Department of Pathobiology, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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19
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Chan EYY, Kim JH, Kwok KO, Huang Z, Hung KKC, Wong ELY, Lee EKP, Wong SYS. Population Adherence to Infection Control Behaviors during Hong Kong's First and Third COVID-19 Waves: A Serial Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111176. [PMID: 34769694 PMCID: PMC8583559 DOI: 10.3390/ijerph182111176] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/20/2021] [Accepted: 10/20/2021] [Indexed: 12/24/2022]
Abstract
Background: Although COVID-19 has affected over 220 countries by October 2021, there is limited research examining the patterns and determinants of adherence to infection control measures over time. Aims: Our study examines the sociodemographic factors associated with changes in the frequency of adherence to personal hygiene and social distancing behaviors in Hong Kong. Methods: A serial cross-sectional telephone survey in the general population was conducted during the first (March 2020) (n = 765) and third wave (December 2020) (n = 651) of the local outbreak of the COVID-19 pandemic. Respondents were asked about their level of compliance with various personal hygiene and social distancing recommendations. Results: By the third wave, mask use increased to 100%, and throughout the study periods, >90% practiced frequent hand hygiene. However, adherence to social distancing measures significantly waned over time: avoidance of social gatherings (80.5% to 72.0%), avoidance of public places/public transport (53.3% to 26.0%), avoidance of international travel (85.8% to 76.6%) (p < 0.05). The practice of ordering food takeout/home delivery, however, increased, particularly among high-income respondents. Higher education, female gender and employment status were the most consistently associated factors with adherence to COVID-19 preventive practices in the multivariable models. Conclusions: In urban areas of this region, interventions to improve personal hygiene in a prolonged pandemic should target males and those with low education. In addition to these groups, the working population needs to be targeted in order to improve adherence to social distancing guidelines.
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Affiliation(s)
- Emily Ying Yang Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (Z.H.); (K.K.C.H.)
- GX Foundation, Hong Kong, China
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (K.-o.K.); (E.L.Y.W.); (E.K.P.L.); (S.Y.S.W.)
- Correspondence:
| | - Jean H. Kim
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (K.-o.K.); (E.L.Y.W.); (E.K.P.L.); (S.Y.S.W.)
| | - Kin-on Kwok
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (K.-o.K.); (E.L.Y.W.); (E.K.P.L.); (S.Y.S.W.)
| | - Zhe Huang
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (Z.H.); (K.K.C.H.)
| | - Kevin Kei Ching Hung
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (Z.H.); (K.K.C.H.)
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (K.-o.K.); (E.L.Y.W.); (E.K.P.L.); (S.Y.S.W.)
- Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Eliza Lai Yi Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (K.-o.K.); (E.L.Y.W.); (E.K.P.L.); (S.Y.S.W.)
| | - Eric Kam Pui Lee
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (K.-o.K.); (E.L.Y.W.); (E.K.P.L.); (S.Y.S.W.)
| | - Samuel Yeung Shan Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (K.-o.K.); (E.L.Y.W.); (E.K.P.L.); (S.Y.S.W.)
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20
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Kwok KO, Li KK, Tang A, Tsoi MTF, Chan EYY, Tang JWT, Wong A, Wei WI, Wong SYS. Psychobehavioral Responses and Likelihood of Receiving COVID-19 Vaccines during the Pandemic, Hong Kong. Emerg Infect Dis 2021; 27:1802-1810. [PMID: 34152948 PMCID: PMC8237883 DOI: 10.3201/eid2707.210054] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To access temporal changes in psychobehavioral responses to the coronavirus disease (COVID-19) pandemic, we conducted a 5-round (R1–R5) longitudinal population-based online survey in Hong Kong during January–September 2020. Most respondents reported wearing masks (R1 99.0% to R5 99.8%) and performing hand hygiene (R1 95.8% to R5 97.7%). Perceived COVID-19 severity decreased significantly, from 97.4% (R1) to 77.2% (R5), but perceived self-susceptibility remained high (87.2%–92.8%). Female sex and anxiety were associated with greater adoption of social distancing. Intention to receive COVID-19 vaccines decreased significantly (R4 48.7% to R5 37.6%). Greater anxiety, confidence in vaccine, and collective responsibility and weaker complacency were associated with higher tendency to receive COVID-19 vaccines. Although its generalizability should be assumed with caution, this study helps to formulate health communication strategies and foretells the initial low uptake rate of COVID-19 vaccines, suggesting that social distancing should be maintained in the medium term.
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21
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Association of Lung Ultrasound Score with Mortality and Severity of COVID-19: A Meta-Analysis and Trial Sequential Analysis. Int J Infect Dis 2021; 108:603-609. [PMID: 34146693 PMCID: PMC8266421 DOI: 10.1016/j.ijid.2021.06.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/31/2021] [Accepted: 06/12/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic has rapidly spread all over the world. Lung ultrasound (LUS) has emerged as a useful tool for diagnosing many respiratory diseases. The prognostic role of LUS in COVID-19 patients has not yet been established. METHODS Several databases were searched on 09 April 2021. The difference in LUS score between the death and survival groups, and the relationship between LUS score and COVID-19 severity were both assessed. RESULTS The LUS score was significantly higher in the death group compared with the survival group (weighted mean difference (WMD) = 8.21, 95% CI: 4.74-11.67, P < 0.001), which was confirmed by trial sequential analysis. Those with mild/moderate, severe and critical COVID-19 had a progressively higher LUS score (critical vs. severe: WMD = 8.78, 95% CI: 4.17-13.38; P < 0.001; critical vs. mild/moderate/severe: WMD = 10.00, 95% CI: 6.83-13.17, P < 0.001; severe vs. moderate: WMD = 5.96, 95% CI: 3.48-8.44, P < 0.001; severe vs. mild/moderate: WMD = 7.31, 95% CI: 4.45-10.17, P < 0.001). CONCLUSIONS The LUS score was associated with mortality and severity of COVID-19. The LUS score might be a risk stratification tool for COVID-19 patients.
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22
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Sridhar S, Nicholls J. Pathophysiology of infection with SARS-CoV-2-What is known and what remains a mystery. Respirology 2021; 26:652-665. [PMID: 34041821 PMCID: PMC8242464 DOI: 10.1111/resp.14091] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/03/2021] [Indexed: 12/12/2022]
Abstract
Coronavirus disease 2019 (COVID‐19), caused by coronavirus severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), has caused extensive disruption and mortality since its recent emergence. Concomitantly, there has been a race to understand the virus and its pathophysiology. The clinical manifestations of COVID‐19 are manifold and not restricted to the respiratory tract. Extrapulmonary manifestations involving the gastrointestinal tract, hepatobiliary system, cardiovascular and renal systems have been widely reported. However, the pathophysiology of many of these manifestations is controversial with questionable support for direct viral invasion and an abundance of alternative explanations such as pre‐existing medical conditions and critical illness. Prior research on SARS‐Co‐V and NL63 was rapidly leveraged to identify angiotensin‐converting enzyme 2 (ACE2) receptor as the key cell surface receptor for SARS‐CoV‐2. The distribution of ACE2 has been used as a starting point for estimating vulnerability of various tissue types to SARS‐CoV‐2 infection. Sophisticated organoid and animal models have been used to demonstrate such infectivity of extrapulmonary tissues in vitro, but the clinical relevance of these findings remains uncertain. Clinical autopsy studies are typically small and inevitably biased towards patients with severe COVID‐19 and prolonged hospitalization. Technical issues such as delay between time of death and autopsy, use of inappropriate antibodies for paraffin‐embedded tissue sections and misinterpretation of cellular structures as virus particles on electron micrograph images are additional problems encountered in the extant literature. Given that SARS‐CoV‐2 is likely to circulate permanently in human populations, there is no doubt that further work is required to clarify the pathobiology of COVID‐19.
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Affiliation(s)
- Siddharth Sridhar
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - John Nicholls
- Department of Pathology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
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23
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Kwok KO, Huang Y, Tsoi MTF, Tang A, Wong SYS, Wei WI, Hui DSC. Epidemiology, clinical spectrum, viral kinetics and impact of COVID-19 in the Asia-Pacific region. Respirology 2021; 26:322-333. [PMID: 33690946 PMCID: PMC8207122 DOI: 10.1111/resp.14026] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/08/2021] [Indexed: 01/08/2023]
Abstract
COVID-19 has hit the world by surprise, causing substantial mortality and morbidity since 2020. This narrative review aims to provide an overview of the epidemiology, induced impact, viral kinetics and clinical spectrum of COVID-19 in the Asia-Pacific Region, focusing on regions previously exposed to outbreaks of coronavirus. COVID-19 progressed differently by regions, with some (such as China and Taiwan) featured by one to two epidemic waves and some (such as Hong Kong and South Korea) featured by multiple waves. There has been no consensus on the estimates of important epidemiological time intervals or proportions, such that using them for making inferences should be done with caution. Viral loads of patients with COVID-19 peak in the first week of illness around days 2 to 4 and hence there is very high transmission potential causing community outbreaks. Various strategies such as government-guided and suppress-and-lift strategies, trigger-based/suppression approaches and alert systems have been employed to guide the adoption and easing of control measures. Asymptomatic and pre-symptomatic transmission is a hallmark of COVID-19. Identification and isolation of symptomatic patients alone is not effective in controlling the ongoing outbreaks. However, early, prompt and coordinated enactment predisposed regions to successful disease containment. Mass COVID-19 vaccinations are likely to be the light at the end of the tunnel. There is a need to review what we have learnt in this pandemic and examine how to transfer and improve existing knowledge for ongoing and future epidemics.
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Affiliation(s)
- Kin On Kwok
- JC School of Public Health and Primary CareThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
- Stanley Ho Centre for Emerging Infectious DiseasesThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
- Shenzhen Research Institute of the Chinese University of Hong KongShenzhenChina
| | - Ying Huang
- JC School of Public Health and Primary CareThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
| | - Margaret Ting Fong Tsoi
- JC School of Public Health and Primary CareThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
| | - Arthur Tang
- Department of SoftwareSungkyunkwan UniversitySeoulRepublic of Korea
| | - Samuel Yeung Shan Wong
- JC School of Public Health and Primary CareThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
| | - Wan In Wei
- JC School of Public Health and Primary CareThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
| | - David Shu Cheong Hui
- Stanley Ho Centre for Emerging Infectious DiseasesThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
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