Is older age associated with COVID-19 mortality in the absence of other risk factors? General population cohort study of 470,034 participants

Exploring the biological mechanisms of severe COVID-19 in the elderly: Insights from an aged mouse model

The elderly population, who have increased susceptibility to severe outcomes, have been particularly impacted by the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), leading to a global health crisis. However, definitive parameters or mechanisms underlying the severity of COVID-19 in elderly people remain unclear. Thus, this study seeks to elucidate the mechanism behind the increased vulnerability of elderly individuals to severe COVID-19. We employed an aged mouse model with a mouse-adapted SARS-CoV-2 strain to mimic the severe symptoms observed in elderly patients with COVID-19. Comprehensive analyses of the whole lung were performed using transcriptome and proteome sequencing, comparing data from aged and young mice. For transcriptome analysis, bulk RNA sequencing was conducted using an Illumina sequencing platform. Proteomic analysis was performed using mass spectrometry following protein extraction, digestion, and peptide labelling. We analysed the transcriptome and proteome profiles of young and aged mice and discovered that aged mice exhibited elevated baseline levels of inflammation and tissue damage repair. After SARS-CoV-2 infection, aged mice showed increased antiviral and inflammatory responses; however, these responses were weaker than those in young mice, with significant complement and coagulation cascade responses. In summary, our study demonstrates that the increased vulnerability of the elderly to severe COVID-19 may be attributed to an attenuated antiviral response and the overactivation of complement and coagulation cascades. Future research on antiviral and inflammatory responses is likely to yield treatments that reduce the severity of viral respiratory diseases in the elderly.

Impact of differences between interim and post-interim analysis populations on outcomes of a group sequential trial: Example of the MOVe-OUT study

BackgroundPre-specified interim analyses allow for more timely evaluation of efficacy or futility, potentially accelerating decision-making on an investigational intervention. In such an analysis, the randomized, double-blind MOVe-OUT trial demonstrated superiority of molnupiravir over placebo for outpatient treatment of COVID-19 in high-risk patients. In the full analysis population, the point estimate of the treatment difference in the primary endpoint was notably lower than at the interim analysis. We conducted a comprehensive assessment to investigate this unexpected difference in treatment effect size, with the goal of informing future clinical research evaluating treatments for rapidly evolving infectious diseases.MethodsThe modified intention-to-treat population of the MOVe-OUT trial was divided into an interim analysis cohort (i.e. all participants included in the interim analysis; prospectively defined) and a post-interim analysis cohort (i.e. all remaining participants; retrospectively defined). Baseline characteristics (including many well-established prognostic factors for disease progression), clinical outcomes, and virologic outcomes were retrospectively evaluated. The impact of changes in baseline characteristics over time was explored using logistic regression modeling and simulations.ResultsBaseline characteristics were well-balanced between arms overall. However, between- and within-arm differences in known prognostic baseline factors (e.g. comorbidities, SARS-CoV-2 viral load, and anti-SARS-CoV-2 antibody status) were observed for the interim and post-interim analysis cohorts. For the individual factors, these differences were generally minor and otherwise not notable; as the trial progressed, however, these shifts in combination increasingly favored the placebo arm across most of the evaluated factors in the post-interim cohort. Model-based simulations confirmed that the reduction in effect size could be accounted for by these longitudinal trends toward a lower-risk study population among placebo participants. Infectivity and viral load data confirmed that molnupiravir's antiviral activity was consistent across both cohorts, which were heavily dominated by different viral clades (reflecting the rapid SARS-CoV-2 evolution).DiscussionThe cumulative effect of randomly occurring minor differences in prognostic baseline characteristics within and between arms over time, rather than virologic factors such as reduced activity of molnupiravir against evolving variants, likely impacted the observed outcomes. Our results have broader implications for group sequential trials seeking to evaluate treatments for rapidly emerging pathogens. During dynamic epidemic or pandemic conditions, adaptive trials should be designed and interpreted especially carefully, considering that they will likely rapidly enroll a large post-interim overrun population and that even small longitudinal shifts across multiple baseline variables can disproportionately impact prespecified efficacy outcomes at different timepoints. Shifts in prognostic factors may introduce additional variability that can be difficult to disentangle from temporal trends in epidemiology (e.g. evolutionary changes in the causative pathogen) or disease management.(ClinicalTrials.gov: NCT04575597.).

Effect of antecedent B-cell depletion therapy for patients hospitalized with COVID-19 within a single health system: a propensity score analysis

B-cell depletion therapy is employed in a variety of clinical contexts from auto-immune diseases to malignancy. Prior research on patients with prior B-cell depletion treatment has suggested a mortality risk in patients hospitalized with COVID-19 however previous case-control studies have differed in their methods of patient comparison. Patients previously treated with B-cell-depletion hospitalized with COVID-19 were compared to matched controls in the Johns Hopkins Health System between March 1, 2020 and November 30, 2021. The primary outcome was 30-day all-cause mortality. Secondary outcomes included time to severe illness or death and time to clinical improvement. To eliminate bias due to imbalanced covariates, each patient who had previously received B-cell depletion therapy was matched with patients who had not received therapy based on age, sex, race, WHO severity score, admission date, COVID-19 specific treatment, and vaccination status. Propensity scores were calculated from a multivariable logistic regression model and performed on the matched sets, using B-cell depletion as the outcome, where the propensity score was the probability of receiving B-cell depletion therapy. The propensity score included matched covariates as well as smoking status, medical comorbidities, and vaccination status. Cox proportional-hazards regression models were applied on the matched sets to perform time to death, time to severe illness or death, and time to clinical improvement analyses. 50 patients were identified who had received B-cell depletion therapy and were compared to 186 matched controls. Patients treated with B-cell depletion experienced 30-day mortality of 6.0% compared to 3.8% in controls, adjusted hazard ratio (aHR) 1.45 (95% CI 0.30 to 6.95). B-cell-depleted patients experienced a longer time to clinical improvement, aHR 0.65 (95% CI 0.45-0.94). In this cohort, patients treated with B-cell depletion experienced a higher mortality rate compared to matched controls however this was not statistically significant. This group also experienced a prolonged time to clinical improvement based on WHO severity score.

Social Participation Patterns Among Community-Dwelling Older Adults Before and During the COVID-19 Pandemic: Roles of Community Social Cohesion and Health

The objectives of this study were to investigate groupwide variations in social participation among older adults before and during the COVID-19 pandemic and how such variations were associated with their community social cohesion and health. Data were from the National Health and Aging Trends Study (2019-2020; n = 2,597 adults aged 65 or older). Latent class analysis was used to identify groupwide variations in social participation. These variations were then incorporated into adjusted regressions to test relationships with social cohesion and health. Four participation patterns emerged: active, selective independent, occasional, and selective religious participants. Selective independent and occasional participants were likely to live in less socially cohesive communities. During the pandemic, active participants were likely to report better self-rated health and lower risks of depressive and anxiety symptoms and dementia. Findings highlight directions for policy and intervention design that can enhance social participation and support healthy aging.

A longitudinal cohort study on dispensed analgesic and psychotropic medications in older adults before, during, and after the COVID-19 pandemic: the HUNT study

BACKGROUND

There is a growing concern and debate over the inappropriate use of analgesics and psychotropic medications by older adults, especially those with dementia. The long-term effects of the COVID-19 pandemic and lockdown measures on these prescriptions remain uncertain.

AIM

The primary aim was to examine changes in the prescription of analgesics (opioids and other analgesics) and psychotropics (anxiolytics/sedatives, antidepressants, and antipsychotics) in Norwegian home-dwelling older adults before, during, and up to 2 years after the COVID-19 lockdown, with a particular focus on dementia status. Secondarily, we explored individual characteristics associated with changes in medication prescriptions.

METHODS

A prospective cohort study using baseline data from 10,464 participants (54% females, mean age 76 years [SD 5.8]) from the Norwegian Trøndelag Health Study (HUNT4 70+) linked with the Norwegian Prescription Database. Age- and education-adjusted Poisson regression was applied to examine changes in prescription fills, and multilevel mixed-effects linear regression was used to estimate the mean sum of defined daily dose (DDD) per person per period during the lockdown (March-September 2020) compared to that during the corresponding months (March-September) in 2019, 2021, and 2022.

RESULTS

Overall, prescriptions of opioids, other analgesics, and anxiolytics/sedatives were higher in 2022 than during the lockdown. People without dementia had increased prescriptions of opioids, other analgesics, and antidepressants after lockdown, whereas no changes were observed among those with dementia. Increases in prescriptions of opioids, other analgesics, anxiolytics/sedatives, and antidepressants between the lockdown and 2022 occurred mainly among those aged < 80 years, without comorbidities or mental distress, with good physical function, low fear of COVID-19, and no social isolation during COVID-19.

CONCLUSION

An increase in analgesics and psychotropics after the lockdown was predominantly observed among younger-old and healthier participants. This indicates that in high-income countries, such as Norway, home-dwelling vulnerable individuals seem to have received adequate care. However, the pandemic may have increased the number of vulnerable individuals. These findings should be considered when identifying future nationwide stressors that may impair social interactions and threaten mental health. They also highlight the need to evaluate medication prescriptions for older adults after the pandemic.

TRIAL REGISTRATION

The study is registered in ClinicalTrials.gov 02.02.2021, with the identification number NCT04792086.

Blood absolute lymphocyte count and trajectory are important in understanding severe COVID-19

BACKGROUND

Low blood absolute lymphocyte count (ALC) may predict severe COVID-19 outcomes. Knowledge gaps remain regarding the relationship of ALC trajectory with clinical outcomes and factors associated with lymphopenia.

METHODS

Our post hoc analysis of the Therapeutics for Inpatients with COVID-19 platform trial utilized proportional hazards models to assess relationships between Day (D) 0 lymphopenia (ALC < 0.9 cells/uL), D0 severe lymphopenia (ALC < 0.5 cells/uL) or lymphopenia trajectory between D0 and D5 with mortality and secondary infections, and with sustained recovery using Fine-Gray models. Logistic regression was used to assess relationships between clinical variables and D0 lymphopenia or lymphopenia trajectory.

RESULTS

D0 lymphopenia (1426/2579) and severe lymphopenia (636/2579) were associated with increased mortality (aHR 1.48; 1.08, 2.05, p = 0.016 and aHR 1.60; 1.20, 2.14, p = 0.001) and decreased recovery (aRRR 0.90; 0.82, 0.99, p = 0.033 and aRRR 0.78; 0.70, 0.87, p < 0.001 respectively). Trial participants with persistent D5 lymphopenia had increased mortality, and increased secondary infections, and participants with persistent or new lymphopenia had impaired recovery, as compared to participants with no lymphopenia. Persistent and new lymphopenia were associated with older age, male sex; prior immunosuppression, heart failure, aspirin use, and normal body mass index; biomarkers of organ damage (renal and lung), and ineffective immune response (elevated IL-6 and viral nucleocapsid antigen levels). Similar results were observed with severe lymphopenia.

CONCLUSIONS

Lymphopenia was predictive of severe COVID-19 outcomes, particularly when persistent or new during hospitalization. A better understanding of the underlying risk factors for lymphopenia will help illuminate disease pathogenesis and guide management strategies.

Exposure to objective/sensationalist information moderates associations between psychological factors and COVID-19 anti-vaccination attitudes: An experimental study

BACKGROUND

Research examining the relationship between psychological factors and COVID-19 vaccine hesitancy has been mostly based on observational designs, with little attention devoted to the role of exposure to objective/sensationalist information.

PURPOSE

This experimental study examined the extent to which exposure to objective or sensationalist news headlines: 1) influenced COVID-19 anti-vaccination attitudes; and 2) moderated the relationship between psychological factors and COVID-19 anti-vaccination attitudes.

METHODS

123 participants (mean age = 28.55, SD = 11.44) completed measures of psychological factors previously associated with vaccine hesitancy (i.e. social norms regarding COVID-19, adherence to non-pharmaceutical interventions (NPIs), perceived health competence, trust in complementary and alternative medicine (CAM), COVID-19 conspiracy beliefs, and COVID-19 risk perception). Next, participants were randomly assigned to view nine print news headlines about COVID-19 vaccines that were depicted in objective or sensationalist terms. Finally, participants completed a measure of COVID-19 anti-vaccination attitudes. A t-test and simple slope analyses were performed to assess whether there were group differences in COVID-19 anti-vaccination attitudes between participants exposed to objective or sensationalist information, and whether exposure to objective or sensationalist information moderated the relationship between psychological factors and COVID-19 anti-vaccination attitudes, respectively.

RESULTS

Participants exposed to sensationalist news headlines reported stronger COVID-19 anti-vaccination attitudes than those exposed to objective headlines. Exposure to objective or sensationalist news headlines moderated the relationship between several psychological factors (i.e. adherence to NPIs, perceived health competence, and trust in CAM) and COVID-19 anti-vaccination attitudes.

CONCLUSIONS

The results highlight that a joint focus on psychological factors and exposure to objective/sensationalist information may contribute to gain a better understanding of vaccine hesitancy in the context of the COVID-19 infodemic.

Sleep quality during and after severe acute respiratory syndrome coronavirus 2 (COVID-19) lockdowns in the UK: Results from the SleepQuest study

Sleep is fundamental to health. The aim of this study was to analyse and determine factors predicting sleep quality during and after national lockdowns due to severe acute respiratory syndrome coronavirus 2 (COVID-19) in the UK. A longitudinal online survey-based study (SleepQuest) involving UK adults was administered in Spring 2020, Winter 2020, and Winter 2022 including questionnaires probing sleep quality, depression, anxiety, beliefs about sleep, demographics, COVID-19 status, and exercise. The primary outcome was sleep quality (Pittsburgh Sleep Quality Index). A linear mixed-effects model evaluated factors associated with baseline and longitudinal sleep quality. Complete data were provided by 3306 participants in Spring 2020, 2196 participants in Winter 2020, and 1193 in Winter 2022. Participants were mostly female (73.8%), white (97.4%), and aged over 50 years (81.0%). On average, participants reported poor sleep quality in Spring 2020 (mean [SD] Pittsburgh Sleep Quality Index score = 6.59 [3.6]) and Winter 2020 (mean [SD] Pittsburgh Sleep Quality Index score = 6.44 [3.6]), with improved but still poor sleep quality in Winter 2022 (mean [SD] Pittsburgh Sleep Quality Index score = 6.17 [3.5]). Improved sleep quality was driven by better subjective sleep and reduced daytime dysfunction and sleep latency. Being female, older, having caring responsibilities, working nightshifts, and reporting higher levels of depression, anxiety, and unhelpful beliefs about sleep were associated with worse baseline PSQI scores. Better sleep quality was associated with more days exercising per week at baseline. Interventions focusing on improving mental health, exercise, and attitudes towards sleep, particularly in at-risk groups, may improve sleep-related outcomes in future pandemics.

An investigation into the contributing factors to survival of ARDS patients supported by veno-venous ECMO

INTRODUCTION

This study aimed to identify characteristics associated with survival during and post Extra Corporeal Membrane Oxygenation (ECMO) therapy, in patients with acute respiratory distress syndrome (ARDS) during the COVID-19 pandemic.

METHODS

A retrospective observational study on 94 consecutive patients with confirmed COVID-19 induced ARDS supported by ECMO was carried out 49/94 (52.7%) patients survived to hospital discharge.

RESULTS

Non-survivors were found to have significantly (p < .05) higher: Pre-ECMO International normalized ratios (INR), carbon dioxide partial pressure (pCO2), Acute Kidney Injury (AKI) scores and blood urea levels. Also, lower pre-ECMO peak inspiratory pressures (PIP), mean arterial pressure, saturation of arterial oxygen (SaO2), blood bicarbonate levels (HCO3), blood Ph and fewer trials off ECMO with shorter combined trial off times. Patients that did not survive were more likely to have renal impairment and have received peri-ECMO haemofiltration. Poor prognosis was significantly associated with: receiving pre-ECMO nitric oxide (HR = 3.047, CI = 1.247-7.447, p = .015), renal impairment (HR = 3.023, CI = 1.586-5.763, p < .001), AKI of 2 (HR = 3.611, CI = 1.382-9.441, p = .009) or 3 (HR = 3.275, CI = 1.235-8.685, p = .017), peri-ECMO haemofiltration (HR = 2.412, CI = 1.310-4.442, p = .005) and the ABO blood group B (HR = 3.103, CI = 1.335-7.212, p = .008). pre-ECMO high CO2 (HR = 1.134, CI = 1.031-1.248, p = .010), blood lactate (HR = 1.350, CI = 1.156-1.576, p < .001), INR (HR = 2.571, CI = 1.438-4.598, p=<0.001) and lower blood Ph (HR = 0.023, CI = 0.002-0.210, p < .001).

CONCLUSIONS

Commonly used mortality scores may not be of use in a COVID-19 cohort of ECMO patients. The initiation of ECMO needs to be implemented prior to metabolic derangements, renal and fulminant respiratory failure.

Risk perception and reappraisal during the COVID-19 pandemic in southeast Alaska: Self-identified determinants of risk and protective health behaviors

Social and cultural context shapes how communities perceive health, well-being, and risk. Risk reappraisal can occur over time as a product of new information and improved understanding. We investigate risk perception and protective behaviors in Lingít Aaní (Southeast Alaska) during the first year of the COVID-19 pandemic. Surveys were circulated at two time points: (1) April-June 2020, before COVID-19 reached epidemic levels in the region, and (2) November 2020-February 2021. Ordinary least squares (OLS) regression models were used to analyze how demographic characteristics of the respondent population were related to risk perception. OLS models were again used to predict how individuals engaged in protective behaviors while controlling for risk perceptions. Controlling for demographic characteristics, risk perception increased as age increased for perceived risk of getting sick and dying from COVID-19, males perceived lower risk in general for all tested variables, and Alaska Native respondents perceived higher risk than non-Alaska Native respondents. Controlling for risk perception, results for protective behaviors were mixed; however, the strongest association identified was that knowing someone with a positive COVID-19 diagnosis increased protective behaviors. Between the two time points, risk perceptions increased significantly for variables related to oneself, others, and community members becoming infected with COVID-19. Protective behaviors like traveling less than normal, buying more cleaning products, and engaging in more subsistence gathering significantly increased. Identifying patterns of risk perception and protective behaviors, and especially how they change over time, are critical to developing place-specific public health recommendations, action, and preparedness plans against future infectious threats.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Routine measurement of cardiometabolic disease risk factors in primary care in England before, during, and after the COVID-19 pandemic: A population-based cohort study

BACKGROUND

This study estimated to what extent the number of measurements of cardiometabolic risk factors (e.g., blood pressure, cholesterol, glycated haemoglobin) were impacted by the COVID-19 pandemic and whether these have recovered to expected levels.

METHODS AND FINDINGS

A cohort of individuals aged ≥18 years in England with records in the primary care-COVID-19 General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR) were identified. Their records of 12 risk factor measurements were extracted between November 2018 and March 2024. Number of measurements per 1,000 individuals were calculated by age group, sex, ethnicity, and area deprivation quintile. The observed number of measurements were compared to a composite expectation band, derived as the union of the 95% confidence intervals of 2 estimates: (1) a projected trend based on data prior to the COVID-19 pandemic; and (2) an assumed stable trend from before pandemic. Point estimates were calculated as the mid-point of the expectation band. A cohort of 49,303,410 individuals aged ≥18 years were included. There was sharp drop in all measurements in March 2020 to February 2022, but overall recovered to the expected levels during March 2022 to February 2023 except for blood pressure, which had prolonged recovery. In March 2023 to March 2024, blood pressure measurements were below expectation by 16% (-19 per 1,000) overall, in people aged 18 to 39 (-23%; -18 per 1,000), 60 to 79 (-17%; -27 per 1,000), and ≥80 (-31%; -57 per 1,000). There was suggestion that recovery in blood pressure measurements was socioeconomically patterned. The second most deprived quintile had the highest deviation (-20%; -23 per 1,000) from expectation compared to least deprived quintile (-13%; -15 per 1,000).

CONCLUSIONS

There was a substantial reduction in routine measurements of cardiometabolic risk factors following the COVID-19 pandemic, with variable recovery. The implications for missed diagnoses, worse prognosis, and health inequality are a concern.

Enhancing nursing care through technology and standardized nursing language: The TEC-MED multilingual platform

PURPOSE

This study describes the design, integration, and semantic interoperability process of a minimum data set using standardized nursing language in the caring module of the TEC-MED care platform.

METHODS

The caring module was developed in three phases (2020-2022): platform concept, functional design and construction, and testing and evaluation. Phases involved collaboration among academics, information technology developers, and social/healthcare professionals. Nursing taxonomies (NANDA-I, NOC, NIC) were integrated to support the nursing process. The platform was piloted in six Mediterranean countries.

FINDINGS

The final platform features an assessment module with eight dimensions for data collection on older adults and their caregivers. A clinical decision support system links assessment data with nursing diagnoses, outcomes, and interventions. The platform is available in six languages (English, Spanish, French, Italian, Greek, and Arabic). Usability testing identified the need for improved Arabic language support.

CONCLUSIONS

The TEC-MED platform is a pioneering tool using standardized nursing language to improve care for older adults in the Mediterranean. The platform's multilingualism promotes accessibility. Limitations include offline use and mobile app functionality. Pilot testing is underway to evaluate effectiveness and facilitate cross-cultural validation of nursing taxonomies.

IMPLICATIONS FOR NURSING PRACTICE

The TEC-MED platform offers standardized nursing care for older adults across the Mediterranean, promoting consistent communication and evidence-based practice. This approach has the potential to improve care quality and accessibility for a vulnerable population.

Priorities and challenges in social and healthcare policies for older people living in the Mediterranean basin: A Delphi panel study

BACKGROUND

Recently, the countries in the Mediterranean basin (which share cultural ties) have been showing a common trend of declining social support for the elderly, with deficiencies in social care models for this demographic. Thus, this Delphi panel study analyzed the gaps in social and integrated care among the participating countries in a European research project.

METHODS

This three-round Delphi panel study focused on the European countries of Greece and Spain and the non-European countries of Egypt, Lebanon, and Tunisia. In this project, experts were identified according to their level of expertise in the subject matter, their gender, and their membership in different social groups. Subsequently, they were asked to identify the current situation of social care, set future goals, and locate the gaps regarding the social and healthcare models for older people in the participating countries. The median score (Mdn) and interquartile range (IQR) were calculated to assess the degree of consensus on the different priorities.

RESULTS

Among the participating countries, there was a lack of state agreements to maintain social care models, a lack of coordination between public and private institutions to provide social care services, territorial inequalities in terms of access and coverage of rights, and job insecurity for professionals. The desired situation was to integrate social and healthcare services with a person-centered social care model, thus promoting autonomy and empowering users and families in participation and decision-making.

CONCLUSIONS

This Delphi study reveals significant disparities in social and healthcare policies for older adults across Mediterranean countries, highlighting shared challenges and specific national needs. European nations like Greece and Spain face fragmented systems, while non-European countries such as Lebanon, Egypt, and Tunisia lack specialized geriatric services and social security. All countries urgently need better professional training, social and economic empowerment of older adults, and integrated national strategies. These findings offer key insights for policymakers to develop equitable, sustainable solutions for aging populations.

Studying the Humoral Response against SARS-CoV-2 in Cuban COVID-19 Recovered Patients

Understanding the immune response generated by SARS-CoV-2 is critical for assessing efficient therapeutic protocols and gaining insights into the durability of protective immunity. The current work was aimed at studying the specific humoral responses against SARS-CoV-2 in Cuban COVID-19 convalescents. We developed suitable tools and methods based on ELISA methodology, for supporting this evaluation. Here, we describe the development of an ELISA for the quantification of anti-RBD IgG titers in a large number of samples and a similar test in the presence of NH4SCN as chaotropic agent for estimating the RBD specific antibody avidity. Additionally, a simple and rapid ELISA based on antibody-mediated blockage of the binding RBD-ACE2 was implemented for detecting, as a surrogate of conventional test, the levels of anti-RBD inhibitory antibodies in convalescent sera. In a cohort of 273 unvaccinated convalescents, we identified higher anti-RBD IgG titer (1 : 1,330, p  < 0.0001) and higher levels of inhibitory antibodies blocking RBD-ACE2 binding (1 : 216, p  < 0.05) among those who had recovered from severe illness. Our results suggest that disease severity, and not demographic features such as age, sex, and skin color, is the main determinant of the magnitude and neutralizing ability of the anti-RBD antibody response. An additional paired longitudinal assessment in 14 symptomatic convalescents revealed a decline in the antiviral antibody response and the persistence of neutralizing antibodies for at least 4 months after the onset of symptoms. Overall, SARS-CoV-2 infection elicits different levels of antibody response according to disease severity that declines over time and can be monitored using our homemade serological assays.

HCoV-NL63 and HCoV-HKU1 seroprevalence and its relationship with the clinical features of COVID-19 patients from Villavicencio, Colombia

INTRODUCTION

Due to the cross-reactivity between SARS-CoV-2 and common human coronaviruses, previous infections with these viruses could contribute to serological or cellular cross-protection against severe COVID-19. However, protective immunity may not develop, or pre-existing immunity could increase COVID-19 severity.

OBJECTIVE

To determine the seroprevalence of IgG antibodies against HCoV-NL63 and HCoV-HKU1 and correlate previous exposure with COVID-19 signs in patients from Villavicencio.

MATERIALS AND METHODS

A cross-sectional retrospective study was conducted. ELISA technique was used to search for IgG antibodies against HCoV-NL3 and HCoV-HKU1 in patients with positive RT-qPCR results for SARS-CoV-2. Patients were grouped according to COVID-19 clinical characteristics in four groups: group 1: asymptomatic (n = 23); group 2: hospitalized (n = 24); group 3: intensive care units (n = 24), and group 4: dead (n = 22).

RESULTS

The overall seroprevalence of IgG antibodies against HCoV was 74.2% (n = 69; 95% CI: 65.3-83.1), with 66.7% of HCoV-NL63 (n = 62; 95% CI: 57,1-76,2), and 25.8% of HCoV-HKU1 (n = 24; 95% CI: 16,9-34,7). Based on crosstab analysis, prior exposure to HCoV-NL63 was associated with protection against severe COVID-19 (p = 0.042; adjusted OR = 0.159; 95% CI: 0.027-0.938), and previous coinfection of HCoV-NL63 and HCoVHKU1 was considered a positive association to severe COVID-19 (p = 0.048; adjusted OR = 16.704; 95% CI: 1.020 - 273.670).

CONCLUSION

To our knowledge, this is the first study addressing seroprevalence of HCoV IgG antibodies in Colombia and Latin America. Previous exposure to HCoV-NL63 could protect against severe COVID-19, whereas patients with underlying HCoV-NL63 and HCoVHKU1 coinfection could be hospitalized with severe signs of COVID-19.

Comparative analysis of COVID-19 diagnoses and mortality among hospitalized indigenous and non-indigenous populations in Chile: 2020-2021

BACKGROUND

Current literature presents mixed effects of the COVID-19 pandemic on Indigenous communities. We aim to highlight potential disparities and temporal shifts in both the impact of COVID-19 and vaccine uptake among hospitalized Indigenous populations in Chile.

METHODS

We conducted an observational analysis utilizing 1,598,492 hospitalization records from 2020 to 2021 based on publicly accessible hospital discharge data spanning 65 healthcare facilities of medium and high complexity funded through the Diagnosis-Related Groups (DRG) mechanism in Chile, representing roughly 70% of the country's total hospitalizations. This was supplemented with publicly available municipal data on COVID-19 vaccinations and socio-demographic variables. We performed logistic regression analysis at 0.05 level of significance to assess the bivariate and multivariable association of Indigenous status with COVID-19 diagnosis and COVID-19 deaths among hospitalized populations. We also performed univariate and multiple linear regression to assess the association of COVID-19 vaccination rate and Indigenous status at the municipality level. In addition, we report the distribution of top 10 secondary diagnoses among hospitalized COVID-19 cases and deaths separately for Indigenous and non-Indigenous populations.

RESULTS

Indigenous populations displayed lower adjusted odds for both COVID-19 diagnosis (OR: 0.76, 95% CI: 0.74, 0.77) and death (OR: 0.91, 95% CI: 0.85, 0.97) when compared to non-Indigenous groups. Notably, the adjusted odds ratio for COVID-19 diagnosis in Indigenous populations rose from 0.59 (95% CI: 0.57, 0.61) in 2020 to 1.17 (95% CI: 1.13, 1.21) in 2021. Factors such as the significantly higher median age and greater number of comorbidities in the non-Indigenous hospitalized groups could account for their increased odds of COVID-19 diagnosis and mortality. Additionally, our data indicates a significantly negative adjusted association between COVID-19 vaccination rates and the proportion of Indigenous individuals.

CONCLUSION

Although Indigenous populations initially showed lower odds of COVID-19 diagnosis and mortality, a marked rise in diagnosis odds among these groups in 2021 underscores the urgency of targeted interventions. The observed negative association between the proportion of Indigenous populations and vaccination rates further underscores the necessity to tackle vaccine access barriers and work towards equitable distribution.

Depressive Symptom Change Patterns during the COVID-19 Pandemic and Their Impact on Psychiatric Treatment Seeking: A 24-Month Observational Study of the Adult Population

Despite the presence of individual differences in the depressive symptom change in adults during the COVID-19 pandemic, most studies have investigated population-level changes in depression during the first year of the pandemic. This longitudinal repeated-measurement study obtained 39,259 observations from 4,361 adults assessed nine times over a 24-month period in Norway (March 2020 to March 2022). Using a Latent Change Score Mixture Model to investigate differential change patterns in depressive symptoms, five profiles were identified. Most adults revealed a consistently resilient (42.52%) or predominantly resilient pattern differentiated by an initial shock in symptomatology (13.17%). Another group exhibited consistently high depressive adversities (8.5%). One group showed mild deterioration with small increases in depressive symptomatology compared to onset levels (29.04%), and a second strong deterioration group exhibited clinically severe levels of gained symptoms over time (6.77%). Both deteriorating depressive symptom change patterns predicted the presence of a psychiatric diagnosis and treatment seeking at the end of the study period. Together, the absence of a preexisting psychiatric diagnosis at the onset of the pandemic and severe symptom increases during, combined with reports of psychiatric treatment seeking and diagnosis at the end of the study period, indicated that the strongly deteriorating subgroup represents an additional and newly emerged group of adults struggling with depressive problems. Factors related to general adverse change (lower education levels, lone residence), initial shocks prior to recovery (frequent information seeking, financial and occupational concerns), and resilience and recovery (older age, being in a relationship, physical activity) were identified. Binge drinking and belonging to an ethnic minority were influential predictors of the strongly deteriorating group. All major change patterns in depressive symptoms occurred during the first 3 months of the pandemic, suggesting this period represents a window of sensitivity for the development of long-lasting depressive states versus patterns of recovery and resilience. These findings call for increased vigilance of psychiatric symptoms during the initial phases of infectious disease outbreaks and highlight a specific target period for the implementation of preventive measures.

The impact of COVID-19 on "biological aging"

The global impact of the SARS-CoV-2 pandemic has been unprecedented, posing a significant public health challenge. Chronological age has been identified as a key determinant for severe outcomes associated with SARS-CoV-2 infection. Epigenetic age acceleration has previously been observed in various diseases including human immunodeficiency virus (HIV), Cytomegalovirus (CMV), cardiovascular diseases, and cancer. However, a comprehensive review of this topic is still missing in the field. In this review, we explore and summarize the research work focusing on biological aging markers, i.e., epigenetic age and telomere attrition in COVID-19 patients. From the reviewed articles, we identified a consistent pattern of epigenetic age dysregulation and shortened telomere length, revealing the impact of COVID-19 on epigenetic aging and telomere attrition.

The Politics of the Gender Gap in COVID-19: Partisanship, Health Behavior, and Policy Preferences in the United States

Several studies demonstrate gender and partisan differences among Americans in COVID-19 socioeconomic consequences, attitudes, and behaviors. The authors of this study use six waves of panel survey data to explore the intersection of gender and party across COVID-19 mitigation behaviors, concerns, and policy preferences. The authors observe small gender gaps on several measures; however, partisan differences are larger than gender differences when considering the interaction between gender and partisanship. Democratic women are more similar to Democratic men on these measures than to Republican women. On virtually all measures, Republican women report lower levels of mitigation behaviors, worries, and support for expansive government policies compared to Democratic women and men. Analyzing the interaction of gender and partisanship illuminates how individuals navigated the pandemic with respect to identity factors that often pull in different directions. These findings suggest that one's partisan identity is more consequential than gender when it comes to COVID behaviors, concerns, and policy preferences.

Modeling mortality prediction in older adults with dementia receiving COVID-19 vaccination

OBJECTIVE

This study compared COVID-19 outcomes between vaccinated and unvaccinated older adults with and without cognitive impairment.

METHOD

Electronic health records from Israel from March 2020-February 2022 were analyzed for a large cohort (N = 85,288) aged 65 + . Machine learning constructed models to predict mortality risk from patient factors. Outcomes examined were COVID-19 mortality and hospitalization post-vaccination.

RESULTS

Our study highlights the significant reduction in mortality risk among older adults with cognitive disorders following COVID-19 vaccination, showcasing a survival rate improvement to 93%. Utilizing machine learning for mortality prediction, we found the XGBoost model, enhanced with inverse probability of treatment weighting, to be the most effective, achieving an AUC-PR value of 0.89. This underscores the importance of predictive analytics in identifying high-risk individuals, emphasizing the critical role of vaccination in mitigating mortality and supporting targeted healthcare interventions.

CONCLUSIONS

COVID-19 vaccination strongly reduced poor outcomes in older adults with cognitive impairment. Predictive analytics can help identify highest-risk cases requiring targeted interventions.

Factors Associated with All-Cause 30-Day Mortality in Indonesian Inpatient COVID-19 Patients at Cipto Mangunkusumo National General Hospital

Introduction: Indonesia, as a developing country, has limited data on the factors associated with 30-day mortality in COVID-19 patients in Indonesia. As a matter of fact, study analyzing factors associated with 30-day mortality of COVID-19 infection in Indonesia has never been conducted. This study aims to fill this gap in the literature by conducting a large-scale analysis of factors associated with 30-day mortality in COVID-19 patients in Indonesia. Method: This study employed a single-center retrospective cohort observational design, and was conducted at Cipto Mangunkusumo National General Hospital between the years 2022 and 2023. Sampling was conducted using the consecutive sampling method. The study included patients aged 18 years and above who had been confirmed to have COVID-19 infection. Survival analysis was conducted using Kaplan-Meier and multivariate Cox regression analysis. Result: Our study included a total of 644 patients, with 120 patients (18.6%) expiring within 30 days. In the multivariate analysis using the backward Wald method, severe COVID-19 (HR: 7.024; 95% CI: 3.971-12.744; p value: <0.0001), moderate COVID-19 infection (HR: 1.660; 95% CI: 1.048-2.629; p value: 0.031), liver cirrhosis (HR: 3.422; 95% CI: 1.208-9.691; p value: 0.021), female sex (HR: 1.738; 95% CI: 1.187-2.545; p value: 0.004), old age (HR: 2.139; 95% CI: 1.279-3.577; p value: 0.004), high leukocyte (HR: 11.502; 95% CI: 1.523-86.874; p value: 0.018), high NLR (HR: 1.720; 95% CI: 1.049-2.819; p value: 0.032), high CRP (HR: 1.906; 95% CI: 1.092-3.329; p value: 0.023), high procalcitonin (HR: 3.281; 95% CI: 1.780-6.049; p value: 0.001), and high creatinine (HR: 1.863; 95% CI: 1.240-2.800; p value: 0.003) were associated with 30-day mortality from COVID-19 infection. Subgroup analysis excluding cancer patients showed that age, D-Dimer, CRP, and PCT were associated with 30-day mortality in COVID-19 patients, while steroid therapy is protective. Conclusions: This study finds that COVID-19 severity, liver cirrhosis, sex, age, leukocyte, NLR, CRP, creatinine, and procalcitonin were associated with COVID-19 mortality within 30 days. These findings underscore the multifactorial nature of COVID-19 infection mortality. It is important, therefore, that patients which exhibit these factors should be treated more aggressively to prevent mortality.

Country-report pattern corrections of new cases allow accurate 2-week predictions of COVID-19 evolution with the Gompertz model

Accurate short-term predictions of COVID-19 cases with empirical models allow Health Officials to prepare for hospital contingencies in a two-three week window given the delay between case reporting and the admission of patients in a hospital. We investigate the ability of Gompertz-type empiric models to provide accurate prediction up to two and three weeks to give a large window of preparation in case of a surge in virus transmission. We investigate the stability of the prediction and its accuracy using bi-weekly predictions during the last trimester of 2020 and 2021. Using data from 2020, we show that understanding and correcting for the daily reporting structure of cases in the different countries is key to accomplish accurate predictions. Furthermore, we found that filtering out predictions that are highly unstable to changes in the parameters of the model, which are roughly 20%, reduces strongly the number of predictions that are way-off. The method is then tested for robustness with data from 2021. We found that, for this data, only 1-2% of the one-week predictions were off by more than 50%. This increased to 3% for two-week predictions, and only for three-week predictions it reached 10%.

Increase in Linguistic Complexity in Older Adults During COVID-19

The reported psychological impact of the COVID-19 pandemic and related public health measures included a decline in cognitive functioning in older adults. Cognitive functioning is known to correlate with the lexical and syntactic complexity of an individual's linguistic productions. We examined written narratives from the CoSoWELL corpus (v 1.0), collected from over 1,000 U.S. and Canadian older adults (55+ y.o.) before and during the first year of the pandemic. We expected a decrease in the linguistic complexity of the narratives, given the oft-reported reduction in cognitive functioning associated with COVID-19. Contrary to this expectation, all measures of linguistic complexity showed a steady increase from the pre-pandemic level throughout the first year of the global lockdown. We discuss possible reasons for this boost in light of existing theories of cognition and offer a speculative link between the finding and reports of increased creativity during the pandemic.

A longitudinal cohort study on the use of health and care services by older adults living at home with/without dementia before and during the COVID-19 pandemic: the HUNT study

BACKGROUND

Older adults and people with dementia were anticipated to be particularly unable to use health and care services during the lockdown period following the COVID-19 pandemic. To better prepare for future pandemics, we aimed to investigate whether the use of health and care services changed during the pandemic and whether those at older ages and/or dementia experienced a higher degree of change than that observed by their counterparts.

METHODS

Data from the Norwegian Trøndelag Health Study (HUNT4 70 + , 2017-2019) were linked to two national health registries that have individual-level data on the use of primary and specialist health and care services. A multilevel mixed-effects linear regression model was used to calculate changes in the use of services from 18 months before the lockdown, (12 March 2020) to 18 months after the lockdown.

RESULTS

The study sample included 10,607 participants, 54% were women and 11% had dementia. The mean age was 76 years (SD: 5.7, range: 68-102 years). A decrease in primary health and care service use, except for contact with general practitioners (GPs), was observed during the lockdown period for people with dementia (p < 0.001) and those aged ≥ 80 years without dementia (p = 0.006), compared to the 6-month period before the lockdown. The use of specialist health services decreased during the lockdown period for all groups (p ≤ 0.011), except for those aged < 80 years with dementia. Service use reached levels comparable to pre-pandemic data within one year after the lockdown.

CONCLUSION

Older adults experienced an immediate reduction in the use of health and care services, other than GP contacts, during the first wave of the COVID-19 pandemic. Within primary care services, people with dementia demonstrated a more pronounced reduction than that observed in people without dementia; otherwise, the variations related to age and dementia status were small. Both groups returned to services levels similar to those during the pre-pandemic period within one year after the lockdown. The increase in GP contacts may indicate a need to reallocate resources to primary health services during future pandemics.

TRIAL REGISTRATION

The study is registered at ClinicalTrials.gov, with the identification number NCT04792086.

Clinical Manifestations and Outcomes of Older Patients with COVID-19: A Comprehensive Review

The consequences of coronavirus disease 2019 (COVID-19) are particularly severe in older adults with a disproportionate number of severe and fatal outcomes. Therefore, this integrative review aimed to provide a comprehensive overview of the clinical characteristics, management approaches, and prognosis of older patients diagnosed with COVID-19. Common clinical presentations in older patients include fever, cough, and dyspnea. Additionally, preexisting comorbidities, especially diabetes and pulmonary and cardiovascular diseases, were frequently observed and associated with adverse outcomes. Management strategies varied, however, early diagnosis, vigilant monitoring, and multidisciplinary care were identified as key factors for enhancing patient outcomes. Nonetheless, the prognosis remains guarded for older patients, with increased rates of hospitalization, mechanical ventilation, and mortality. However, timely therapeutic interventions, especially antiviral and supportive treatments, have demonstrated some efficacy in mitigating the severe consequences in this age group. In conclusion, while older adults remain highly susceptible to severe outcomes from COVID-19, early intervention, rigorous monitoring, and comprehensive care can play a pivotal role in improving their clinical outcomes.

Excess of body weight is associated with accelerated T-cell senescence in hospitalized COVID-19 patients

BACKGROUND

Several risk factors have been involved in the poor clinical progression of coronavirus disease-19 (COVID-19), including ageing, and obesity. SARS-CoV-2 may compromise lung function through cell damage and paracrine inflammation; and obesity has been associated with premature immunosenescence, microbial translocation, and dysfunctional innate immune responses leading to poor immune response against a range of viruses and bacterial infections. Here, we have comprehensively characterized the immunosenescence, microbial translocation, and immune dysregulation established in hospitalized COVID-19 patients with different degrees of body weight.

RESULTS

Hospitalised COVID-19 patients with overweight and obesity had similarly higher plasma LPS and sCD14 levels than controls (all p < 0.01). Patients with obesity had higher leptin levels than controls. Obesity and overweight patients had similarly higher expansions of classical monocytes and immature natural killer (NK) cells (CD56+CD16-) than controls. In contrast, reduced proportions of intermediate monocytes, mature NK cells (CD56+CD16+), and NKT were found in both groups of patients than controls. As expected, COVID-19 patients had a robust expansion of plasmablasts, contrasting to lower proportions of major T-cell subsets (CD4 + and CD8+) than controls. Concerning T-cell activation, overweight and obese patients had lower proportions of CD4+CD38+ cells than controls. Contrasting changes were reported in CD25+CD127low/neg regulatory T cells, with increased and decreased proportions found in CD4+ and CD8+ T cells, respectively. There were similar proportions of T cells expressing checkpoint inhibitors across all groups. We also investigated distinct stages of T-cell differentiation (early, intermediate, and late-differentiated - TEMRA). The intermediate-differentiated CD4 + T cells and TEMRA cells (CD4+ and CD8+) were expanded in patients compared to controls. Senescent T cells can also express NK receptors (NKG2A/D), and patients had a robust expansion of CD8+CD57+NKG2A+ cells than controls. Unbiased immune profiling further confirmed the expansions of senescent T cells in COVID-19.

CONCLUSIONS

These findings suggest that dysregulated immune cells, microbial translocation, and T-cell senescence may partially explain the increased vulnerability to COVID-19 in subjects with excess of body weight.

[Epidemiological, clinical, and functional characteristics of patients older than 75 years admitted to a tertiary hospital during the first wave of the SARS-CoV-2 pandemic]

BACKGROUND

The objective of the present study is to analyze the epidemiological, clinical and functional characteristics of patients admitted to the University Hospital of Navarra due to SARS-CoV-2 infection, as well as the predictors of mortality, during the first wave of the pandemic caused by this virus.

METHODOLOGY

An observational, retrospective study was performed, including all hospitalized patients older than 75 years. Information has been obtained on multiple variables, among which it is worth mentioning previous geriatric syndromes or those that have appeared during hospitalization, or past medical history considered relevant in SARS-CoV-2 infection. A descriptive analysis of the data, comparisons according to various factors of interest and multivariate analysis to analyze factors associated with mortality were carried out.

RESULTS

Data have been obtained from a total of 426 patients with a mean age of 83.2 years (52.6% men). 34.7% died in hospital and 4.5% within 1 month after hospital discharge. The factors related to mortality were: worse baseline functional status, chronic kidney disease, and fever or dyspnea as forms of presentation. The most frequent typical symptoms were: fever, dyspnea, cough, asthenia and hyporexia. Up to 42.1% presented delirium as a symptom of atypical onset. We observed a functional deterioration that was not recover after a month of follow-up (baseline Barthel index 81.12; 70.08 at discharge; 75.55 after a month).

CONCLUSIONS

SARS-CoV-2 infection has caused high mortality rates in older adults. In this age group, the atypical presentation of this disease and functional deterioration during hospitalization are frequent. In the present study, a worse previous functional status has been identified as a predictor of mortality. More studies are needed to evaluate the impact that the disease and hospitalization have on the older patient, with the aim of implementing preventive, diagnostic and therapeutic measures that are necessary to avoid functional deterioration and adverse health events related to it.

Differences in Covid-19 mortality among persons 70 years and older in an integrated care setting in region Stockholm: a multi-level analysis between March 2020-February 2021

BACKGROUND

In Norrtälje municipality, within Region Stockholm, there is a joint integrated care organisation providing health and social care, which may have facilitated a more coordinated response to the covid-19 pandemic compared to the otherwise decentralised Swedish system. This study compares the risk of covid-19 mortality among persons 70 years and older, in the municipalities of Stockholm, Södertälje, and Norrtälje, while considering area and individual risk factors.

METHODS

A population-based study using linked register data to examine covid-19 mortality among those 70 + years (N = 127,575) within the municipalities of interest between the periods March-August 2020 and September 2020-February 2021. The effect of individual and area level variables on covid-19 mortality among inhabitants in 68 catchment areas were examined using multi-level logistic models.

RESULTS

Individual factors associated with covid-19 mortality were sex, older age, primary education, country of birth and poorer health as indicated by the Charlson Co-morbidity Index. The area-level variables associated were high deprivation (OR: 1.56, CI: 1.18-2.08), population density (OR: 1.14, CI: 1.08-1.21), and usual care. Together, this explained 85.7% of the variation between catchment areas in period 1 and most variation was due to individual risk factors in period 2. Little of the residual variation was attributed to differences between catchment areas.

CONCLUSION

Integrated care in Norrtälje may have facilitated a more coordinated response during period 1, compared to municipalities with usual care. In the future, integrated care should be considered as an approach to better protect and meet the care needs of older people during emergency situations.

Approaching Personalized Medicine: The Use of Machine Learning to Determine Predictors of Mortality in a Population with SARS-CoV-2 Infection

The COVID-19 pandemic demonstrated the need to develop strategies to control a new viral infection. However, the different characteristics of the health system and population of each country and hospital would require the implementation of self-systems adapted to their characteristics. The objective of this work was to determine predictors that should identify the most severe patients with COVID-19 infection. Given the poor situation of the hospitals in the first wave, the analysis of the data from that period with an accurate and fast technique can be an important contribution. In this regard, machine learning is able to objectively analyze data in hourly sets and is used in many fields. This study included 291 patients admitted to a hospital in Spain during the first three months of the pandemic. After screening seventy-one features with machine learning methods, the variables with the greatest influence on predicting mortality in this population were lymphocyte count, urea, FiO2, potassium, and serum pH. The XGB method achieved the highest accuracy, with a precision of >95%. Our study shows that the machine learning-based system can identify patterns and, thus, create a tool to help hospitals classify patients according to their severity of illness in order to optimize admission.

Increases in New but Not Returning Families to a Midwestern Food Pantry Network During the COVID-19 Pandemic

BACKGROUND

Food pantries are a resource for those experiencing food insecurity.

OBJECTIVE

The purpose of this study was to evaluate changes in food pantry utilization and volunteerism for a food pantry network during the COVID-19 pandemic.

DESIGN

This 36-month longitudinal, observational study is a secondary analysis of data collected from an Ohio food pantry network.

PARTICIPANTS/SETTING

Participants were clients of a food pantry network. The data represent visits from 12 months prepandemic (March 2019 through February 2020), during the pandemic (March 2020 through February 2021), and after vaccines were readily available (March 2021 through February 2022).

MAIN OUTCOME MEASURES

Each data point represents a visit to the pantry network. The main outcome measures were total, returning, and new visits (ie, households that had not previously used this pantry network). The secondary outcome was volunteer hours by month.

STATISTICAL ANALYSIS

In order to account for month-to-month variability in pantry utilization, the data were analyzed using a time-series linear regression analysis with the month as the unit of analysis.

RESULTS

A total of 174,397 visits were recorded during the course of 36 months. Sixty-nine percent of reporting household members were female, 48% reported at least 1 senior in the home, and 41% reported at least 1 child at home. There was no significant change in total or returning visits during the pandemic or after vaccines were available compared with prepandemic levels. However, there was a significant increase in new households to the food pantry network during the pandemic compared with prepandemic (P = .05). Volunteer hours decreased significantly during the pandemic compared with prepandemic months and remained low even after vaccines were available (P = .004 and P = .003, respectively).

CONCLUSIONS

Although there was an increase in households new to the food pantry, overall utilization did not increase.

Predictors of mortality among inpatients in COVID-19 treatment centers in the city of Butembo, North Kivu, Democratic Republic of Congo

Determining the risk factors for severe disease and death among hospitalized Covid-19 patients is critical to optimize health outcomes and health services efficiency, especially in resource-constrained and humanitarian settings. This study aimed to identify the predictors of mortality of Covid-19 patients in North Kivu province in the Democratic Republic of Congo.A retrospective cohort study was conducted in 6 Covid-19 treatment centers in the city of Butembo from 1 January to 31 December 2021. The time to event (death), the outcome variable, was visualized by Kaplan-Meier curves and the log-rank test was used to confirm differences in trends. Cox regression was used for all the predictors in the bivariate analysis and multivariate analysis was done using predictors found statistically significant in the bivariate analysis. The following variables were considered for inclusion to the Cox regression model: Age, Sex, Disease length, Treatment site, History of at least one co-morbidity, Body mass index, Stage according to SpO2 and the NEWS-modified score.Among the 303 participants (mean age of 53 years), the fatality rate was 33.8 deaths per 1000 patient-days. Four predictors were independently associated with inpatient death: age category (≥ 60 years) (adjusted HR: 9.90; 95% CI: 2.68-36.27), presence of at least one comorbidity (adjusted HR: 11.39; 95% CI: 3.19-40.71); duration of illness of > 5 days before hospitalization (adjusted HR:1.70, 95% CI: 1.04-2.79) and peripheral capillary oxygen saturation (SpO2) < 90% (adjusted HR = 14.02, 95% CI: 2.23-88.32). In addition to advanced age, comorbidity, and length of disease before hospitalization, ambient air SpO2 measured by healthcare providers using low-tech, affordable and relatively accessible pulse oximetry could inform the care pathways of Covid-19 inpatients in resource-challenged health systems in humanitarian settings.

Association between mortality risk levels and AIFELL triage scores for suspected COVID-19 patients

BACKGROUND

It is crucial to examine and classify patients as soon as possible to save their lives when they display Coronavirus Disease of 2019 (COVID-19) symptoms. The Altered sense of smell/taste, Inflammation, Fever, Elevated Lactate dehydrogenase, and Lymphocytopenia (AIFELL) evaluation tool is quick, easy, and simple for medical professionals.

OBJECTIVES

Determine the relationship between the COVID-19 patient confirmation and the AIFELL score. Examine any relationships between the AIFELL score and the degree of mortality.

MATERIALS AND METHODS

A retrospective study was conducted on 970 hospitalized (18 years or older) with a COVID-19 diagnosis in 2021. Patients admitted to the intensive care unit (ICU) as critical cases and moderate cases. The Chi-square test was utilized.

RESULTS

The scores of the AIFELL tool ranged from 0 to 6 points; the AIFELL score for COVID-19 symptoms with a high score (4-6) made up 41.5% of the patients. More than half of the patients (58.7%) were men; the oldest age group ranged from 40 to 50 years. A very high risk of dying due to a positive COVID-19 virus exists in more than a fifth of patients (21.5%). The ICU (37.5%) received around a third of the patients. The findings showed significant associations between levels of mortality risk and gender and age. There were significant associations between AIFELL scores and mortality risk levels. AIFELL scores, mortality risk levels, and patient admissions to the critical care unit were strongly associated.

CONCLUSION

The AIFELL scores were excellent for predicting COVID-19 mortality risk levels and ICU admission.

Predictors of poor outcome in critically ill patients with COVID-19 pneumonia treated with extracorporeal membrane oxygenation

INTRODUCTION

We aimed to identify risk factors associated with ICU mortality in critically ill patients with COVID-19 pneumonia treated with Extracorporeal membrane oxygenation (ECMO). We also aimed to assess protocol violations of the local eligibility criteria of ECMO initiation.

METHODS

All 31 consecutive adult patients with confirmed COVID-19 pneumonia admitted to ICU and treated with ECMO from March 13th 2020 to 8 December 2021 were enrolled. Eligibility criteria for ECMO initiation were: P/F-ratio<50 mmHg >3 hours, P/F-ratio<80 mmHg >6 hours or pH<7.25 + PaCO2>60 mmHg >6 hours, despite maximal protective invasive ventilation. Primary outcome was ICU mortality. Univariate logistic regression analyses were performed to identify predictors of ICU mortality.

RESULTS

12 out of 31 patients (38.7%) did not survive ECMO treatment in ICU. Half of the non-survivors suffered from acute kidney failure compared to 3 out of 19 survivors (15.79%) (p = .04). Half of the non-survivors required CRRT treatment versus 1 patient in the survivor group (5.3%) (p < .01). Higher age (2.45 (0.97-6.18), p = .05), the development of AKI (5.33 (1.00-28.43), p = .05), need of CRRT during ICU stay (18.00 (1.79-181.31), p = .01) and major bleeding during ECMO therapy (0.51 (0.19-0.89), p < .01) were identified to be predictors of ICU mortality.

CONCLUSION

Almost 60% of patients could be treated successfully with ECMO with sustained results at 3 months. Predictors for ICU mortality were development of AKI and need of CRRT during ICU stay, higher age category and major bleeding. Inadvertent ECMO allocation was noted in almost one in five patients.

Mental health and self-rated health of older carers during the COVID-19 pandemic: evidence from England

OBJECTIVES

Older carers play a vital role supporting population health and protecting health and social care systems, yet there has been little research on understanding the effect of the pandemic on this group. In this paper, we investigate caring as a factor contributing to mental and self-rated health.

METHODS

We investigate cross-sectional and longitudinal associations between provision of family care and mental health and wellbeing using longitudinal data from 5,149 members of the English Longitudinal Study of Ageing who responded to Wave 9 (2018/2019) and two COVID-19 sub-studies (June/July 2020; November/December 2020). We use logistic or linear regression models depending on outcome measures, controlling for pre-pandemic socioeconomic, demographic, and health-related variables.

RESULTS

Before the pandemic, 21% of respondents cared for family or friends. Older people caring for someone inside the household mostly continued to provide care during the pandemic, with more than a quarter reporting an increase in the amount of care provided. Co-resident carers were disproportionately female, older, in the lowest wealth quintile, and more likely to report disability and chronic conditions. Both cross-sectional and longitudinal analyses suggest that, compared to those caring for people living outside the household, co-resident carers were significantly more likely to report poorer mental health and self-rated health.

CONCLUSION

The health of older carers worsened disproportionately in the first year of the pandemic, a period also characterised by disruptions to support and closure of respite services. Support for carers' mental and physical health requires greater policy attention, especially in pandemic conditions.

The course of COVID-19 in patients with hematological malignancies and risk factors affecting mortality: A cross-sectional study

OBJECTIVE

This study aimed to determine the clinical outcomes and risk factors affecting mortality in patients with COVID-19 following hematological malignancy (HM).

METHODS

Patients diagnosed with HM and hospitalized for COVID-19 were included in this retrospective study. The age, demographic and clinical characteristics, prognosis and treatment of surviving and non-surviving patients were compared.

RESULTS

A total of 49 patients were included in this study, 17 (34.6%) of whom died within 28 days of being diagnosed with COVID-19. Older age (p = 0.001), diabetes (p = 0.001), chronic obstructive pulmonary disease (p = 0.002), secondary infection (p < 0.001) and secondary bacterial infection (p = 0.005) were statistically significantly higher in non-survivors. The remission status of HM was higher in surviving patients (p < 0.001). In multivariate regression analysis, age (OR: 1.102, p = 0.035) and secondary infection (OR: 16.677, p = 0.024) were risk factors increasing mortality, the remission status of HM (OR: 0.093, p = 0.047) was a protective factor from mortality.

CONCLUSION

The older age, the remission status of HM and secondary infection due to COVID-19 were determined as prognostic factors predicting mortality in HM patients with following COVID-19.

COVID's long shadow: How SARS-CoV-2 infection, COVID-19 severity, and vaccination status affect long-term cognitive performance and health

COVID-19 affects a variety of organs and systems of the body including the central nervous system. Recent research has shown that COVID-19 survivors often experience neurological and psychiatric complications that can last for months after infection. We conducted a large Internet study using online tests to analyze the effects of SARS-CoV-2 infection, COVID-19 severity, and vaccination on health, intelligence, memory, and information processing precision and speed in a cohort of 4445 subjects. We found that both SARS-CoV-2 infection and COVID-19 severity were associated with negative impacts on patients' health. Furthermore, we observed a negative association between COVID-19 severity and cognitive performance. Younger participants had a higher likelihood of SARS-CoV-2 contraction, while the elderly had a higher likelihood of severe COVID-19 and vaccination. The association between age and COVID-19 severity was primarily mediated by older participants' impaired long-term health. Vaccination was positively associated with intelligence and the precision of information processing. However, the positive association between vaccination and intelligence was likely mediated by achieved education, which was itself strongly associated with the likelihood of being vaccinated.

Quantity of antibiotic use and its association with clinical outcomes in COVID-19 patients: A snapshot from a provincial referral hospital in Indonesia

Irrational antibiotic use in Indonesia is considered high, yet there are still lacks reliable information regarding the issue. The quantity of antibiotic use studies, in particular during coronavirus disease 2019 (COVID-19) pandemic, was not well reported. The aim of this study was to evaluate antibiotic use in COVID-19 patients at a province referral hospital in Aceh, Indonesia, Dr Zainoel Abidin Hospital, and to assess the association between antibiotic use and COVID-19 clinical outcomes. The defined daily dose (DDD) method was used and expressed in DDDs per 100 patient-days as in hospital setting. The data were obtained from inpatient confirmed COVID-19 patients between March 2020 and December 2021. A logistic regression was used to determine the association between patients' characteristics and antibiotic usage with clinical outcomes. A total of 361 treated COVID-19 patients were included using a random sampling technique and analyzed. Out of 361 patients, 89.2% of them were treated with antibiotic(s). All the antibiotics were given empirically except for cefazoline (5.5%) that was used as prophylaxis to obstetric patients who underwent the c-section. Azithromycin was the most prescribed antibiotic and levofloxacin had the highest DDD. Our data suggested that there was no association between antibiotic use and clinical outcomes of COVID-19 patients (p=0.128). Having sepsis and another pulmonary disease however were associated with mortality of COVID-19 patients with adjusted odds ratio (aOR) 14.14; 95%CI 2.94-67.90, p=0.001 and aOR 8.64; 95%CI 3.30-22.63, p<0.001, respectively. In addition, patients older than 60-year-old had a higher chance to an unfavorable outcome compared to those younger than 30-year-old, aOR: 7.61; 95%CI: 1.07-53.94. In conclusion, the use of antibiotics is prevalent among COVID-19 and it is not directly associated with clinical outcomes.

Cardiometabolic risk management: insights from a European Society of Cardiology Cardiovascular Round Table

Metabolic comorbidities are common in patients with cardiorenal disease; they can cause atherosclerotic cardiovascular disease (ASCVD), speed progression, and adversely affect prognosis. Common comorbidities are Type 2 diabetes mellitus (T2DM), obesity/overweight, chronic kidney disease (CKD), and chronic liver disease. The cardiovascular system, kidneys, and liver are linked to many of the same risk factors (e.g. dyslipidaemia, hypertension, tobacco use, diabetes, and central/truncal obesity), and shared metabolic and functional abnormalities lead to damage throughout these organs via overlapping pathophysiological pathways. The COVID-19 pandemic has further complicated the management of cardiometabolic diseases. Obesity, T2DM, CKD, and liver disease are associated with increased risk of poor outcomes of COVID-19 infection, and conversely, COVID-19 can lead to worsening of pre-existing ASCVD. The high rates of these comorbidities highlight the need to improve recognition and treatment of ASCVD in patients with obesity, insulin resistance or T2DM, chronic liver diseases, and CKD and equally, to improve recognition and treatment of these diseases in patients with ASCVD. Strategies to prevent and manage cardiometabolic diseases include lifestyle modification, pharmacotherapy, and surgery. There is a need for more programmes at the societal level to encourage a healthy diet and physical activity. Many pharmacotherapies offer mechanism-based approaches that can target multiple pathophysiological pathways across diseases. These include sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, selective mineralocorticoid receptor antagonists, and combined glucose-dependent insulinotropic peptide/glucagon-like peptide-1 receptor agonist. Non-surgical and surgical weight loss strategies can improve cardiometabolic disorders in individuals living with obesity. New biomarkers under investigation may help in the early identification of individuals at risk and reveal new treatment targets.

The elderly population are more vulnerable for the management of colorectal cancer during the COVID-19 pandemic: a nationwide, population-based study

BACKGROUND/AIMS

The impact of coronavirus disease 2019 (COVID-19) on the management of colorectal cancer (CRC) may worse in elderly population, as almost all COVID-19 deaths occurred in the elderly patients. This study aimed to evaluate the impact of COVID-19 on CRC management in the elderly population.

METHODS

The numbers of patients who underwent colonoscopy, who visited hospitals or operated for CRC in 2020 and 2021 (COVID-19 era) were compared with those in 2019, according to 3 age groups (≥70 years, 50-69 years, and ≤49 years), based on the nationwide, population-based database (2019-2021) in South Korea.

RESULTS

The annual volumes of colonoscopy and hospital visits for CRC in 2020 were more significantly declined in the old age group than in the young age group (both P<0.001). In addition, the annual volume of patients operated for CRC numerically more declined in old age group than in young age group. During the first surge of COVID-19 (March and April 2020), old age patients showed statistically significant declines for the monthly number of colonoscopies (-46.5% vs. -39.3%, P<0.001), hospital visits (-15.4% vs. -7.9%, P<0.001), CRC operations (-33.8% vs. -0.7%, P<0.05), and colonoscopic polypectomies (-41.8% vs. -38.0%, P<0.001) than young age patients, compared with those of same months in 2019.

CONCLUSIONS

Elderly population are more vulnerable for the management of CRC during the COVID-19 pandemic. Therefore, the elderly population are more carefully cared for in the management of CRC during the next pandemic.

Cognitive and social well-being in older adulthood: The CoSoWELL corpus of written life stories

This paper presents the Cognitive and Social WELL-being (CoSoWELL) project that consists of two components. One is a large corpus of narratives written by over 1000 North American older adults (55+ years old) in five test sessions before and during the first year of the COVID-19 pandemic. The other component is a rich collection of socio-demographic data collected through a survey from the same participants. This paper introduces the first release of the corpus consisting of 1.3 million tokens and the survey data (CoSoWELL version 1.0). It also presents a series of analyses validating design decisions for creating the corpus of narratives written about personal life events that took place in the distant past, recent past (yesterday) and future, along with control narratives. We report results of computational topic modeling and linguistic analyses of the narratives in the corpus, which track the time-locked impact of the COVID-19 pandemic on the content of autobiographical memories before and during the COVID-19 pandemic. The main findings demonstrate a high validity of our analytical approach to unique narrative data and point to both the locus of topical shifts (narratives about recent past and future) and their detailed timeline. We make the CoSoWELL corpus and survey data available to researchers and discuss implications of our findings in the framework of research on aging and autobiographical memories under stress.

Multimorbidity patterns in COVID-19 patients and their relationship with infection severity: MRisk-COVID study

BACKGROUND

Several chronic conditions have been identified as risk factors for severe COVID-19 infection, yet the implications of multimorbidity need to be explored. The objective of this study was to establish multimorbidity clusters from a cohort of COVID-19 patients and assess their relationship with infection severity/mortality.

METHODS

The MRisk-COVID Big Data study included 14 286 COVID-19 patients of the first wave in a Spanish region. The cohort was stratified by age and sex. Multimorbid individuals were subjected to a fuzzy c-means cluster analysis in order to identify multimorbidity clusters within each stratum. Bivariate analyses were performed to assess the relationship between severity/mortality and age, sex, and multimorbidity clusters.

RESULTS

Severe infection was reported in 9.5% (95% CI: 9.0-9.9) of the patients, and death occurred in 3.9% (95% CI: 3.6-4.2). We identified multimorbidity clusters related to severity/mortality in most age groups from 21 to 65 years. In males, the cluster with highest percentage of severity/mortality was Heart-liver-gastrointestinal (81-90 years, 34.1% severity, 29.5% mortality). In females, the clusters with the highest percentage of severity/mortality were Diabetes-cardiovascular (81-95 years, 22.5% severity) and Psychogeriatric (81-95 years, 16.0% mortality).

CONCLUSION

This study characterized several multimorbidity clusters in COVID-19 patients based on sex and age, some of which were found to be associated with higher rates of infection severity/mortality, particularly in younger individuals. Further research is encouraged to ascertain the role of specific multimorbidity patterns on infection prognosis and identify the most vulnerable morbidity profiles in the community.

TRIAL REGISTRATION

NCT04981249. Registered 4 August 2021 (retrospectively registered).

Infection pre-Ad26.COV2.S-vaccination primes greater class switching and reduced CXCR5 expression by SARS-CoV-2-specific memory B cells

Neutralizing antibodies strongly correlate with protection for COVID-19 vaccines, but the corresponding memory B cells that form to protect against future infection are relatively understudied. Here we examine the effect of prior SARS-CoV-2 infection on the magnitude and phenotype of the memory B cell response to single dose Johnson and Johnson (Ad26.COV2.S) vaccination in South African health care workers. Participants were either naïve to SARS-CoV-2 or had been infected before vaccination. SARS-CoV-2-specific memory B-cells expand in response to Ad26.COV2.S and are maintained for the study duration (84 days) in all individuals. However, prior infection is associated with a greater frequency of these cells, a significant reduction in expression of the germinal center chemokine receptor CXCR5, and increased class switching. These B cell features correlated with neutralization and antibody-dependent cytotoxicity (ADCC) activity, and with the frequency of SARS-CoV-2 specific circulating T follicular helper cells (cTfh). Vaccination-induced effective neutralization of the D614G variant in both infected and naïve participants but boosted neutralizing antibodies against the Beta and Omicron variants only in participants with prior infection. In addition, the SARS-CoV-2 specific CD8+ T cell response correlated with increased memory B cell expression of the lung-homing receptor CXCR3, which was sustained in the previously infected group. Finally, although vaccination achieved equivalent B cell activation regardless of infection history, it was negatively impacted by age. These data show that phenotyping the response to vaccination can provide insight into the impact of prior infection on memory B cell homing, CSM, cTfh, and neutralization activity. These data can provide early signals to inform studies of vaccine boosting, durability, and co-morbidities.

Increased risk of SARS-CoV-2 infection and COVID-19 death among older patients at long-term care hospitals in Korea

Introduction

Long-term care hospitals are known to be vulnerable to SARS-CoV-2 infection and death given their numerous older chronic disease patients. However, the actual effect of long-term care hospital admission is not well known in Korea; hence, this study sought to analyze the effect of long-term care hospitalization on SARS-CoV-2 infection and COVID-19 death by correcting for patients' characteristics.

Methods

This cross-sectional study used the data from K-COV-N cohort, which is linked to the National Health Insurance Service and the Korea Disease Control and Prevention Agency; it analyzed 70,373 individuals aged ≥60 years, who had been tested for COVID-19 between January 1 and May 30, 2020 (KDCA-NHIS-2020-1-601). Patients admitted to a long-term care hospital were defined as those with a confirmed history of hospitalization within 30 days of the COVID-19 testing date. The final data analysis was performed in December 2022. Logistic regression analysis of the national data was employed to determine the association between long-term care hospital admission, the risk of SARS-CoV-2 infection, and death from COVID-19. The odds ratios for SARS-CoV-2 infection and death from COVID-19 were calculated by adjusting for sex, age, residential area, health insurance premium, disability, and the Charlson Comorbidity Index.

Results

Older patients at long-term care hospitals had a high risk of SARS-CoV-2 infection (OR:2.91, 95% CI:2.33-3.64) and death from COVID-19 (OR:3.58, 95% CI:2.13-6.02). A difference in SARS-CoV-2 infection risk was observed based on residential area, health insurance premium (economic level), and disability; no difference was observed for COVID-19 mortality risk.

Discussion

Admission to a long-term care hospital itself could be a risk factor for SARS-CoV-2 infection and the consequent high mortality risk after adjusting for sex, age, disability, and comorbidities. Patients are at high risk of infection through contact with workers, leading to death; therefore, quarantine policies for workers must be strengthened.

Developing Prediction Models for COVID-19 Outcomes: A Valuable Tool for Resource-Limited Hospitals

Purpose

Coronavirus disease is a global pandemic with millions of confirmed cases and hundreds of thousands of deaths worldwide that continues to create a significant burden on the healthcare systems. The aim of this study was to determine the patient clinical and paraclinical profiles that associate with COVID-19 unfavourable outcome and generate a prediction model that could separate between high-risk and low-risk groups.

Patients and Methods

The present study is a multivariate observational retrospective study. A total of 483 patients, residents of the municipality of Timișoara, the biggest city in the Western Region of Romania, were included in the study group that was further divided into 3 sub-groups in accordance with the disease severity form.

Results

Increased age (cOR=1.09, 95% CI: 1.06-1.11, p<0.001), cardiovascular diseases (cOR=3.37, 95% CI: 1.96-6.08, p<0.001), renal disease (cOR=4.26, 95% CI: 2.13-8.52, p<0.001), and neurological disorder (cOR=5.46, 95% CI: 2.71-11.01, p<0.001) were all independently significantly correlated with an unfavourable outcome in the study group. The severe form increases the risk of an unfavourable outcome 19.59 times (95% CI: 11.57-34.10, p<0.001), while older age remains an independent risk factor even when disease severity is included in the statistical model. An unfavourable outcome was positively associated with increased values for the following paraclinical parameters: white blood count (WBC; cOR=1.10, 95% CI: 1.05-1.15, p<0.001), absolute neutrophil count (ANC; cOR=1.15, 95% CI: 1.09-1.21, p<0.001) and C-reactive protein (CRP; cOR=1.007, 95% CI: 1.004-1.009, p<0.001). The best prediction model including age, ANC and CRP achieved a receiver operating characteristic (ROC) curve with the area under the curve (AUC) = 0.845 (95% CI: 0.813-0.877, p<0.001); cut-off value = 0.12; sensitivity = 72.3%; specificity = 83.9%.

Conclusion

This model and risk profiling may contribute to a more precise allocation of limited healthcare resources in a clinical setup and can guide the development of strategies for disease management.

Mental Health, Social Connectedness, and Fear During the COVID-19 Pandemic: A Qualitative Perspective from Older Women with HIV

Older women with HIV (WWH) confront significant biopsychosocial challenges that may be exacerbated by the COVID-19 pandemic. Between May 2020 and April 2021, following a resiliency intervention conducted as part of a randomized parent trial, 24 cisgender WWH (M = 58 years old) completed quantitative assessments and qualitative interviews exploring the impact of COVID-19 on mental health. Qualitative data were analyzed via rapid analysis. Most participants were Black (62.5%) and non-Hispanic or Latina (87.5%). Emergent themes included (1) increased anxiety and depression; (2) a loss of social connectedness; (3) fear of unknown interactions among COVID-19, HIV, and other comorbidities; and (4) the use of largely adaptive strategies to cope with these issues. Findings suggest that older WWH face significant COVID-19-related mental health challenges, compounding existing stressors. As the pandemic persists, it will be important to assess the impact of these stressors on wellbeing, identify effective coping strategies, and provide increased support to mitigate COVID-19-related mental health issues over time. Trial Registration: ClinicalTrials.gov identifier: NCT03071887.

Is Age the Most Important Risk Factor in COVID-19 Patients? The Relevance of Comorbidity Burden: A Retrospective Analysis of 10,551 Hospitalizations

Purpose

To assess the contribution of age and comorbidity to the risk of critical illness in hospitalized COVID-19 patients using increasingly exhaustive tools for measuring comorbidity burden.

Patients and Methods

We assessed the effect of age and comorbidity burden in a retrospective, multicenter cohort of patients hospitalized due to COVID-19 in Catalonia (North-East Spain) between March 1, 2020, and January 31, 2022. Vaccinated individuals and those admitted within the first of the six COVID-19 epidemic waves were excluded from the primary analysis but were included in secondary analyses. The primary outcome was critical illness, defined as the need for invasive mechanical ventilation, transfer to the intensive care unit (ICU), or in-hospital death. Explanatory variables included age, sex, and four summary measures of comorbidity burden on admission extracted from three indices: the Charlson index (17 diagnostic group codes), the Elixhauser index and count (31 diagnostic group codes), and the Queralt DxS index (3145 diagnostic group codes). All models were adjusted by wave and center. The proportion of the effect of age attributable to comorbidity burden was assessed using a causal mediation analysis.

Results

The primary analysis included 10,551 hospitalizations due to COVID-19; of them, 3632 (34.4%) experienced critical illness. The frequency of critical illness increased with age and comorbidity burden on admission, irrespective of the measure used. In multivariate analyses, the effect size of age decreased with the number of diagnoses considered to estimate comorbidity burden. When adjusting for the Queralt DxS index, age showed a minimal contribution to critical illness; according to the causal mediation analysis, comorbidity burden on admission explained the 98.2% (95% CI 84.1-117.1%) of the observed effect of age on critical illness.

Conclusion

Comorbidity burden (when measured exhaustively) explains better than chronological age the increased risk of critical illness observed in patients hospitalized with COVID-19.

Acute and post-acute sequelae of SARS-CoV-2 infection: a review of risk factors and social determinants

SARS-CoV-2 infection leading to Coronavirus Disease 2019 (COVID-19) has caused more than 762 million infections worldwide, with 10-30% of patients suffering from post-acute sequelae of SARS-CoV-2 infections (PASC). Initially thought to primarily affect the respiratory system, it is now known that SARS-CoV-2 infection and PASC can cause dysfunction in multiple organs, both during the acute and chronic stages of infection. There are also multiple risk factors that may predispose patients to worse outcomes from acute SARS-CoV-2 infection and contribute to PASC, including genetics, sex differences, age, reactivation of chronic viruses such as Epstein Barr Virus (EBV), gut microbiome dysbiosis, and behavioral and lifestyle factors, including patients' diet, alcohol use, smoking, exercise, and sleep patterns. In addition, there are important social determinants of health, such as race and ethnicity, barriers to health equity, differential cultural perspectives and biases that influence patients' access to health services and disease outcomes from acute COVID-19 and PASC. Here, we review risk factors in acute SARS-CoV-2 infection and PASC and highlight social determinants of health and their impact on patients affected with acute and chronic sequelae of COVID-19.

Mental health and well-being in the first year of the COVID-19 pandemic among different population subgroups: evidence from representative longitudinal data in Germany

OBJECTIVES

To examine potential deteriorations in mental health and well-being in the first COVID-19 pandemic year compared with the previous decade focusing on the following vulnerable subgroups in Germany: women with minor children in the household, those living without a partner, younger and older adults, those in a precarious labour market situation, immigrants and refugees, and those with pre-existing physical or mental health risks.

DESIGN

Analyses of secondary longitudinal survey data using cluster-robust pooled ordinary least squares models.

PARTICIPANTS

More than 20 000 individuals (aged 16+ years) in Germany.

PRIMARY AND SECONDARY OUTCOME MEASURES

Mental Component Summary Scale (MCS) of the 12-item Short-Form Health Survey measuring mental health-related quality of life, single item on life satisfaction (LS).

RESULTS

We find a decline in the average MCS in the 2020 survey that is not particularly striking in the overall time course, still resulting in a mean score below those of all preceding waves since 2010. We find no change in LS from 2019 to 2020 against the background of a general upward trend. Regarding vulnerability factors, only the results on age and parenthood are partially in line with our expectations. In 2020, LS declined among the youngest adults; MCS declined among mothers (and women and men without children) but not fathers. Unlike respective comparison groups, refugees, those unemployed before the pandemic and those with pre-existing mental health risks experienced no MCS declines in 2020, whereas persons living without a partner, the eldest, and those with pre-existing health risks exhibited continued increases in LS.

CONCLUSIONS

There is no evidence for substantial breakdowns in mental health or subjective well-being in the first pandemic year in the German population or its subgroups, particularly when considering developments of the previous decade. Since the majority of hypothesised vulnerable groups to pandemic stressors showed more stable MCS and LS, our results warrant further study.

Association between Older Age and Psychiatric Symptoms in a Population of Hospitalized Patients with COVID-19

Increased rates of anxiety and depression have been reported for older adults during the COVID-19 pandemic. However, little is known regarding the onset of mental health morbidity during the acute phase of the disease and the role of age as potential independent risk factor for psychiatric symptoms. The cross-sectional association between older age and psychiatric symptoms has been estimated in a sample of 130 patients hospitalized for COVID-19 during the first and second wave of the pandemic. Compared to younger patients, those who were 70 years of age or older resulted at a higher risk of psychiatric symptoms measured on the Brief Psychiatric Symptoms Rating Scale (BPRS) (adjusted (adj.) odds ratio (OR) 2.36, 95% confidence interval (CI) 1.05-5.30) and delirium (adj. OR 5.24, 95% CI 1.63-16.8)). No association was found between older age and depressive symptoms or anxiety. Age was associated with psychiatric symptoms independently of gender, marital status, history of psychiatric illness, severity of disease and cardiovascular morbidity. Older adults appear at high risk of developing psychiatric symptoms related to COVID-19 disease during hospital stay. Multidisciplinary preventive and therapeutic interventions should be implemented to reduce the risk of psychiatric morbidity and related adverse health care outcomes among older hospital inpatients with COVID-19.