SARS-CoV-2 and COVID-19 in older adults: what we may expect regarding pathogenesis, immune responses, and outcomes

Immunosenescence and inflamm-ageing in COVID-19

The destructive effects of coronavirus disease 2019 (COVID-19) on the elderly and people with cardiovascular disease have been proven. New findings shed light on the role of aging pathways on life span and health age. New therapies that focus on aging-related pathways may positively impact the treatment of this acute respiratory infection. Using new therapies that boost the level of the immune system can support the elderly with co-morbidities against the acute form of COVID-19. This article discusses the effect of the aging immune system against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the pathways affecting this severity of infection.

An overview on role of nutrition on COVID-19 immunity: Accumulative review from available studies

The novel coronavirus infection (COVID-19) conveys a serious global threat to health and economy. A common predisposing factor for development to serious progressive disease is presence of a low-grade inflammation, e.g., as seen in diabetes, metabolic syndrome, and heart failure. Micronutrient deficiencies may also contribute to the development of this state. Therefore, the aim of the present study is to explore the role of the nutrition to relieve progression of COVID-19. According PRISMA protocol, we conducted an online databases search including Scopus, PubMed, Google Scholar and web of science for published literatures in the era of COVID-19 Outbreak regarding to the status of nutrition and COVID-19 until December 2021. There were available studies (80 studies) providing direct evidence regarding the associations between the status of nutrition and COVID-19 infection. Adequate nutritional supply is essential for resistance against other viral infections and also for improvement of immune function and reduction of inflammation. Hence, it is suggested that nutritional intervention which secures an adequate status might protect against the novel coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome - coronavirus-2) and mitigate its course. We also recommend initiation of adequate nutritional supplementation in high-risk areas and/or soon after the time of suspected infection with SARS-CoV-2. Subjects in high-risk groups should have high priority for applying this nutritive adjuvant therapy that should be started prior to administration of specific and supportive medical measures.

Risk Factors for One-Year Mortality in Hospitalized Adults with Severe COVID-19

As the body's immunity declines with age, elderly-hospitalized patients due to COVID-19 might be at higher mortality risk. Therefore, the aim of this prospective study was to examine the possible risk factors (demographic, social or comorbidities) most associated with mortality one-year after diagnosis of COVID-19. Routine data were collected from a cohort of hospitalized adults with severe COVID-19. The primary endpoint was mortality at one-year after diagnosis of COVID-19. We used a Cox proportional hazard model to estimate the hazard ratios (HRs) for both all-cause and specific cardiorespiratory mortality. A fully adjusted model included sex, socioeconomic status, institutionalization status, disability, smoking habit, and comorbidities as confounders. A total of 368 severe cases hospitalized on average 67.3 ± 15.9 years old were included. Participants aged ≥ 71 years had significantly higher HRs for all-cause mortality (adjusted HRs = 2.86, 95%CI: 2.01-4.07) and cardiorespiratory mortality (adjusted HRs = 2.86, 95%CI: 1.99-4.12). The association between age and mortality after diagnosis of COVID-19 due to both all-causes and cardiorespiratory mortality showed a consistent dose-response fashion. Institutionalization, disability, and socioeconomic status also showed a significant association with mortality. In conclusion, aging itself was the most important risk factor associated with mortality one year after diagnosis of COVID-19. People with disabilities, institutionalized or low socioeconomic status are significantly more likely to die after COVID-19.

Defending against SARS-CoV-2: The T cell perspective

SARS-CoV-2-specific T cell response has been proven essential for viral clearance, COVID-19 outcome and long-term memory. Impaired early T cell-driven immunity leads to a severe form of the disease associated with lymphopenia, hyperinflammation and imbalanced humoral response. Analyses of acute SARS-CoV-2 infection have revealed that mild COVID-19 course is characterized by an early induction of specific T cells within the first 7 days of symptoms, coordinately followed by antibody production for an effective control of viral infection. In contrast, patients who do not develop an early specific cellular response and initiate a humoral immune response with subsequent production of high levels of antibodies, develop severe symptoms. Yet, delayed and persistent bystander CD8+ T cell activation has been also reported in hospitalized patients and could be a driver of lung pathology. Literature supports that long-term maintenance of T cell response appears more stable than antibody titters. Up to date, virus-specific T cell memory has been detected 22 months post-symptom onset, with a predominant IL-2 memory response compared to IFN-γ. Furthermore, T cell responses are conserved against the emerging variants of concern (VoCs) while these variants are mostly able to evade humoral responses. This could be partly explained by the high HLA polymorphism whereby the viral epitope repertoire recognized could differ among individuals, greatly decreasing the likelihood of immune escape. Current COVID-19-vaccination has been shown to elicit Th1-driven spike-specific T cell response, as does natural infection, which provides substantial protection against severe COVID-19 and death. In addition, mucosal vaccination has been reported to induce strong adaptive responses both locally and systemically and to protect against VoCs in animal models. The optimization of vaccine formulations by including a variety of viral regions, innovative adjuvants or diverse administration routes could result in a desirable enhanced cellular response and memory, and help to prevent breakthrough infections. In summary, the increasing evidence highlights the relevance of monitoring SARS-CoV-2-specific cellular immune response, and not only antibody levels, as a correlate for protection after infection and/or vaccination. Moreover, it may help to better identify target populations that could benefit most from booster doses and to personalize vaccination strategies.

Role of endocrine PACAP in age-related diseases

Pituitary adenylate cyclase activating polypeptide (PACAP) is a conserved neuropeptide, which confers diverse anti-aging endocrine and paracrine/autocrine effects, including anti-apoptotic, anti-inflammatory and antioxidant action. The results of the in vivo and in vitro experiments show that increasing emphasis is being placed on the diagnostic/prognostic biomarker potential of this neuropeptide in a wide array of age-related diseases. After the initial findings regarding the presence and alteration of PACAP in different body fluids in physiological processes, an increasing number of studies have focused on the changes of its levels in various pathological conditions associated with advanced aging. Until 2016 - when the results of previous human studies were reviewed - a vast majority of the studies had dealt with age-related neurological diseases, like cerebrovascular and neurodegenerative diseases, multiple sclerosis, as well as some other common diseases in elderly such as migraine, traumatic brain injury and post-traumatic stress disorder, chronic hepatitis and nephrotic syndrome. The aim of this review is to summarize the old and the new results and highlight those 'classical' and emerging clinical fields in which PACAP may become subject to further investigation as a diagnostic and/or prognostic biomarker in age-related diseases.

Perceived stress among older adults during COVID-19 outbreak: A cross-sectional study in Southern Iran

Background and Aims

The stress associated with the coronavirus disease 2019 (COVID-19) pandemic significantly affects people's lives, especially older adults. The present study aimed to identify risk factors leading to the perceived stress associated with COVID-19 among the adults over 60 years old of Southern Iran.

Methods

This cross-sectional study was conducted in December 2021 in Bandar Abbas among older adults. The COVID-PSS-10 (Perceived Stress Scale) questionnaire was distributed among the older adults receiving healthcare services from health centers in Bandar Abbas selected through a convenient sampling method. Then, answers to the questions resulted in the score (without units).

Results

A total number of 456 participants between 60 and 90 years with an average age of 64 ± 5.12 years took part in this study. The mean ± SD score of total perceived stress was 16.45 ± 8.36 (the mean score of stress was 10.30 ± 6.16 and coping was 6.15 ± 3.83). Of the total, 129 participants (28.28%) were grouped as the high-stress group. Results showed that the 70-79 years age group had higher odds of belonging to the stressed group than the 60-69 years age group (odds ratio = 2.336). Moreover, participants with a diploma were 57% more stressed than illiterate participants. The latter perceived less stress and had lower odds of belonging to the high-stress group. The employed were 61% less likely to be categorized in the stressed group than the unemployed. Among women, 43% were less likely than men to be in the high-stress group.

Conclusion

As the present findings showed, the risk factors of perceived stress induced by COVID-19 are old age, low education, unemployment, and masculinity. Therefore, planning to improve stress-coping skills such as entertainment, strengthening social relationships, physical activity, and the peace of mind of this population are suggested under the supervision of geriatric specialists and psychiatrists.

Knowledge, attitudes, practices, and its associated factors toward COVID-19 pandemic among Bangladeshi older adults

BACKGROUND

The newly emerged COVID-19 has an unprecedented impact on all classes of people, particularly the elderly. The knowledge, attitudes, and practices (KAP) of older adults toward COVID-19 are currently unknown. This study aimed to investigate the KAP and its associated factors toward COVID-19 among older adults in Bangladesh.

METHODS

A cross-sectional survey was conducted from April to May 2021 among Bangladeshi older adults. Face-to-face interviews were used to collect data from five selected divisions in Bangladesh using simple random sampling. The questionnaire consisted of socio-demographic characteristics, disease conditions, and KAP toward COVID-19. Descriptive statistics, t-tests, one-way analysis of variance (ANOVA), and logistic regression analyses were performed.

RESULTS

Out of 900 respondents, the majority of older adults (82.9%) indicated that COVID-19 is a viral disease and the major clinical symptom of COVID-19 (86.5%). Only 22.1% of participants always washed their hands with soap or hand sanitizer, and 27.6% wore a mask to protect against the virus when going outside the home. Overall, 55.2% had adequate knowledge, 50.2% had positive attitudes toward COVID-19 and only 22.7% had good practices. Out of 30 scores, mean score values were 20.8±6.7 in the knowledge section, 21.2±4.3 in the attitude section, and 11.3±6.7 in the practice section out of 30. In binary logistic regression analysis, factors associated with poor knowledge, and practices were being male, aged >70 years, having a primary education, less income <5000BDT, and multimorbidity (p < 0.05). Participants having poor knowledge of COVID-19 had higher likelihood of negative attitudes (OR: 6.79, 95% CI = 4.87-9.47, p < 0.001) and poor practices (OR: 9.15, 95% CI = 6.94-13.16, p < 0.001).

CONCLUSION

The findings highlight the need for immediate implementation of health education programs and adequate intervention programs for COVID-19 which integrates consideration of associated factors to improve the level of older adults' knowledge, attitudes, and practices.

Swimming competitions in the era of COVID-19: Lessons from successfully hosting the International Swimming League

Background

Organization of mass sport events in the COVID-19 era is utterly complicated. Containments measures, required to avoid a virus outbreak, force athletes to compete under circumstances they never experienced before, most likely having a deleterious effect on their performance.

Purpose

We aimed to design a so-called athlete-friendly bubble system for the International Swimming League 2020 event, which is strict enough to avoid a COVID-19 outbreak, but still provides a supportive environment for the athletes.

Methods

To avoid the feeling of imprisonment, athletes were permitted to spend a certain amount of time in the parks surrounding the hotels. Such alleviations were possible to apply with strict adherence to the hygienic and social distancing protocols and regular COVID-19 testing. Evaluation of every COVID-19 positive case was key, and if prolonged PCR positivity or false positive PCR result was identified, the unnecessary quarantine was planned to be lifted. Return to play protocol (RTP) was planned, in case of a COVID-19 infection of an athlete inside the bubble. To test, if the athlete-friendly system provided a supportive environment, we evaluated athlete performance.

Results

11,480 PCR tests were performed for 1,421 individuals. 63 COVID-19 positive cases were detected, of which 5 turned out to be clinically insignificant, either because of prolonged PCR positivity or because of a false positive result. 93.1% of the positive cases were detected in the local crew, while no athlete got infected inside the bubble, as the two infected athletes were tested positive upon arrival. RTP was provided for two athletes. 85% of the athletes showed improvement during the bubble and 8 world records were broken.

Conclusion

The applied protocol proved to be effective, as no athlete got infected inside the bubble, moreover, the athlete-friendly system supported the athletes to improve their performance.

Does COVID-19 Escalate Aging Process? A Possible Concern

A key challenge after the COVID-19 pandemic will be managing the long-term sequelae for the millions of individuals who recover from the disease. Based on the available evidence, our hypothesis is that the SARS-CoV-2 pandemic and its long-term complications will lead to premature aging (in terms of health) of many people in the world. Obviously, to maintain appropriate public health and prevent poor health-care services, countries should think and plan about the health problems and the long-term consequences of SARS-CoV-2 after controlling the COVID-19 pandemic.

Analysis of Prior Aspirin Treatment on in-Hospital Outcome of Geriatric COVID-19 Infected Patients

Background and Objectives: Aspirin (ASA) is a commonly used antithrombotic drug that has been demonstrated to reduce venous thromboembolism. The aim was to analyze if geriatric COVID-19 patients undergoing a 100 mg/day Aspirin (ASA) treatment prior to hospitalization differ in hospital outcome compared to patients without previous ASA therapy. Materials and Methods: An observational retrospective study was carried out using an anonymized database including geriatric COVID-19 patients (March to April 2020) admitted to Madrid Hospitals Group. A group of COVID-19 patients were treated with low ASA (100 mg/day) prior to COVID-19 infection. Results: Geriatric ASA-treated patients were older (mean age over 70 years; n = 41), had higher frequency of hypertension and hyperlipidemia, and upon admission had higher D-dimer levels than non-ASA-treated patients (mean age over 73 years; n = 160). However, patients under ASA treatment did not show more frequent pulmonary thromboembolism (PE) than non-ASA-treated patients. ASA-treated geriatric COVID-19-infected patients in-hospital < 30 days all-cause mortality was more frequent than in non-ASA-treated COVID-19 patients. In ASA-treated COVID-19-infected geriatric patients, anticoagulant therapy with low molecular weight heparin (LMWH) significantly reduced need of ICU care, but tended to increase in-hospital < 30 days all-cause mortality. Conclusions: Prior treatment with a low dose of ASA in COVID-19-infected geriatric patients increased frequency of in-hospital < 30 days all-cause mortality, although it seemed to not increase PE frequency despite D-dimer levels upon admission being higher than in non-ASA users. In ASA-treated geriatric COVID-19-infected patients, addition of LMWH therapy reduced frequency of ICU care, but tended to increase in-hospital < 30 days all-cause mortality.

Functional Expression of the Recombinant Spike Receptor Binding Domain of SARS-CoV-2 Omicron in the Periplasm of Escherichia coli

A new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant known as Omicron has caused a rapid increase in recent global patients with coronavirus infectious disease 2019 (COVID-19). To overcome the COVID-19 Omicron variant, production of a recombinant spike receptor binding domain (RBD) is vital for developing a subunit vaccine or a neutralizing antibody. Although bacterial expression has many advantages in the production of recombinant proteins, the spike RBD expressed in a bacterial system experiences a folding problem related to disulfide bond formation. In this study, the soluble Omicron RBD was obtained by a disulfide isomerase-assisted periplasmic expression system in Escherichia coli. The Omicron RBD purified from E. coli was very well recognized by anti-SARS-CoV-2 antibodies, sotrovimab (S309), and CR3022, which were previously reported to bind to various SARS-CoV-2 variants. In addition, the kinetic parameters of the purified Omicron RBD upon binding to the human angiotensin-converting enzyme 2 (ACE2) were similar to those of the Omicron RBD produced in the mammalian expression system. These results suggest that an E. coli expression system would be suitable to produce functional and correctly folded spike RBDs of the next emerging SARS-CoV-2 variants quickly and inexpensively.

Retrospective Analysis of the SARS-CoV-2 Infection Profile in COVID-19 Positive Patients in Vitoria da Conquista, Northeast Brazil

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is responsible for causing Coronavirus Disease-2019 (COVID-19), a heterogeneous clinical condition that manifests varying symptom severity according to the demographic profile of the studied population. While many studies have focused on the spread of COVID-19 in large urban centers in Brazil, few have evaluated medium or small cities in the Northeast region. The aims of this study were: (i) to identify risk factors for mortality from SARS-CoV-2 infection, (ii) to evaluate the gene expression patterns of key immune response pathways using nasopharyngeal swabs of COVID-19 patients, and (iii) to identify the circulating SARS-CoV-2 variants in the residents of a medium-sized city in Northeast Brazil. A total of 783 patients infected with SARS-CoV-2 between May 2020 and August 2021 were included in this study. Clinical-epidemiological data from patients who died and those who survived were compared. Patients were also retrospectively divided into three groups based on disease severity: asymptomatic, mild, and moderate/severe. Samples were added to a qPCR array for analyses of 84 genes involved with immune response pathways and sequenced using the Oxford Nanopore MinION technology. Having pre-existing comorbidity; being male; having cardiovascular disease, diabetes, and/or chronic obstructive pulmonary disease; and PCR cycle threshold (Ct) values under 22 were identified as risk factors for mortality. Analysis of the expression profiles of inflammatory pathway genes showed that the greater the infection severity, the greater the activation of inflammatory pathways, triggering the cytokine storm and downregulating anti-inflammatory pathways. Viral genome analysis revealed the circulation of multiple lineages, such as B.1, B.1.1.28, Alpha, and Gamma, suggesting that multiple introduction events had occurred over time. This study's findings help identify the specific strains and increase our understanding of the true state of local health. In addition, our data demonstrate that epidemiological and genomic surveillance together can help formulate public health strategies to guide governmental actions.

Falls Among Older Adults During the COVID-19 Pandemic: A Multicenter Cross-Sectional Study in Vietnam

Purpose

We aimed to investigate the prevalence and factors associated with falls in older adult outpatients during the coronavirus disease (COVID-19) pandemic in Vietnam.

Patients and Methods

From February 2022 to June 2022, this cross-sectional study included 814 patients (aged ≥60 years; mean age 71.8 ± 7.3 years; women, 65.2%) attending three geriatric clinics for a comprehensive geriatric assessment. Self-reported fall events in the past 12 months and post-COVID-19 falls were assessed. Factors associated with falls were determined using logistic regression analysis.

Results

In total, 188 patients (23.1%) had falls (single fall, 75.5%; recurrent falls, 24.5%). The most frequent location, time, and circumstance of falls were the bedroom (43.1%), morning (54.3%), and dizziness (34.6%), respectively. Most patients experienced health issues after falls (bruise/grazes, 53.7%; fracture, 12.8%; immobility, 9.6%; hospital admission, 14.9%). In the adjusted model, factors associated with falls were being underweight (odds ratio [OR] 2.50, 95% confidence interval [CI] 1.37–4.56, P = 0.003), limitations in instrumental activities of daily living (OR 2.03, 95% CI 1.05–3.95, P = 0.036), poor sleep quality (OR 1.83, 95% CI 1.10–3.05, P = 0.020), and fear of falling (OR 3.45, 95% CI 2.23–5.33, P <0.001). Among 357 COVID-19 infected patients, post-COVID-19 falls occurred in 35 patients (9.8%) and were associated with fear of falling (OR 3.14, 95% CI 1.18–8.40, P = 0.023) and post-COVID-19 lower limb weakness (OR 2.55, 95% CI 1.07–6.10, P = 0.035).

Conclusion

Our study found a substantial prevalence of falls among older outpatients during the COVID-19 pandemic in Vietnam. Management of factors associated with falls may be needed to reduce the burden of falls in the older population.

With age comes well-being: older age associated with lower stress, negative affect, and depression throughout the COVID-19 pandemic

Objectives: Despite initial concerns about older adult's emotional well-being during the COVID-19 pandemic, reports from the first months of the pandemic suggested that older adults were faring better than younger adults, reporting lower stress, negative affect, depression, and anxiety. In this study, we examined whether this pattern would persist as the pandemic progressed.Method: A convenience sample of 1,171 community-dwelling adults in the United States, ages 18-90, filled out surveys on various metrics of emotional well-being starting in March 2020 and at various time points through April 2021. We created time bins to account for the occurrence of significant national events, allowing us to determine how age would relate to affective outcomes when additional national-level emotional events were overlaid upon the stress of the pandemic.Results: Older age was associated with lower stress, negative affect, and depressive symptomatology, and with higher positive affect, and this effect was consistent across time points measured from March, 2020 through April, 2021. Age was less associated with measures of worry and social isolation, but older adults were more worried about their personal health throughout the pandemic.Conclusion: These results are consistent with literature suggesting that older age is associated with increased resilience in the face of stressful life experiences and show that this pattern may extend to resilience in the face of a prolonged real-world stressor.Supplemental data for this article can be accessed online at https://doi.org/10.1080/13607863.2021.2010183 .

The majority of severe COVID-19 patients develop anti-cardiac autoantibodies

Severe cases of COVID-19 are characterized by an inflammatory burst, which is accompanied by multiorgan failure. The elderly population has higher risk for severe or fatal outcome for COVID-19. Inflammatory mediators facilitate the immune system to combat viral infection by producing antibodies against viral antigens. Several studies reported that the pro-inflammatory state and tissue damage in COVID-19 also promotes autoimmunity by autoantibody generation. We hypothesized that a subset of these autoantibodies targets cardiac antigens. Here we aimed to detect anti-cardiac autoantibodies in severe COVID-19 patients during hospitalization. For this purpose, 104 COVID-19 patients were recruited, while 40 heart failure patients with dilated cardiomyopathy and 20 patients with severe aortic stenosis served as controls. Patients were tested for anti-cardiac autoantibodies, using human heart homogenate as a bait. Follow-up samples were available in 29 COVID-19 patients. Anti-cardiac autoantibodies were detected in 68% (71 out of 104) of severe COVID-19 patients. Overall, 39% of COVID-19 patients had anti-cardiac IgG autoantibodies, while 51% had anti-cardiac autoantibodies of IgM isotype. Both IgG and IgM anti-cardiac autoantibodies were observed in 22% of cases, and multiple cardiac antigens were targeted in 38% of COVID-19 patients. These anti-cardiac autoantibodies targeted a diverse set of myocardial proteins, without apparent selectivity. As controls, heart failure patients (with dilated cardiomyopathy) had similar occurrence of IgG (45%, p = 0.57) autoantibodies, while significantly lower occurrence of IgM autoantibodies (30%, p = 0.03). Patients with advanced aortic stenosis had significantly lower number of both IgG (11%, p = 0.03) and IgM (10%, p < 0.01) type anti-cardiac autoantibodies than that in COVID-19 patients. Furthermore, we detected changes in the anti-cardiac autoantibody profile in 7 COVID-19 patients during hospital treatment. Surprisingly, the presence of these anti-cardiac autoantibodies did not affect the clinical outcome and the prevalence of the autoantibodies did not differ between the elderly (over 65 years) and the patients younger than 65 years of age. Our results demonstrate that the majority of hospitalized COVID-19 patients produce novel anti-cardiac IgM autoantibodies. COVID-19 also reactivates resident IgG autoantibodies. These autoantibodies may promote autoimmune reactions, which can complicate post-COVID recuperation, contributing to post-acute sequelae of COVID-19 (long COVID).

Correlation between Type I Interferon Associated Factors and COVID-19 Severity

Antiviral type I interferons (IFN) produced in the early phase of viral infections effectively inhibit viral replication, prevent virus-mediated tissue damages and promote innate and adaptive immune responses that are all essential to the successful elimination of viruses. As professional type I IFN producing cells, plasmacytoid dendritic cells (pDC) have the ability to rapidly produce waste amounts of type I IFNs. Therefore, their low frequency, dysfunction or decreased capacity to produce type I IFNs might increase the risk of severe viral infections. In accordance with that, declined pDC numbers and delayed or inadequate type I IFN responses could be observed in patients with severe coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as compared to individuals with mild or no symptoms. Thus, besides chronic diseases, all those conditions, which negatively affect the antiviral IFN responses lengthen the list of risk factors for severe COVID-19. In the current review, we would like to briefly discuss the role and dysregulation of pDC/type I IFN axis in COVID-19, and introduce those type I IFN-dependent factors, which account for an increased risk of COVID-19 severity and thus are responsible for the different magnitude of individual immune responses to SARS-CoV-2.

Psychological stress creates an immune suppressive environment in the lung that increases susceptibility of aged mice to Mycobacterium tuberculosis infection

Age is a major risk factor for chronic infections, including tuberculosis (TB). Elderly TB patients also suffer from elevated levels of psychological stress. It is not clear how psychological stress impacts immune response to Mycobacterium tuberculosis (M.tb). In this study, we used social disruption stress (SDR) to investigate effects of psychological stress in young and old mice. Unexpectedly, we found that SDR suppresses lung inflammation in old mice as evidenced by lower pro-inflammatory cytokine levels in bronchial lavage fluid and decreased cytokine mRNA expression by alveolar macrophages. To investigate effects of stress on M.tb infection, mice were subjected to SDR and then infected with M.tb. As previously reported, old mice were better at controlling infection at 30 days than young mice. This control was transient as CFUs at 60 days were higher in old control mice compared to young mice. Consistently, SDR significantly increased M.tb growth at 60 days in old mice compared to young mice. In addition, SDR in old mice resulted in accumulation of IL-10 mRNA and decreased IFN-γ mRNA at 60 days. Also, confocal microscopy of lung sections from old SDR mice showed increased number of CD4 T cells which express LAG3 and CD49b, markers of IL-10 secreting regulatory T cells. Further, we also demonstrated that CD4 T cells from old SDR mice express IL-10. Thus, we conclude that psychological stress in old mice prior to infection, increases differentiation of IL-10 secreting T cells, which over time results in loss of control of the infection.

Goblet Cell Hyperplasia Increases SARS-CoV-2 Infection in Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is one of the underlying conditions in adults of any age that place them at risk for developing severe illnesses associated with COVID-19. To determine whether SARS-CoV-2's cellular tropism plays a critical role in severe pathophysiology in the lung, we investigated its host cell entry receptor distribution in the bronchial airway epithelium of healthy adults and high-risk adults (those with COPD). We found that SARS-CoV-2 preferentially infects goblet cells in the bronchial airway epithelium, as mostly goblet cells harbor the entry receptor angiotensin-converting enzyme 2 (ACE2) and its cofactor transmembrane serine protease 2 (TMPRSS2). We also found that SARS-CoV-2 replication was substantially increased in the COPD bronchial airway epithelium, likely due to COPD-associated goblet cell hyperplasia. Likewise, SARS-CoV and Middle East respiratory syndrome (MERS-CoV) infection increased disease pathophysiology (e.g., syncytium formation) in the COPD bronchial airway epithelium. Our results reveal that goblet cells play a critical role in SARS-CoV-2-induced pathophysiology in the lung. IMPORTANCE SARS-CoV-2 or COVID-19's first case was discovered in December 2019 in Wuhan, China, and by March 2020 it was declared a pandemic by the WHO. It has been shown that various underlying conditions can increase the chance of having severe COVID-19. COPD, which is the third leading cause of death worldwide, is one of the conditions listed by the CDC which can increase the chance of severe COVID-19. The present study uses a healthy and COPD-derived bronchial airway epithelial model to study the COVID-19 and host factors which could explain the reason for COPD patients developing severe infection due to COVID-19.

COVID-19 and the potential of Janus family kinase (JAK) pathway inhibition: A novel treatment strategy

Recent evidence proposed that the severity of the coronavirus disease 2019 (COVID-19) in patients is a consequence of cytokine storm, characterized by increased IL-1β, IL-6, IL-18, TNF-α, and IFN-γ. Hence, managing the cytokine storm by drugs has been suggested for the treatment of patients with severe COVID-19. Several of the proinflammatory cytokines involved in the pathogenesis of COVID-19 infection recruit a distinct intracellular signaling pathway mediated by JAKs. Consequently, JAK inhibitors, including baricitinib, pacritinib, ruxolitinib, and tofacitinib, may represent an effective therapeutic strategy for controlling the JAK to treat COVID-19. This study indicates the mechanism of cytokine storm and JAK/STAT pathway in COVID-19 as well as the medications used for JAK/STAT inhibitors.

Socio-economic analysis of short-term trends of COVID-19: modeling and data analytics

BACKGROUND

COVID-19 caused a worldwide outbreak leading the majority of human activities to a rough breakdown. Many stakeholders proposed multiple interventions to slow down the disease and number of papers were devoted to the understanding the pandemic, but to a less extend some were oriented socio-economic analysis. In this paper, a socio-economic analysis is proposed to investigate the early-age effect of socio-economic factors on COVID-19 spread.

METHODS

Fifty-two countries were selected for this study. A cascade algorithm was developed to extract the R0 number and the day J*; these latter should decrease as the pandemic flattens. Subsequently, R0 and J* were modeled according to socio-economic factors using multilinear stepwise-regression.

RESULTS

The findings demonstrated that low values of days before lockdown should flatten the pandemic by reducing J*. Hopefully, DBLD is only parameter to be tuned in the short-term; the other socio-economic parameters cannot easily be handled as they are annually updated. Furthermore, it was highlighted that the elderly is also a major influencing factor especially because it is involved in the interactions terms in R0 model. Simulations proved that the health care system could improve the pandemic damping for low elderly. In contrast, above a given elderly, the reproduction number R0 cannot be reduced even for developed countries (showing high HCI values), meaning that the disease's severity cannot be smoothed regardless the performance of the corresponding health care system; non-pharmaceutical interventions are then expected to be more efficient than corrective measures.

DISCUSSION

The relationship between the socio-economic factors and the pandemic parameters R0 and J* exhibits complex relations compared to the models that are proposed in the literature. The quadratic regression model proposed here has discriminated the most influencing parameters within the following approximated order, DLBL, HCI, Elderly, Tav, CO2, and WC as first order, interaction, and second order terms.

CONCLUSIONS

This modeling allowed the emergence of interaction terms that don't appear in similar studies; this led to emphasize more complex relationship between the infection spread and the socio-economic factors. Future works will focus on enriching the datasets and the optimization of the controlled parameters to short-term slowdown of similar pandemics.

Measuring anxiety and fear of Covid-19 among older people: psychometric properties of anxiety and fear of Covid-19 scale (AMICO) in Spain

BACKGROUND

The elderly population has proven to be a particularly vulnerable group with regard to the effects of the COVID-19 pandemic. The aim of this study was to study the psychometric properties of the Ansiedad y MIedo a Covid-19 scale (AMICO) on a population-based sample of elderly people.

METHODS

A descriptive and psychometric cross-sectional study, based on questionnaires, was carried out. An exploratory and confirmatory factor analysis was performed, as well as a bivariate analysis between the different sociodemographic variables with respect to the total scale score.

RESULTS

A sample of 720 adults over 65 years of age was obtained, 52.2% of whom were women. The structure of the factor of the scale showed two factors (fear and anxiety) and was confirmed with good fit parameters. The overall reliability of the scale in terms of internal consistency was α = 0.94.

CONCLUSIONS

The AMICO scale is a valid and reliable instrument to measure anxiety and fear of COVID-19 in the Spanish population over 65 years of age. Women and subjects with a partner showed the highest values of fear and anxiety.

Associations Between Covid-19-Related Threat, Stress, and Smoking in UK Adults Aged Under- and Over-30

It has been suggested that smoking and age are associated with higher vulnerability to Covid-19. While threat of Covid-19 may reduce or stop smoking, increased stress due to lockdown could increase smoking behaviour. This study aimed to investigate changes in smoking behaviour in relation to age, Covid-19-related threat and subjective perceived stress during the UK lockdown. A cross-sectional study was performed. Online adverts were used to recruit UK residents who smoked combustible tobacco any time from January 2020. A questionnaire measured demographic information, smoking behaviour pre- and during-lockdown, perceived subjective stress (PSS), and Covid-19 related threat. Data were collected from a total of 145 participants (58% women, 39% men, 3% non-binary; mean age: 26 years, SD = 7.7), during UK lockdown between 22nd May and 22nd June 2020. Independent of stress and Covid-19-related threat, smoking was reduced in those aged less than 30 years. In participants aged 30 and above, increases in smoking behaviour were associated with higher PSS. The results highlight the relevance of the different stages of life on the relationship between stress, threat, and smoking behaviour. Greater emphasis should be placed on stress reduction for adult smokers aged 30 and above to enable smoking cessation.

Factors associated with depressive and anxiety symptoms in older adults during the COVID-19 pandemic: a Brazilian study

Objectives: Older adults are one of the most vulnerable age groups to the social distance measures imposed by the COVID-19 pandemic. This study aimed to assess factors associated with depressive and anxiety symptoms in Brazilian older adults during the pandemic.Method: This cross-sectional online study assessed 380 older adults (over 60 years of age) living in Brazil, from 26th May 2020 to 29th June 2020. A self-reported questionnaire included sociodemographic data, lifestyle, health characteristics, and the COVID-19 related variables. The Geriatric Depression Scale (GDS) and the Geriatric Anxiety Inventory (GAI) were also applied. Data were analyzed via logistic regression models, using a hierarchical approach.Results: The prevalence of depressive symptoms according to GDS was 28.7% (95% CI = 24.4%, 33.4%) and the prevalence of anxiety symptoms according to GAI was 26.1% (95% CI = 21.9%, 30.7%). Physically inactive older adults, the ones who were in social isolation for more days, feel much vulnerable to contracting COVID-19, and never or almost never receive support from family/friends were more likely to have depressive symptoms. Being female, physically inactive or physically active 1-3 times/week, feel very vulnerable to contracting COVID-19 and never or almost never receive support from family/friends were associated with the anxiety symptoms.Conclusion: A high prevalence of depressive and anxious symptoms was identified in Brazilian older adults. The data can help in planning interventions aimed at older adults, also including their families, health professionals, and the whole society.

Aging alters antiviral signaling pathways resulting in functional impairment in innate immunity in response to pattern recognition receptor agonists

The progressive impairment of immunity to pathogens and vaccines with aging is a significant public health problem as the world population shifts to an increased percentage of older adults (> 65). We have previously demonstrated that cells obtained from older volunteers have delayed and defective induction of type I interferons and T cell and B cell helper cytokines in response to TLR ligands when compared to those from adult subjects. However, the underlying intracellular mechanisms are not well described. Herein, we studied two critical pathways important in the production of type I interferon (IFN), the interferon response factor 7 (pIRF7), and TANK-binding kinase (pTBK-1). We show a decrease in pIRF7 and pTBK-1 in cross-priming dendritic cells (cDC1s), CD4⁺ T cell priming DCs (cDC2s), and CD14^dimCD16⁺ vascular patrolling monocytes from older adults (n = 11) following stimulation with pathway-specific agonists in comparison with young individuals (n = 11). The decrease in these key antiviral pathway proteins correlates with decreased phagocytosis, suggesting impaired function in Overall, our findings describe molecular mechanisms which explain the innate functional impairment in older adults and thus could inform us of novel approaches to restore these defects.

Predictive factors of Quality of Life in older adults during the COVID-19 pandemic

BACKGROUND

Given the vulnerability of older people to COVID-19, it is important to consider their physical and mental wellbeing and quality of life (QoL) in the COVID-19 pandemic. Therefore, the present study was aimed to identify the QoL and its predictive factors among a sample of Iranian older adults during the COVID-19 pandemic.

METHODS

This descriptive and cross-sectional study was conducted on 500 older people residing in Qazvin, Iran, from May 22th to November 21rd, 2021. Multistage cluster sampling method was used for selecting the eligible older adults. Data were collected using the demographic checklist, fear of COVID-19 scale, and Elderly Quality of Life Questionnaire (LIPAD). The multivariate regression model was used for determining the predictive factors of QoL in older people.

RESULTS

The mean age of older participants was 69.17 ± 6.75 years old. The results of multivariate regression model showed that fear of COVID-19, age, marital status, level of education, living arrangement, and economic situation were the significant predictors of QoL in the older adults during the COVID-19 pandemic.

CONCLUSIONS

It is recommended to pay close attention to divorced, lonely, and illiterate older people and those with low economic situation during the COVID-19 pandemic.

Lifelong cytomegalovirus and early-LIFE irradiation synergistically potentiate age-related defects in response to vaccination and infection

While whole-body irradiation (WBI) can induce some hallmarks of immune aging, (re)activation of persistent microbial infection also occurs following WBI and may contribute to immune effects of WBI over the lifespan. To test this hypothesis in a model relevant to human immune aging, we examined separate and joint effects of lifelong latent murine cytomegalovirus (MCMV) and of early-life WBI over the course of the lifespan. In late life, we then measured the response to a West Nile virus (WNV) live attenuated vaccine, and lethal WNV challenge subsequent to vaccination. We recently published that a single dose of non-lethal WBI in youth, on its own, was not sufficient to accelerate aging of the murine immune system, despite widespread DNA damage and repopulation stress in hematopoietic cells. However, 4Gy sub-lethal WBI caused manifest reactivation of MCMV. Following vaccination and challenge with WNV in the old age, MCMV-infected animals experiencing 4Gy, but not lower, dose of sub-lethal WBI in youth had reduced survival. By contrast, old irradiated mice lacking MCMV and MCMV-infected, but not irradiated, mice were both protected to the same high level as the old non-irradiated, uninfected controls. Analysis of the quality and quantity of anti-WNV immunity showed that higher mortality in MCMV-positive WBI mice correlated with increased levels of MCMV-specific immune activation during WNV challenge. Moreover, we demonstrate that infection, including that by WNV, led to MCMV reactivation. Our data suggest that MCMV reactivation may be an important determinant of increased late-life mortality following early-life irradiation and late-life acute infection.

The Impact of COVID-19 on Domestic Tourism by Older People in Taiwan

Taiwan's older population (those over the age of 65) reached ~3.95 million at the end of January 2022, accounting for around 16.9% of the country's total population. It is already an “aged society.” With the gradual increase in the older population, the older people tourism market is also getting more and more attention. This article explores how older people tourism was affected by the COVID-19 pandemic (present in Tawian from early 2020), which was a major international public health event. This study adopts quantitative and PCA methods to statistically analyze the changes before and after the pandemic. The study results found that the frequency of tourism decreased after the pandemic: the number was 5.32, a decrease of 0.77, and instances of at least 1 tourist trip decreased by 3.87% after the pandemic. Regarding the reasons for not participating in tourism, during the COVID-19 pandemic, the COVID-19 accounted for a factor of 19.9%. Total travel expenses were NT$2,590, an increase of NT$229.67, and were not affected by the pandemic. We carried out a PCA analysis on tourism spending. The first component was food, accommodation, shopping, and other expenses. The factor loadings were 0.989, 0.931, 0.641 and −0.948, respectively. The second component was entertainment and transportation expenses. The factor loadings were 0.997 and 0.902, respectively. In conclusion, we put forward relevant discussions and suggestions to make tourism for older people healthier and more sustainable.

Sequencing during Times of Change: Evaluating SARS-CoV-2 Clinical Samples during the Transition from the Delta to Omicron Wave

The pandemic of SARS-CoV-2 is characterized by the emergence of new variants of concern (VOCs) that supplant previous waves of infection. Here, we describe our investigation of the lineages and host-specific mutations identified in a particularly vulnerable population of predominantly older and immunosuppressed SARS-CoV-2-infected patients seen at our medical center in Chicago during the transition from the Delta to Omicron wave. We compare two primer schemes, ArticV4.1 and VarSkip2, used for short read amplicon sequencing, and describe our strategy for bioinformatics analysis that facilitates identifying lineage-associated mutations and host-specific mutations that arise during infection. This study illustrates the ongoing evolution of SARS-CoV-2 VOCs in our community and documents novel constellations of mutations that arise in individual patients. The ongoing evaluation of the evolution of SARS-CoV-2 during this pandemic is important for informing our public health strategies.

Uncovering the genetic links of SARS-CoV-2 infections on heart failure co-morbidity by a systems biology approach

Aims

The co‐morbidities contribute to the inferior prognosis of COVID‐19 patients. Recent reports suggested that the higher co‐morbidity rate between COVID‐19 and heart failure (HF) leads to increased mortality. However, the common pathogenic mechanism between them remained elusive. Here, we aimed to reveal underlying molecule mechanisms and genetic correlation between COVID‐19 and HF, providing a new perspective on current clinical management for patients with co‐morbidity.

Methods

The gene expression profiles of HF (GSE26887) and COVID‐19 (GSE147507) were retrieved from the GEO database. After identifying the common differentially expressed genes (|log2FC| > 1 and adjusted P < 0.05), integrated analyses were performed, namely, enrichment analyses, protein–protein interaction network, module construction, critical gene identification, and functional co‐expression analysis. The performance of critical genes was validation combining hierarchical clustering, correlation, and principal component analysis in external datasets (GSE164805 and GSE9128). Potential transcription factors and miRNAs were obtained from the JASPER and RegNetwork repository used to construct co‐regulatory networks. The candidate drug compounds in potential genetic link targets were further identified using the DSigDB database.

Results

The alteration of 12 genes was identified as a shared transcriptional signature, with the role of immune inflammatory pathway, especially Toll‐like receptor, NF‐kappa B, chemokine, and interleukin‐related pathways that primarily emphasized in response to SARS‐CoV‐2 complicated with HF. Top 10 critical genes (TLR4, TLR2, CXCL8, IL10, STAT3, IL1B, TLR1, TP53, CCL20, and CXCL10) were identified from protein–protein interaction with topological algorithms. The unhealthy microbiota status and gut–heart axis in co‐morbidity were identified as potential disease roads in bridging pathogenic mechanism, and lipopolysaccharide acts as a potential marker for monitoring HF during COVID‐19. For transcriptional and post‐transcriptional levels, regulation networks tightly coupling with both disorders were constructed, and significant regulator signatures with high interaction degree, especially FOXC1, STAT3, NF‐κB1, miR‐181, and miR‐520, were detected to regulate common differentially expressed genes. According to genetic links targets, glutathione‐based antioxidant strategy combined with muramyl dipeptide‐based microbe‐derived immunostimulatory therapies was identified as promising anti‐COVID‐19 and anti‐HF therapeutics.

Conclusions

This study identified shared transcriptomic and corresponding regulatory signatures as emerging therapeutic targets and detected a set of pharmacologic agents targeting genetic links. Our findings provided new insights for underlying pathogenic mechanisms between COVID‐19 and HF.

Ready for Vaccination? COVID-19 Vaccination Willingness of Older People in Austria

In spite of findings highlighting higher health risk from infection compared to younger people, a certain percentage of older people in Austria still lack a valid vaccination certificate. The current gaps in vaccination coverage in countries such as Austria are likely to be in large part due to vaccination refusal and pose or will pose problems for the health system and consequently for all of society should the initial findings on Omicron coronavirus infectivity prove true. Surprisingly, only a few studies around the globe explicitly address older people's COVID-19 vaccination willingness. The present work therefore intends to contribute to this field by identifying factors associated with the decision for or against a vaccination among the older population in Austria. Data collected between late 2020 and early 2021 via the cross-national panel study Survey of Health, Aging and Retirement in Europe (SHARE) are used to perform multinomial logistic regression to analyse differences between COVID-19 vaccination supporters, undecided persons and rejectors. The results show that persons exhibiting a low risk assessment toward COVID-19, less health protection behaviors, lower education and belonging to households with financial burdens are significantly more likely to refuse vaccination or be ambivalent. Although multimorbidity reduces risk of vaccination refusal, poor subjective health was significantly related to a higher risk of refusing vaccination. The results point to the importance of addressing the factors related to refusal. Only by understanding these factors will it be possible to increase vaccination rates and thus minimize other restrictive measures.

Implication of the emergence of the delta (B.1.617.2) variants on vaccine effectiveness

INTRODUCTION

COVID-19 vaccines have been developed to compact the current SARS-CoV-2 pandemic and have been administered to people all over the world. These vaccines have been quite effective in reducing the possibility of severe illness, hospitalization and death. However, the recent emergence of Variants of Concern specifically the delta variant, B.1.617.2, had resulted in additional waves of the pandemic.

METHODS

We aim to review the literature to understand the transmission and disease severity, and determine the efficacy of the current COVID-19 vaccines. We searched Pubmed, Scopus, and Embase till August 4th 2021, and used the search terms "delta variant", "vaccinations"," breakthrough infections", and "neutralizing antibody". For the meta-analysis, 21 studies were screened in particular and five articles (148,071 cases) were included in the study, and only four were analyzed in the meta-analysis.

RESULTS

In this review, both in vitro and in vivo studies showed significant reductions in neutralization rates against delta variants for vaccinated individuals and convalescent patients with prior history of COVID-19. However, There was a lower incidence of infection with SARS-CoV-2 due to Delta variant was found after the second dose of Pfizer-BioNTech, Oxford-AstraZeneca and Moderna vaccines.

CONCLUSION

In fully vaccinated individuals, symptomatic infection with the delta variant was significantly reduced, and therefore, vaccinations play an important role to assist the fight against delta variant.

One-Year Report of COVID-19 Impact on Geriatric Patients: a Bio-Psycho-Social Approach

Background

Since December of 2019, coronavirus 19 (COVID-19) has spread rapidly around the world. Our understanding of the infection has grown over the past year, and its impact on older adults is particularly significant. Apart from the direct impacts of COVID-19 infections, it has also led to lockdowns which, in turn, result in isolation and loneliness.

Method

We conducted a literature review of publicly available articles of the COVID-19 pandemic impact on the geriatric population between December 2019 and April 2021, a total of 748 articles.

Results

The review will be presented with the Bio-Psycho-Social model, covering how the biological, psychological, and sociological aspects of health are intertwined and impact older adults. Early studies have also highlighted the prevalence of post-COVID infection symptoms that typically fall under geriatric medicine care. We highlight the bidirectional impact of isolation and COVID-19 infections on geriatric health, as well as discuss pertinent topics such as vaccine efficacy, long-term sequelae of COVID-19 infections, and ageism.

Conclusion

This review seeks to present a one-year report of what is known about COVID-19 and geriatric medicine, as well as provide guidance to practitioners who care for older adults based on the most up-to-date literature.

Long non-coding RNAs in virus-related cancers

Some viral infections lead to tumourigenesis explained by a variety of underlying molecular mechanisms. Long non-coding RNAs (lncRNAs) have the potential to be added to this list due to their diverse mechanisms in biological functions and disease processes via gene alternation, transcriptional regulation, protein modification, microRNA sponging and interaction with RNA/DNA/proteins. In this review, we summarise the dysregulation and mechanism of lncRNAs in virus-related cancers focussing on Hepatitis B virus, Epstein-Barr virus, Human Papillomavirus. We will also discuss the potential implications of lncRNAs in COVID-19.

Therapeutic possibilities of rehabilitation of patients who have undergone COVID-19 with residual changes in the lungs: A review

The article presents data on the mechanisms of formation of preservation of residual changes in lung tissue lesions in patients with a new coronavirus infection COVID-19. The main risk factors leading to the formation of lung tissue damage, such as age, severity of the disease, being on a ventilator, smoking, chronic alcoholism, are considered. The main directions of the search for antifibrotic drugs are presented. The rationale for the use of the pharmaceutical drug Longidaze is given, based on experimental and clinical studies. The main problems faced by doctors during the ongoing COVID-19 pandemic are identified. The schemes of administration of the drug Longidaze in patients with pulmonary fibrosis after a new coronavirus infection are considered.

Comorbidities and increased mortality of COVID-19 among the elderly: A systematic review

Purpose

The purpose of current review is to conduct a systematic overview of articles published between 2019 and 2021 on the relationship of comorbidities and mortality due to Coronavirus Disease 2019 (COVID-19) among the elderly population.

Methods

We conducted a systematic search on PubMed for articles published between 2019 and 2021 to identify any cohort and case-control studies that investigated the relationship of comorbidities and COVID-19 mortality among the elderly, defined as 60 years of age and above. Databases were searched independently by two authors. Disagreements were resolved by the inclusion of a third investigator. Reviews, systematic reviews, and meta-analyses were excluded from our systematic review.

Results

A total of 15 studies were selected for our systematic review. Of the included studies, 3 were case-control, 3 were prospective cohort studies and 9 were retrospective cohort studies. As for size, 10 studies were conducted on populations of <1000 participants, 3 ranging from 1001 to 10,000, and 2 on populations of >10,000 individuals. The included studies found that the presence of certain conditions, such as cardiovascular, respiratory, renal diseases, malignancies, diseases of the nervous system and diabetes are associated to increased mortality in populations that consisted of elderly patients.

Conclusion

Results of our systematic review suggest that comorbidities contribute to increased COVID-19 mortality among the elderly. The detrimental effect of comorbidities and advanced age on the immune response could lead to a more frequent occurrence of symptomatic and severe infections with COVID-19.

Advances in Research on Antiviral Activities of Sulfated Polysaccharides from Seaweeds

In recent years, various viral diseases have suddenly erupted, resulting in widespread infection and death. A variety of biological activities from marine natural products have gradually attracted the attention of people. Seaweeds have a wide range of sources, huge output, and high economic benefits. This is very promising in the pharmaceutical industry. In particular, sulfated polysaccharides derived from seaweeds, considered a potential source of bioactive compounds for drug development, have shown antiviral activity against a broad spectrum of viruses, mainly including common DNA viruses and RNA viruses. In addition, sulfated polysaccharides can also improve the body’s immunity. This review focuses on recent advances in antiviral research on the sulfated polysaccharides from seaweeds, including carrageenan, galactan, fucoidan, alginate, ulvan, p-KG03, naviculan, and calcium spirulan. We hope that this review will provide new ideas for the development of COVID-19 therapeutics and vaccines.

30-day Mortality Following COVID-19 and Influenza Hospitalization Among US Veterans Aged 65 and Older

Background

COVID‐19 and influenza are important sources of morbidity and mortality among older adults. Understanding how outcomes differ for older adults hospitalized with either infection is important for improving care. We compared outcomes from infection with COVID‐19 and influenza among hospitalized older adults.

Methods

We conducted a retrospective study of 30‐day mortality among veterans aged 65+ hospitalized with COVID‐19 from March 1, 2020–December 31, 2020 or with influenza A/B from September 1, 2017 to August 31, 2019 in Veterans Affairs Health Care System (VAHCS). COVID‐19 infection was determined by a positive PCR test and influenza by tests used in the VA system. Frailty was defined by the claims‐based Veterans Affairs Frailty Index (VA‐FI). Logistic regressions of mortality on frailty, age, and infection were adjusted for multiple confounders.

Results

A total of 15,474 veterans were admitted with COVID‐19 and 7867 with influenza. Mean (SD) ages were 76.1 (7.8) and 75.8 (8.3) years, 97.7% and 97.4% were male, and 66.9% and 76.4% were white in the COVID‐19 and influenza cohorts respectively. Crude 30‐day mortality (95% CI) was 18.9% (18.3%–19.5%) for COVID‐19 and 4.3% (3.8%–4.7%) for influenza.

Combining cohorts, the odds ratio for 30‐day mortality from COVID‐19 (versus influenza) was 6.61 (5.74–7.65). There was a statistically significant interaction between infection with COVID‐19 and frailty, but there was no significant interaction between COVID‐19 and age.

Separating cohorts, greater 30‐day mortality was significantly associated with older age (p: COVID‐19: <0.001, Influenza: <0.001) and for frail compared with robust individuals (p for trend: COVID‐19: <0.001, Influenza: <0.001).

Conclusion

Mortality from COVID‐19 exceeded that from influenza among hospitalized older adults. However, odds of mortality were higher at every level of frailty among those admitted with influenza compared to COVID‐19. Prevention will remain key to reducing mortality from viral illnesses among older adults.

COVID-19 Incidence Prediction Model Based on Community Behavior With Neural Networks

Abstract BACKGROUNDS : The COVID-19 pandemic has created a global health emergency that requires a public health response to prevent the spread of the virus. AIM: The purpose of this study was to determine the prediction model for the incidence of COVID-19 based on community behavior. METHODS: This study used a cross-sectional study design. The study population was all people aged >18 years in Medan City and obtained a sample of 395 people with stratified random sampling technique. The research instrument used a questionnaire in google form, then, using Microsoft Office Excel, we transferred the data from the survey to a computer program. Furthermore, the data was analyzed using the neural networks method. Then the features importance will be calculated using the Random Forest with Mean Decrease Impurity (RF-MDI) method. RESULT: The results showed that based on the confusion matrix, the prediction value for those who did not suffer from COVID-19 was correct from negative data = 8, the correct prediction value for COVID-19 from positive data = 8. While the incorrect prediction value for machines that predicted negative results but the actual data was positive = 2, and predicts a positive result but the actual data is negative = 4. Thus, based on the neural net classification method, the accuracy value is 72%. The results of this study indicate that poor preventive behavior by the community greatly affects the spread of COVID-19 cases. CONCLUSION: Poor community behavior, such as not limiting their interaction/contact with other people, not exercising frequently, leaving the house without keeping a safe distance, and not washing hands regularly, can all impact COVID-19 transmission in the community Keywords: Behavior Prediction Model, COVID-19 Incidence, Neural Network

Modeling of nursing care-associated airborne transmission of SARS-CoV-2 in a real-world hospital setting

Respiratory transmission of SARS-CoV-2 from one older patient to another by airborne mechanisms in hospital and nursing home settings represents an important health challenge during the COVID-19 pandemic. However, the factors that influence the concentration of respiratory droplets and aerosols that potentially contribute to hospital- and nursing care-associated transmission of SARS-CoV-2 are not well understood. To assess the effect of health care professional (HCP) and patient activity on size and concentration of airborne particles, an optical particle counter was placed (for 24 h) in the head position of an empty bed in the hospital room of a patient admitted from the nursing home with confirmed COVID-19. The type and duration of the activity, as well as the number of HCPs providing patient care, were recorded. Concentration changes associated with specific activities were determined, and airway deposition modeling was performed using these data. Thirty-one activities were recorded, and six representative ones were selected for deposition modeling, including patient's activities (coughing, movements, etc.), diagnostic and therapeutic interventions (e.g., diagnostic tests and drug administration), as well as nursing patient care (e.g., bedding and hygiene). The increase in particle concentration of all sizes was sensitive to the type of activity. Increases in supermicron particle concentration were associated with the number of HCPs (r = 0.66; p < 0.05) and the duration of activity (r = 0.82; p < 0.05), while submicron particles increased with all activities, mainly during the daytime. Based on simulations, the number of particles deposited in unit time was the highest in the acinar region, while deposition density rate (number/cm2/min) was the highest in the upper airways. In conclusion, even short periods of HCP-patient interaction and minimal patient activity in a hospital room or nursing home bedroom may significantly increase the concentration of submicron particles mainly depositing in the acinar regions, while mainly nursing activities increase the concentration of supermicron particles depositing in larger airways of the adjacent bed patient. Our data emphasize the need for effective interventions to limit hospital- and nursing care-associated transmission of SARS-CoV-2 and other respiratory pathogens (including viral pathogens, such as rhinoviruses, respiratory syncytial virus, influenza virus, parainfluenza virus and adenoviruses, and bacterial and fungal pathogens).

Perception about vaccines and level of knowledge, attitudes and practices towards COVID-19 in older adults in Lima, Peru

This study aimed to describe the perception about vaccines and the level of knowledge, attitudes and practices towards COVID-19 in older adults from a hospital in Lima, Peru. Descriptive and cross-sectional study carried out from March to November 2021. An instrument was adapted and validated to measure the level of knowledge, attitudes and practices; the perception about vaccines was evaluated with an exploratory questionnaire. Eighty-three older adults were surveyed, the mean age was 74.0 years and 62.7% were women. Most of the participants knew the cause and symptoms, and 50.6% believed that it could be transmitted by contaminated food. Additionally, 61.7% used traditional medicine to prevent it, and 65.4% considered that the level of social awareness was insufficient; 91.5% were vaccinated against COVID-19, and 65.4% considered these vaccines to be safe. In conclusion, most older adults showed a high level of knowledge, attitudes and practices and a positive perception about the vaccine against COVID-19.

Alterations in clinical characteristics of blood donors post COVID-19 recovery

BACKGROUND

Corona Virus Disease-19 (COVID-19), a current worldwide pandemic is a cuase of concern. Risk-adjusted differences in outcomes of the patients are not well characterized. Susceptibility to infection with respect to blood group, blood pressure, pulse rate, hemoglobin, age and BMI were analyzed.

METHODS

Blood donors, of all the ages and gender, who recovered from COVID-19 infection, were selected for the study Samples from Regional laboratory and the Central blood bank of Hafr al Batin, Saudi Arabia were collected. Out of 1508 healthy blood donor 134 had recovered from corona without any preexisting diseases.

RESULTS

Major donors were male (85.1%). 28% donors in age range of 26-35 years. O+(32.8%) were the highest donors. Systolic and diastolic blood pressure and pulse rate elevated significantly of age group 46-55 (p<0.05) and 56-65 (p<0.001). Systolic blood pressure in males (134.13 ± 9.57) was significantly higher (p<0.05) than those of females (129.35 ± 10.61). Donors with Rh+ significantly higher systolic (p<0.05) and pulse rate (p<0.05) as compared to Rh-.

DISCUSSION

O+ donors were highly susceptible. Blood pressure, pulse rate and Hb alter with age. Males exhibit higher variation in systolic blood pressure, with Rh+ factor playing a predominant role. Donors above 45-years of age and a high BMI have significantly elevated blood pressure and pulse. These results are challenging or contradictory from the results of Turkish and Chinese studies where blood group A+ was more predominantly affected by the SARS-CoV-2 with minimum infection rate on females and Rh- donors.

CONCLUSION

Factors like blood group V-2 treatment especially with the age group of 45 years and above.

Psychological Health and Digital Social Participation of the Older Adults during the COVID-19 Pandemic in Blekinge, Sweden-An Exploratory Study

COVID-19 has affected the psychological health of older adults directly and indirectly through recommendations of social distancing and isolation. Using the internet or digital tools to participate in society, one might mitigate the effects of COVID-19 on psychological health. This study explores the social participation of older adults through internet use as a social platform during COVID-19 and its relationship with various psychological health aspects. In this study, we used the survey as a research method, and we collected data through telephonic interviews; and online and paper-based questionnaires. The results showed an association of digital social participation with age and feeling lack of company. Furthermore, in addition, to the increase in internet use in older adults in Sweden during COVID-19, we conclude that digital social participation is essential to maintain psychological health in older adults.

Interleukin-6-Production Is Responsible for Induction of Hepatic Synthesis of Several Chemokines as Acute-Phase Mediators in Two Animal Models: Possible Significance for Interpretation of Laboratory Changes in Severely Ill Patients

Simple Summary

The release of acute-phase proteins and cytokine storms are considered critical parameters for the progression of COVID-19 disease. The increase in the serum levels of cytokines such as IL6 and IL8 observed in patients primarily infected with the SARS-CoV-2 virus has been used to determine the severity of clinical conditions resulting from infection and for prognostic purposes. Animal models have been used to understand the mechanisms of the changes in homeostasis observed under pathological conditions. In the present study, we therefore report the changes in serum levels and hepatic gene expression of cytokines and chemokines in two different animal models of acute-phase responses. The acute-phase response is a transient emergency response aimed at preserving life and bringing about the changes necessary to reduce and repair tissue damage after the removal of damaging noxious agents. Our data suggest that the liver may be responsible for the increase in the serum levels of cytokines and chemokines as part of the body’s defense response to tissue damage. It is therefore doubtful that inhibiting this response at any stage after infection could improve the prognosis of patients. These results may help to interpret the laboratory changes observed in critically ill patients, as may be the case following SARS-CoV-2 infection.

Abstract

A mild to moderate increase in acute-phase proteins (APPs) and a decrease in serum albumin levels are detected in hospitalized COVID-19 patients. A similar trend is also observed for acute-phase cytokines (APC), mainly IL6, besides chemokines (e.g., CXCL8 and CCL2). However, the source of the chemokines in these patients at different stages of disease remains to be elucidated. We investigated hepatic gene expression of CXC- and CC-chemokines in a model of a localized extrahepatic aseptic abscess and in a model of septicemia produced by the intramuscular injection of turpentine oil (TO) into each hindlimb or lipopolysaccharide (LPS) intraperitoneally (i.p.) in rats and mice (wild-type (WT) and IL6-KO). Together with a striking increase in the serum IL6 level, strong serum CXCL2 and CXCL8 concentrations were detected. Correspondingly, rapid (2 h) upregulation of CXCL1, CXCL2, CXCL5, and CXCL8 was observed in rat liver after intramuscular TO injection. The induction of the gene expression of CXCL1 and CXCL8 was the fastest and strongest. The hepatic CXC-chemokines behaved like positive APPs that depend on IL6 production by activated macrophages recruited to extrahepatic damaged tissue. Chemokine upregulation was greatly reduced in IL6-KO mice. However, IL6 was dispensable in the LPS–APR model, as massive induction of hepatic chemokines studied was measured in IL6-KO mice.

COVID-19 and cognitive impairment: A cross-sectional clinic-based study

BACKGROUND

Patients with dementia are more prone to acquire COVID-19 infection. Patients with COVID-19 showed a tendency to develop cognitive impairment.

OBJECTIVES

We aimed to study the clinical manifestations of COVID-19 infection among adult Sudanese demented patients and the prevalence of cognitive impairment among adult Sudanese nondemented patients.

METHODOLOGY

This is a descriptive cross-sectional study that took place in Sudan, Khartoum state in the period (September to December 2021) in a private neurology/psychiatry clinic. A total of 135 adult Sudanese patients were included in this study and were divided into two groups. The first group consists of 100 patients with a known history of dementia that got infected recently with COVID-19, while the second group consists of 35 patients who developed some sort of cognitive impairment after recovering from COVID-19 infection. Regarding the second group, cognitive functions were assessed by senior consultant neurologist and senior consultant psychiatrist using a well validated neuropsychological measure.

RESULTS

Out of 100 patients in the first group, females were 60 and males were 40. Age distribution is between 63 and 98. The common presenting symptoms of COVID-19 among this group were cough and fever (90 patients), diarrhea and vomiting (5 patients), breathlessness (4 patients), coughing of blood (5 patients), convulsions (1 patient), paraplegia (1 patient), and hemiplegia (1 patient). Regarding the second group, age distribution varied from 30 to 80 years. Cognitive functions impairment was noticed as follows: memory recall (22%), memory recognition (23%), memory encoding (24%), processing speed (16%), executive functioning (19%), phonemic fluency (17%), and category fluency (17%).

CONCLUSION

Patients with dementia are more susceptible to develop COVID-19 infection. Patients with COVID-19 Infection are at risk of developing some sort of cognitive impairment after recovery.

Impact of Smoking on COVID-19 Symptoms in Non-Vaccinated Patients: A Matched Observational Study from Qatar

Purpose

Predisposition to acute illness from COVID-19 is suggested to correlate with cigarette smoking as it augments the risk of developing cardiovascular and respiratory illnesses, including infections. However, the effects of smoking on COVID-19 symptoms are not well described and controversial. In this study, we aim to explore the associations between smoking and COVID-19 symptoms.

Subjects and Methods

A cross-sectional study using the Ministry of Public Health (MoPH), Qatar database was administered to a Qatari population with confirmed COVID-19 disease who filled in pre-defined phone-call questionnaire between 27th February 2020 and 31st December 2020. We analyzed 11,701 non-vaccinated COVID-19 individuals (2952 smokers and 8749 non-smokers) with confirmed RT-PCR test results. The association of smoking and the presence of symptoms as well as patient characteristics was calculated using Pearson’s Chi-square and Fisher’s exact tests, adjusting for potential covariates.

Results

Compared with the non-smokers, symptomatic COVID-19 infection is significantly higher in smokers. In addition, we found fever as the most common symptom developed in COVID-19 patients followed by cough, headache, muscle ache, and sore throat. As compared to other symptoms, association of smoking with chills and abdominal pain was less evident (P < 0.05 and P < 0.001, respectively). However, both groups showed similar rates of developing cough.

Conclusion

In conclusion, smoking is associated with COVID-19 symptoms frequency in non-vaccinated patients; nevertheless, further investigations are necessary to understand the mechanism of this association which could generate new targets for the management of COVID-19 in smoker patients.

COVID-19 infection in patients with chronic obstructive pulmonary disease: From pathophysiology to therapy. Mini-review

INTRODUCTION

Patients with chronic obstructive pulmonary disease (COPD) are a vulnerable group in terms of the outcome of coronavirus infection in relation to their disease or its treatment, with a higher risk of developing serious complications compared to the healthy population.

AIM

The aim of our summary study is to review the background and health outcomes of chronic obstructive pulmonary disease and COVID-19 infection in the presence of both diseases.

METHODS

Review of national and international medical databases (PubMed, MEDLINE, and MOB) with keywords COPD, COVID-19, disease risk, cause, prevention, complications, and prognosis.

RESULTS

Meta-analyses show that COPD is one of the most common underlying conditions in patients hospitalized for COVID-19. Such patients are five times more likely to develop a serious complication due to oxygen supply problems therefore they are more likely to be admitted to intensive care units, where they may require mechanical ventilation. In the case of underlying COPD, the usual care plan for COVID-19 infection should be followed, as well as all public health recommendations to minimize the risk of developing and transmitting COVID-19.

CONCLUSION

Coronavirus infection is especially dangerous for COPD patients, who are much more likely to become seriously ill, so increased surveillance, prevention, early detection, adequate treatment and rehabilitation of the disease group are of paramount importance.