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Liu HH, Xie Y, Yang BP, Wen HY, Yang PH, Lu JE, Liu Y, Chen X, Qu MM, Zhang Y, Hong WG, Li YG, Fu J, Wang FS. Safety, immunogenicity and protective effect of sequential vaccination with inactivated and recombinant protein COVID-19 vaccine in the elderly: a prospective longitudinal study. Signal Transduct Target Ther 2024; 9:129. [PMID: 38740763 DOI: 10.1038/s41392-024-01846-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 02/19/2024] [Accepted: 04/25/2024] [Indexed: 05/16/2024] Open
Abstract
The safety and efficacy of COVID-19 vaccines in the elderly, a high-risk group for severe COVID-19 infection, have not been fully understood. To clarify these issues, this prospective study followed up 157 elderly and 73 young participants for 16 months and compared the safety, immunogenicity, and efficacy of two doses of the inactivated vaccine BBIBP-CorV followed by a booster dose of the recombinant protein vaccine ZF2001. The results showed that this vaccination protocol was safe and tolerable in the elderly. After administering two doses of the BBIBP-CorV, the positivity rates and titers of neutralizing and anti-RBD antibodies in the elderly were significantly lower than those in the young individuals. After the ZF2001 booster dose, the antibody-positive rates in the elderly were comparable to those in the young; however, the antibody titers remained lower. Gender, age, and underlying diseases were independently associated with vaccine immunogenicity in elderly individuals. The pseudovirus neutralization assay showed that, compared with those after receiving two doses of BBIBP-CorV priming, some participants obtained immunological protection against BA.5 and BF.7 after receiving the ZF2001 booster. Breakthrough infection symptoms last longer in the infected elderly and pre-infection antibody titers were negatively associated with the severity of post-infection symptoms. The antibody levels in the elderly increased significantly after breakthrough infection but were still lower than those in the young. Our data suggest that multiple booster vaccinations at short intervals to maintain high antibody levels may be an effective strategy for protecting the elderly against COVID-19.
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MESH Headings
- Humans
- COVID-19/prevention & control
- COVID-19/immunology
- Female
- Male
- Aged
- COVID-19 Vaccines/immunology
- COVID-19 Vaccines/adverse effects
- COVID-19 Vaccines/administration & dosage
- SARS-CoV-2/immunology
- Prospective Studies
- Antibodies, Viral/immunology
- Antibodies, Viral/blood
- Vaccines, Inactivated/immunology
- Vaccines, Inactivated/adverse effects
- Vaccines, Inactivated/administration & dosage
- Antibodies, Neutralizing/immunology
- Antibodies, Neutralizing/blood
- Aged, 80 and over
- Adult
- Vaccination
- Longitudinal Studies
- Middle Aged
- Vaccines, Synthetic/immunology
- Vaccines, Synthetic/adverse effects
- Vaccines, Synthetic/administration & dosage
- Immunogenicity, Vaccine/immunology
- Immunization, Secondary
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Affiliation(s)
- Hong-Hong Liu
- Out-patient Department of Day Diagnosis and Treatment, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Yunbo Xie
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, 100039, China
- Chinese PLA Medical School, Chinese PLA General Hospital, Beijing, 100039, China
| | - Bao-Peng Yang
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, 100039, China
| | - Huan-Yue Wen
- Hunyuan County People's Hospital, Datong, 037499, Shanxi Province, China
| | - Peng-Hui Yang
- Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jin-E Lu
- Hunyuan County People's Hospital, Datong, 037499, Shanxi Province, China
| | - Yan Liu
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, 100039, China
| | - Xi Chen
- Out-patient Department of Day Diagnosis and Treatment, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Meng-Meng Qu
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, 100039, China
| | - Yang Zhang
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, 100039, China
| | - Wei-Guo Hong
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, 100039, China
| | - Yong-Gang Li
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, 100039, China
| | - Junliang Fu
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, 100039, China.
- Chinese PLA Medical School, Chinese PLA General Hospital, Beijing, 100039, China.
| | - Fu-Sheng Wang
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, 100039, China.
- Chinese PLA Medical School, Chinese PLA General Hospital, Beijing, 100039, China.
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Ramirez GA, Damanti S, Caruso PF, Mette F, Pagliula G, Cariddi A, Sartorelli S, Falbo E, Scotti R, Di Terlizzi G, Dagna L, Praderio L, Sabbadini MG, Bozzolo EP, Tresoldi M. Sustainability in Internal Medicine: A Year-Long Ward-Wide Observational Study. J Pers Med 2024; 14:115. [PMID: 38276237 PMCID: PMC10820757 DOI: 10.3390/jpm14010115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Population aging and multimorbidity challenge health system sustainability, but the role of assistance-related variables rather than individual pathophysiological factors in determining patient outcomes is unclear. To identify assistance-related determinants of sustainable hospital healthcare, all patients hospitalised in an Internal Medicine Unit (n = 1073) were enrolled in a prospective year-long observational study and split 2:1 into a training (n = 726) and a validation subset (n = 347). Demographics, comorbidities, provenance setting, estimates of complexity (cumulative illness rating scale, CIRS: total, comorbidity, CIRS-CI, and severity, CIRS-SI subscores) and intensity of care (nine equivalents of manpower score, NEMS) were analysed at individual and Unit levels along with variations in healthcare personnel as determinants of in-hospital mortality, length of stay and nosocomial infections. Advanced age, higher CIRS-SI, end-stage cancer, and the absence of immune-mediated diseases were correlated with higher mortality. Admission from nursing homes or intensive care units, dependency on activity of daily living, community- or hospital-acquired infections, oxygen support and the number of exits from the Unit along with patient/physician ratios were associated with prolonged hospitalisations. Upper gastrointestinal tract disorders, advanced age and higher CIRS-SI were associated with nosocomial infections. In addition to demographic variables and multimorbidity, physician number and assistance context affect hospitalisation outcomes and healthcare sustainability.
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Affiliation(s)
- Giuseppe A. Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Sarah Damanti
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Pier Francesco Caruso
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Francesca Mette
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Gaia Pagliula
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Adriana Cariddi
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Silvia Sartorelli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Elisabetta Falbo
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Raffaella Scotti
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Gaetano Di Terlizzi
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
| | - Luisa Praderio
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Maria Grazia Sabbadini
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Enrica P. Bozzolo
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
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Baron-Franco B, Ollero-Baturone M, Ternero-Vega JE, Nieto-Martín MD, Moreno-Gaviño L, Conde-Guzmán C, Gutiérrez-Rivero S, Rincón-Gómez M, Díaz-Jiménez P, Muñoz-Lopez JJ, Giménez-Miranda L, Fernández-Nieto C, Bernabeu-Wittel M. Survival Impact of an On-Site Medicalization Program in the Control of COVID-19 Outbreaks in 11 Nursing Homes. J Clin Med 2023; 12:6517. [PMID: 37892655 PMCID: PMC10607111 DOI: 10.3390/jcm12206517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/24/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The elderly admitted to nursing homes have especially suffered the havoc of the COVID-19 pandemic since most of them are not prepared to face such health problems. METHODS An innovative coordinated on-site medicalization program (MP) in response to a sizeable COVID-19 outbreak in three consecutive waves was deployed, sharing coordination and resources among primary care, the referral hospital, and the eleven residences. The objectives were providing the best possible medical care to residents in their environment, avoiding dehumanization and loneliness of hospital admission, and reducing the saturation of hospitals and the risk of spreading the infection. The main outcomes were a composite endpoint of survival or optimal palliative care (SOPC), survival, and referral to the hospital. RESULTS 587 of 1199 (49%) residents were infected, of whom 123 (21%) died. Patients diagnosed before the start of the MP presented SOPC, survival, and referrals to the hospital of 83%, 74%, and 22.4%, opposite to 96%, 84%, and 10.6% of patients diagnosed while the MP was set up. The SOPC was independently associated with an MP (OR 3.4 [1.6-7.2]). CONCLUSION During the COVID-19 outbreak, a coordinated MP successfully obtained a better rate of SOPC while simultaneously reducing the need for hospital admissions, combining optimal medical management with a more compassionate and humanistic approach in older people.
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Affiliation(s)
- Bosco Baron-Franco
- Internal Medicine Department, University Hospital Virgen del Rocío, 41013 Seville, Spain
| | - Manuel Ollero-Baturone
- Internal Medicine Department, University Hospital Virgen del Rocío, 41013 Seville, Spain
| | | | | | - Lourdes Moreno-Gaviño
- Internal Medicine Department, University Hospital Virgen del Rocío, 41013 Seville, Spain
| | | | - Sonia Gutiérrez-Rivero
- Internal Medicine Department, University Hospital Virgen del Rocío, 41013 Seville, Spain
| | - Manuel Rincón-Gómez
- Internal Medicine Department, University Hospital Virgen del Rocío, 41013 Seville, Spain
| | - Pablo Díaz-Jiménez
- Internal Medicine Department, University Hospital Virgen del Rocío, 41013 Seville, Spain
| | - Juan José Muñoz-Lopez
- Internal Medicine Department, Hospital Alta Resolución de Utrera, 41710 Seville, Spain
| | - Luis Giménez-Miranda
- Internal Medicine Department, University Hospital Virgen del Rocío, 41013 Seville, Spain
| | - Celia Fernández-Nieto
- Internal Medicine Department, University Hospital Virgen del Rocío, 41013 Seville, Spain
| | - Máximo Bernabeu-Wittel
- Internal Medicine Department, University Hospital Virgen del Rocío, 41013 Seville, Spain
- Department of Medicine, University of Seville, 41004 Seville, Spain
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4
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Ramos-Rincon JM, Lopez-Sampalo A, Cobos-Palacios L, Ricci M, Rubio-Rivas M, Díaz-Simón R, Martín-Escalante MD, Castañeda-Pérez S, Fernández-Madera-Martínez R, Beato-Perez JL, García-García GM, García-Andreu MDM, Arnalich-Fernandez F, Molinos-Castro S, Vargas-Núñez JA, Artero A, Freire-Castro SJ, Fernández-Gómez J, Cubo-Romano P, Hernández-Milián A, Inés-Revuelta SM, Boixeda R, Fernández-Pedregal E, Gómez-Huelgas R. Nosocomial COVID-19: A Nationwide Spanish Study. Gerontology 2023:1-13. [PMID: 36682355 PMCID: PMC9893008 DOI: 10.1159/000527711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 09/14/2022] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION SARS-CoV-2 is a highly contagious virus, and despite professionals' best efforts, nosocomial COVID-19 (NC) infections have been reported. This work aimed to describe differences in symptoms and outcomes between patients with NC and community-acquired COVID-19 (CAC) and to identify risk factors for severe outcomes among NC patients. METHODS This is a nationwide, retrospective, multicenter, observational study that analyzed patients hospitalized with confirmed COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry) from March 1, 2020, to April 30, 2021. NC was defined as patients admitted for non-COVID-19 diseases with a positive SARS-CoV-2 test on the fifth day of hospitalization or later. The primary outcome was 30-day in-hospital mortality (IHM). The secondary outcome was other COVID-19-related complications. A multivariable logistic regression analysis was performed. RESULTS Of the 23,219 patients hospitalized with COVID-19, 1,104 (4.8%) were NC. Compared to CAC patients, NC patients were older (median 76 vs. 69 years; p < 0.001), had more comorbidities (median Charlson Comorbidity Index 5 vs. 3; p < 0.001), were less symptomatic (p < 0.001), and had normal chest X-rays more frequently (30.8% vs. 12.5%, p < 0.001). After adjusting for sex, age, dependence, COVID-19 wave, and comorbidities, NC was associated with lower risk of moderate/severe acute respiratory distress syndrome (ARDS) (adjusted odds ratio [aOR]: 0.72; 95% confidence interval [CI]: 0.59-0.87; p < 0.001) and higher risk of acute heart failure (aOR: 1.40; 1.12-1.72; p = 0.003), sepsis (aOR: 1.73; 1.33-2.54; p < 0.001), and readmission (aOR: 1.35; 1.03-1.83; p = 0.028). NC was associated with a higher case fatality rate (39.1% vs. 19.2%) in all age groups. IHM was significantly higher among NC patients (aOR: 2.07; 1.81-2.68; p < 0.001). Risk factors for increased IHM in NC patients were age, moderate/severe dependence, malignancy, dyspnea, moderate/severe ARDS, multiple organ dysfunction syndrome, and shock; odynophagia was associated with lower IHM. CONCLUSIONS NC is associated with greater mortality and complications compared to CAC. Hospital strategies to prevent NC must be strengthened.
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Affiliation(s)
- Jose-Manuel Ramos-Rincon
- Clinical Medicine Department, Miguel Hernandez University of Elche, Alicante, Spain,*Jose-Manuel Ramos-Rincon,
| | - Almudena Lopez-Sampalo
- Internal Medicine Department, Regional University Hospital of Málaga and Biomedical Research Institute of Málaga (IBIMA), and University of Málaga (UMA), Málaga, Spain
| | - Lidia Cobos-Palacios
- Internal Medicine Department, Regional University Hospital of Málaga and Biomedical Research Institute of Málaga (IBIMA), and University of Málaga (UMA), Málaga, Spain
| | - Michele Ricci
- Internal Medicine Department, Regional University Hospital of Málaga and Biomedical Research Institute of Málaga (IBIMA), and University of Málaga (UMA), Málaga, Spain
| | - Manel Rubio-Rivas
- Internal Medicine Department, Bellvitge University Hospital–IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Raquel Díaz-Simón
- Internal Medicine Department, 12 Octubre University Hospital, Madrid, Spain
| | | | - Sabela Castañeda-Pérez
- Internal Medicine Department, Internal Medicine Department, Gregorio Marañon University Hospital, Madrid, Spain
| | | | | | | | | | | | - Sonia Molinos-Castro
- Internal Medicine Department, Santiago de Compostela Clinic Hospital, Santiago de Compostela, A Coruña, Spain
| | | | - Arturo Artero
- Internal Medicine Department, Dr. Peset University Hospital, Valencia, Spain
| | | | | | - Pilar Cubo-Romano
- Internal Medicine Department, Infanta Cristina University Hospital, Madrid, Spain
| | | | | | - Ramon Boixeda
- Internal Medicine Department, Mataró Hospital, Barcelona, Spain
| | | | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga and Biomedical Research Institute of Málaga (IBIMA), and University of Málaga (UMA), Málaga, Spain
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Radcliffe NJ, Lau L, Hack E, Huynh A, Puri A, Yao H, Wong A, Kohler S, Chua M, Amadoru S, Haywood C, Yates P. Site of care and factors associated with mortality in unvaccinated Australian aged care residents during COVID-19 outbreaks. Intern Med J 2022; 53:690-699. [PMID: 36008359 PMCID: PMC9539151 DOI: 10.1111/imj.15914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 08/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Residential InReach presents an alternative to hospital admission for aged care residents swabbed for COVID-19, though relative outcomes remain unknown. AIMS To compare rates and predictors of 28-day mortality for aged care residents seen by InReach with COVID-19, or 'suspected COVID-19' ('sCOVID'), including hospital vs InReach-based care. METHODS Prospective observational study of consecutive patients referred to a Victorian InReach service meeting COVID-19 testing criteria between April-October 2020 (pre-vaccine availability). COVID-19 was determined by positive polymerase chain reaction testing on nasopharyngeal swab. sCOVID-19 was defined as meeting symptomatic Victorian Government testing criteria but persistently swab negative. RESULTS There were no significant differences in age, gender, Clinical Frailty Score (CFS) or Charlson Comorbidity Index (CCI) between 152 patients with COVID-19 and 118 patients with sCOVID. 28-day mortality was similar between patients with COVID-19 (35/152, 23%) and sCOVID (32/118, 27%) (p=0.4). For the combined cohort, 28-day mortality was associated with initial oxygen saturation (p<0.001), delirium (p<0.001), hospital transfer for acuity (p=0.02; but not public health/facility reasons), CFS (p=0.04), prior ischaemic heart disease (p=0.01) and dementia (p=0.02). For COVID-19 patients, 28-day mortality was associated with initial oxygen saturation (p=0.02), delirium (p<0.001), and hospital transfer for acuity (p=0.01), but not public health/facility reasons. CONCLUSION Unvaccinated aged care residents meeting COVID-19 testing criteria seen by InReach during a pandemic experience high mortality rates, including with negative swab result. Residents remaining within-facility (with InReach) experienced similar adjusted mortality odds to residents transferred to hospital for public health/facility-based reasons, and lower than those transferred for clinical acuity. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Nicholas J Radcliffe
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Liza Lau
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Emma Hack
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Andrew Huynh
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia.,Florey Neuroscience Institute, Melbourne, Victoria, Australia
| | - Arvind Puri
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Henry Yao
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Aaron Wong
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia.,Melbourne Health, Parkville, Melbourne, Australia
| | - Sabrina Kohler
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Maggie Chua
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia.,Department of Aged Care, Northern Health, Melbourne, Victoria, Australia
| | - Sanka Amadoru
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Cilla Haywood
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia.,University of Melbourne, Department of Medicine, Austin Health, Melbourne, Victoria, Australia.,Department of Aged Care, Northern Health, Melbourne, Victoria, Australia
| | - Paul Yates
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia.,University of Melbourne, Department of Medicine, Austin Health, Melbourne, Victoria, Australia.,Florey Neuroscience Institute, Melbourne, Victoria, Australia
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6
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Zhang XS, Charland K, Quach C, Nguyen QD, Zinszer K. Institutional, therapeutic, and individual factors associated with 30-day mortality after COVID-19 diagnosis in Canadian long-term care facilities. J Am Geriatr Soc 2022; 70:3210-3220. [PMID: 35906882 PMCID: PMC9353371 DOI: 10.1111/jgs.17975] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022]
Abstract
Background Canadian long‐term care facility (LTCF) residents experienced higher death rates compared to other countries during the first wave of the COVID‐19 pandemic. This cohort study analyzes the individual, therapeutic, and institutional factors associated with death in LTCFs. Methods Institutional data for 17 LTCFs in Montreal, Canada were obtained from local administrative registries. Individual data for 1197 residents infected by SARS‐CoV‐2 between February 23 and July 11, 2020 were obtained through chart reviews. A multivariable modified Poisson regression model, which accounted for LTCF clustering, was used to identify resident and facility covariates associated with 30‐day mortality after COVID‐19 diagnosis. Results Severe shortage of licensed practical nurses (RR 2.60 95% CI 1.20–5.61) and medium‐sized facilities compared to smaller‐sized facilities (RR 2.73 95% CI 1.23–6.07) were associated with 30‐day mortality. Later COVID‐19 diagnosis (RR 0.98 95% CI 0.97–0.99 per additional day) was associated with survival. Individual risk factors for death included age (RR 1.33 95% CI 1.23–1.45 per additional 10 years), male sex (RR 1.46 95% CI 1.24–1.71), functional impairment (RR 1.08 95% CI 1.04–1.12 per unit increase of SMAF), as well as a diagnosis of congestive heart failure (RR 1.31 95% CI 1.04–1.66) and neurocognitive disorder (RR 1.31 95% CI 1.01–1.70). Among severe cases, anticoagulation was associated with survival (RR 0.70 95% CI 0.51–0.96). Conclusions This study identified practical nurse shortages and facility size as institutional risk factors for COVID‐19 death. Anticoagulation was associated with survival among severe cases.
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Affiliation(s)
- Xi Sophie Zhang
- Department of General Medicine, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada.,Department of Family and Emergency Medicine, University of Montreal, Montreal, Canada
| | | | - Caroline Quach
- Department of Microbiology, Infectious Disease, and Immunology, University of Montreal, Montreal, Canada.,Clinical Department of Laboratory Medicine, Centre hospitalier universitaire de Sainte-Justine (CHUSJ), Montreal, Canada
| | - Quoc Dinh Nguyen
- Department of Geriatric Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada.,Department of Medicine, University of Montreal, Montreal, Canada
| | - Kate Zinszer
- Centre de recherche en santé publique, Montreal, Canada.,Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada
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7
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Ramos-Rincon JM, Cobos-Palacios L, López-Sampalo A, Ricci M, Rubio-Rivas M, Nuñez-Rodriguez MV, Miranda-Godoy R, García-Leoni ME, Fernández-Madera-Martínez R, García-García GM, Beato-Perez JL, Monge-Monge D, Asín-Samper U, Bustamante-Vega M, Rábago-Lorite I, Freire-Castro SJ, Miramontes-González JP, Magallanes-Gamboa JO, Alcalá-Pedrajas JN, García-Gómez M, Cano-Llorente V, Carrasco-Sánchez FJ, Martinez-Carrilero J, Antón-Santos JM, Gómez-Huelgas R. Differences in clinical features and mortality in very old unvaccinated patients (≥ 80 years) hospitalized with COVID-19 during the first and successive waves from the multicenter SEMI-COVID-19 Registry (Spain). BMC Geriatr 2022; 22:546. [PMID: 35773622 PMCID: PMC9244878 DOI: 10.1186/s12877-022-03191-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/03/2022] [Indexed: 01/08/2023] Open
Abstract
Background Old age is one of the most important risk factors for severe COVID-19. Few studies have analyzed changes in the clinical characteristics and prognosis of COVID-19 among older adults before the availability of vaccines. This work analyzes differences in clinical features and mortality in unvaccinated very old adults during the first and successive COVID-19 waves in Spain. Methods This nationwide, multicenter, retrospective cohort study analyzes unvaccinated patients ≥ 80 years hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). Patients were classified according to whether they were admitted in the first wave (March 1-June 30, 2020) or successive waves (July 1-December 31, 2020). The endpoint was all-cause in-hospital mortality, expressed as the case fatality rate (CFR). Results Of the 21,461 patients hospitalized with COVID-19, 5,953 (27.7%) were ≥ 80 years (mean age [IQR]: 85.6 [82.3–89.2] years). Of them, 4,545 (76.3%) were admitted during the first wave and 1,408 (23.7%) during successive waves. Patients hospitalized in successive waves were older, had a greater Charlson Comorbidity Index and dependency, less cough and fever, and met fewer severity criteria at admission (qSOFA index, PO2/FiO2 ratio, inflammatory parameters). Significant differences were observed in treatments used in the first (greater use of antimalarials, lopinavir, and macrolides) and successive waves (greater use of corticosteroids, tocilizumab and remdesivir). In-hospital complications, especially acute respiratory distress syndrome and pneumonia, were less frequent in patients hospitalized in successive waves, except for heart failure. The CFR was significantly higher in the first wave (44.1% vs. 33.3%; -10.8%; p < 0.001) and was higher among patients ≥ 95 years (54.4% vs. 38.5%; -15.9%; p < 0.001). After adjustments to the model, the probability of death was 33% lower in successive waves (OR: 0.67; 95% CI: 0.57–0.79). Conclusions Mortality declined significantly between the first and successive waves in very old unvaccinated patients hospitalized with COVID-19 in Spain. This decline could be explained by a greater availability of hospital resources and more effective treatments as the pandemic progressed, although other factors such as changes in SARS-CoV-2 virulence cannot be ruled out. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03191-4.
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Affiliation(s)
- Jose-Manuel Ramos-Rincon
- Department of Clinical Medicine, Miguel Hernández University of Elche, Ctra N332 s/n, 03550, Sant Joan d'Alacant, Alicante, Spain.
| | - Lidia Cobos-Palacios
- Department of Internal Medicine, Instituto de Investigación Biomédica de Málaga (IBIMA), Regional University Hospital of Málaga & University of Málaga, Málaga, Spain
| | - Almudena López-Sampalo
- Department of Internal Medicine, Instituto de Investigación Biomédica de Málaga (IBIMA), Regional University Hospital of Málaga & University of Málaga, Málaga, Spain
| | - Michele Ricci
- Department of Internal Medicine, Instituto de Investigación Biomédica de Málaga (IBIMA), Regional University Hospital of Málaga & University of Málaga, Málaga, Spain
| | - Manel Rubio-Rivas
- Internal Medicine Department, Bellvitge University Hospital, , Barcelona, L'Hospitalet de Llobregat, Spain
| | | | | | | | | | | | | | | | - Uxua Asín-Samper
- Internal Medicine Department, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Isabel Rábago-Lorite
- Internal Medicine Department, Infanta Sofía University Hospital, S. S. de los Reyes, Madrid, Spain
| | | | | | | | | | - Miriam García-Gómez
- Internal Medicine Department, Alfredo Espinosa Hospital, Urduliz, Vizcaya, Spain
| | | | | | | | | | - Ricardo Gómez-Huelgas
- Department of Internal Medicine, Instituto de Investigación Biomédica de Málaga (IBIMA), Regional University Hospital of Málaga & University of Málaga, Málaga, Spain.,CIBER de Fisiopatología de La Obesidad Y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
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8
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Liang CK, Lee WJ, Peng LN, Meng LC, Hsiao FY, Chen LK. COVID-19 Vaccines in Older Adults: Challenges in Vaccine Development and Policy-Making. Clin Geriatr Med 2022; 38:605-620. [PMID: 35868676 PMCID: PMC8934735 DOI: 10.1016/j.cger.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Chih-Kuang Liang
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wei-Ju Lee
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yi-Lan, Taiwan
| | - Li-Ning Peng
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Lin-Chieh Meng
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University, Taipei, Taiwan
| | - Liang-Kung Chen
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), Taipei, Taiwan.
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9
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Nuevo-Ortega P, Reina-Artacho C, Dominguez-Moreno F, Becerra-Muñoz VM, Ruiz-Del-Fresno L, Estecha-Foncea MA. Prognosis of COVID-19 pneumonia can be early predicted combining Age-adjusted Charlson Comorbidity Index, CRB score and baseline oxygen saturation. Sci Rep 2022; 12:2367. [PMID: 35149742 PMCID: PMC8837655 DOI: 10.1038/s41598-022-06199-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 12/30/2021] [Indexed: 12/21/2022] Open
Abstract
In potentially severe diseases in general and COVID-19 in particular, it is vital to early identify those patients who are going to progress to severe disease. A recent living systematic review dedicated to predictive models in COVID-19, critically appraises 145 models, 8 of them focused on prediction of severe disease and 23 on mortality. Unfortunately, in all 145 models, they found a risk of bias significant enough to finally "not recommend any for clinical use". Authors suggest concentrating on avoiding biases in sampling and prioritising the study of already identified predictive factors, rather than the identification of new ones that are often dependent on the database. Our objective is to develop a model to predict which patients with COVID-19 pneumonia are at high risk of developing severe illness or dying, using basic and validated clinical tools. We studied a prospective cohort of consecutive patients admitted in a teaching hospital during the "first wave" of the COVID-19 pandemic. Follow-up to discharge from hospital. Multiple logistic regression selecting variables according to clinical and statistical criteria. 404 consecutive patients were evaluated, 392 (97%) completed follow-up. Mean age was 61 years; 59% were men. The median burden of comorbidity was 2 points in the Age-adjusted Charlson Comorbidity Index, CRB was abnormal in 18% of patients and basal oxygen saturation on admission lower than 90% in 18%. A model composed of Age-adjusted Charlson Comorbidity Index, CRB score and basal oxygen saturation can predict unfavorable evolution or death with an area under the ROC curve of 0.85 (95% CI 0.80-0.89), and 0.90 (95% CI 0.86 to 0.94), respectively. Prognosis of COVID-19 pneumonia can be predicted without laboratory tests using two classic clinical tools and a pocket pulse oximeter.
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Affiliation(s)
- Pilar Nuevo-Ortega
- Intensive Care Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain.
| | - Carmen Reina-Artacho
- Intensive Care Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Francisco Dominguez-Moreno
- Intensive Care Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Victor Manuel Becerra-Muñoz
- Intensive Care Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Ruiz-Del-Fresno
- Intensive Care Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Maria Antonia Estecha-Foncea
- Intensive Care Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
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10
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Zhang S, Yang Z, Li ZN, Chen ZL, Yue SJ, Fu RJ, Xu DQ, Zhang S, Tang YP. Are Older People Really More Susceptible to SARS-CoV-2? Aging Dis 2022; 13:1336-1347. [PMID: 36186126 PMCID: PMC9466979 DOI: 10.14336/ad.2022.0130] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/30/2022] [Indexed: 12/15/2022] Open
Abstract
Since the outbreak, COVID-19 has spread rapidly across the globe due to its high infectivity and lethality. Age appears to be one of the key factors influencing the status and progression of SARS-CoV-2 infection, as multiple reports indicated that the majority of COVID-19 infections and severe cases are elderly. Most people simply assume that the elderly are more susceptible to SARS-CoV-2 than the young, but the mechanism behind it is still open to question. The older and younger people are at similar risk of infection because their infection process is the same and they must be exposed to the virus first. However, whether they will get sick after exposure to the virus and how their disease progresses depend on their immune mechanisms. In older populations, inflammation and immune aging reduce their ability to resist SARS-CoV-2 infection. Meanwhile, under the influence of comorbidities, ACE2 receptor and various cytokines undergo corresponding changes, thus accelerating the entry, replication, and transmission of SARS-CoV-2 in the body, promoting disease progression, and leading to severe illness and even death. In addition, the relatively fragile mental state of the elderly can also affect their timely recovery from COVID-19. Therefore, once older people are infected with SARS-CoV-2, they are more prone to severe illness and death with a poor prognosis, and they should strengthen protection to avoid exposure to the virus.
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Affiliation(s)
- Shuo Zhang
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, and Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi’an, Shaanxi, China.
- School of Clinical Medicine (Guang’anmen Hospital), Beijing University of Chinese Medicine, Beijing, China.
| | - Zhen Yang
- School of Public Health, Shaanxi University of Chinese Medicine, Xi’an, Shaanxi, China.
| | - Zhuo-Ning Li
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, and Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi’an, Shaanxi, China.
| | - Zhen-Lin Chen
- International Programs Office, Shaanxi University of Chinese Medicine, Xi’an, Shaanxi, China.
- Correspondence should be addressed to: Dr. Zhen-Lin Chen, International Programs Office, Shaanxi University of Chinese Medicine, Xi’an, Shaanxi, China. ; Dr. Yu-Ping Tang, Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, Shaanxi University of Chinese Medicine, Xi’an, Shaanxi, China. .
| | - Shi-Jun Yue
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, and Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi’an, Shaanxi, China.
| | - Rui-Jia Fu
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, and Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi’an, Shaanxi, China.
| | - Ding-Qiao Xu
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, and Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi’an, Shaanxi, China.
| | - Sai Zhang
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, and Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi’an, Shaanxi, China.
| | - Yu-Ping Tang
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, and Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi’an, Shaanxi, China.
- Correspondence should be addressed to: Dr. Zhen-Lin Chen, International Programs Office, Shaanxi University of Chinese Medicine, Xi’an, Shaanxi, China. ; Dr. Yu-Ping Tang, Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, Shaanxi University of Chinese Medicine, Xi’an, Shaanxi, China. .
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11
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Axenhus M, Schedin-Weiss S, Winblad B, Wimo A. Changes in mortality trends amongst common diseases during the COVID-19 pandemic in Sweden. Scand J Public Health 2021; 50:748-755. [PMID: 34933630 PMCID: PMC9361422 DOI: 10.1177/14034948211064656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE It has been found that COVID-19 increases deaths within common diseases in countries that have implemented strict lockdowns. In order to elucidate the proper national response to a pandemic, the mortality rates within COVID-19 and various diseases need to be studied in countries whose pandemic response differ. Sweden represents a country with lax pandemic restrictions, and we aimed to study the effects of COVID-19 on historical mortality rates within common diseases during 2020. METHODS Regression models and moving averages were used to predict expected premature mortality per the ICD-10 during 2020 using historical data sets. Predicted values were then compared to recorded premature mortality to identify changes in mortality trends. RESULTS Seasonal increased mortality was found within neurological diseases. Infectious diseases, tumours and cardiac disease mortality rates decreased compared to expected outcome. CONCLUSIONS Changes in mortality trends were observed for several common diseases during the COVID-19 pandemic. Neurological and cardiac conditions, infections and tumours are examples of diseases that were heavily affected by the pandemic. The indirect effects of COVID-19 on certain patient populations should be considered when determining pandemic impact.
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Affiliation(s)
- Michael Axenhus
- Division of Neurogeriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.,Theme Inflammation and Aging, Karolinska University Hospital, Sweden
| | - Sophia Schedin-Weiss
- Division of Neurogeriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
| | - Bengt Winblad
- Division of Neurogeriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.,Theme Inflammation and Aging, Karolinska University Hospital, Sweden
| | - Anders Wimo
- Division of Neurogeriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.,Primary Care, Hudiksvall-Nordanstig, Sweden
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12
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van Dam PMEL, Zelis N, van Kuijk SMJ, Linkens AEMJH, Brüggemann RAG, Spaetgens B, van der Horst ICC, Stassen PM. Performance of prediction models for short-term outcome in COVID-19 patients in the emergency department: a retrospective study. Ann Med 2021; 53:402-409. [PMID: 33629918 PMCID: PMC7919920 DOI: 10.1080/07853890.2021.1891453] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/12/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) has a high burden on the healthcare system. Prediction models may assist in triaging patients. We aimed to assess the value of several prediction models in COVID-19 patients in the emergency department (ED). METHODS In this retrospective study, ED patients with COVID-19 were included. Prediction models were selected based on their feasibility. Primary outcome was 30-day mortality, secondary outcomes were 14-day mortality and a composite outcome of 30-day mortality and admission to medium care unit (MCU) or intensive care unit (ICU). The discriminatory performance of the prediction models was assessed using an area under the receiver operating characteristic curve (AUC). RESULTS We included 403 patients. Thirty-day mortality was 23.6%, 14-day mortality was 19.1%, 66 patients (16.4%) were admitted to ICU, 48 patients (11.9%) to MCU, and 152 patients (37.7%) met the composite endpoint. Eleven prediction models were included. The RISE UP score and 4 C mortality scores showed very good discriminatory performance for 30-day mortality (AUC 0.83 and 0.84, 95% CI 0.79-0.88 for both), significantly higher than that of the other models. CONCLUSION The RISE UP score and 4 C mortality score can be used to recognise patients at high risk for poor outcome and may assist in guiding decision-making and allocating resources.
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Affiliation(s)
- Paul M. E. L. van Dam
- Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Noortje Zelis
- Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sander M. J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Aimée E. M. J. H. Linkens
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Renée A. G. Brüggemann
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bart Spaetgens
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Iwan C. C. van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Patricia M. Stassen
- Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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13
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Kamle S, Ma B, He CH, Akosman B, Zhou Y, Lee CM, El-Deiry WS, Huntington K, Liang O, Machan JT, Kang MJ, Shin HJ, Mizoguchi E, Lee CG, Elias JA. Chitinase 3-like-1 is a therapeutic target that mediates the effects of aging in COVID-19. JCI Insight 2021; 6:e148749. [PMID: 34747367 PMCID: PMC8663553 DOI: 10.1172/jci.insight.148749] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 09/29/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 is caused by SARS-CoV-2 (SC2) and is more prevalent and severe in elderly and patients with comorbid diseases (CM). Because chitinase 3-like-1 (CHI3L1) is induced during aging and CM, the relationships between CHI3L1 and SC2 were investigated. Here, we demonstrate that CHI3L1 is a potent stimulator of the SC2 receptor angiotensin converting enzyme 2 (ACE2) and viral spike protein priming proteases (SPP), that ACE2 and SPP are induced during aging, and that anti-CHI3L1, kasugamycin, and inhibitors of phosphorylation abrogate these ACE2- and SPP-inductive events. Human studies also demonstrate that the levels of circulating CHI3L1 are increased in the elderly and patients with CM, where they correlate with COVID-19 severity. These studies demonstrate that CHI3L1 is a potent stimulator of ACE2 and SPP, that this induction is a major mechanism contributing to the effects of aging during SC2 infection, and that CHI3L1 co-opts the CHI3L1 axis to augment SC2 infection. CHI3L1 plays a critical role in the pathogenesis of and is an attractive therapeutic target in COVID-19.
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Affiliation(s)
| | - Bing Ma
- Molecular Microbiology and Immunology
| | | | | | - Yang Zhou
- Molecular Microbiology and Immunology
| | | | - Wafik S. El-Deiry
- Pathology and Laboratory Medicine
- Hematology-Oncology Division, Department of Medicine
- The Joint Program in Cancer Biology
- Cancer Center at Brown University, and
| | - Kelsey Huntington
- Pathology and Laboratory Medicine
- Hematology-Oncology Division, Department of Medicine
- The Joint Program in Cancer Biology
- Cancer Center at Brown University, and
| | - Olin Liang
- Hematology-Oncology Division, Department of Medicine
- The Joint Program in Cancer Biology
- Cancer Center at Brown University, and
| | - Jason T. Machan
- Department of Biostatistics, Lifespan Health System, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Min-Jong Kang
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Hyeon Jun Shin
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Emiko Mizoguchi
- Molecular Microbiology and Immunology
- Department of Immunology, Kurume University, School of Medicine, Kurume, Fukuoka, Japan
| | | | - Jack A. Elias
- Molecular Microbiology and Immunology
- The Joint Program in Cancer Biology
- Cancer Center at Brown University, and
- Department of Medicine, Brown University, Providence, Rhode Island, USA
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14
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Ramos-Rincón JM, Bernabeu-Whittel M, Fiteni-Mera I, López-Sampalo A, López-Ríos C, García-Andreu MDM, Mancebo-Sevilla JJ, Jiménez-Juan C, Matía-Sanz M, López-Quirantes P, Rubio-Rivas M, Paredes-Ruiz D, González-San-Narciso C, González-Vega R, Sanz-Espinosa P, Hernández-Milián A, Gonzalez-Noya A, Gil-Sánchez R, Boixeda R, Alcalá-Pedrajas JN, Palop-Cervera M, Cortés-Rodríguez B, Guisado-Espartero ME, Mella-Pérez C, Gómez-Huelgas R. Clinical features and risk factors for mortality among long-term care facility residents hospitalized due to COVID-19 in Spain. J Gerontol A Biol Sci Med Sci 2021; 77:e138-e147. [PMID: 34626477 DOI: 10.1093/gerona/glab305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 severely impacted older adults and long-term care facility (LTCF) residents. Our primary aim was to describe differences in clinical and epidemiological variables, in-hospital management, and outcomes between LTCF residents and community-dwelling older adults hospitalized with COVID-19. The secondary aim was to identify risk factors for mortality due to COVID-19 in hospitalized LTCF residents. METHODS This is a cross-sectional analysis within a retrospective cohort of hospitalized patients≥75 years with confirmed COVID-19 admitted to 160 Spanish hospitals. Differences between groups and factors associated with mortality among LTCF residents were assessed through comparisons and logistic regression analysis. RESULTS Of 6,189 patients≥75 years, 1,185 (19.1%) were LTCF residents and 4,548 (73.5%) were community-dwelling. LTCF residents were older (median: 87.4 vs. 82.1 years), mostly female (61.6% vs. 43.2%), had more severe functional dependence (47.0% vs 7.8%), more comorbidities (Charlson Comorbidity Index: 6 vs 5), had dementia more often (59.1% vs. 14.4%), and had shorter duration of symptoms (median: 3 vs 6 days) than community-dwelling patients (all, p<.001). Mortality risk factors in LTCF residents were severe functional dependence (aOR:1.79;95%CI:1.13-2.83;p=.012), dyspnea (1.66;1.16-2.39;p=.004), SatO2<94% (1.73;1.27-2.37;p=.001), temperature≥37.8ºC (1.62;1.11-2.38; p=.013); qSOFA index≥2 (1.62;1.11-2.38;p=.013), bilateral infiltrates (1.98;1.24-2.98;p<.001), and high C-reactive protein (1.005;1.003-1.007;p<.001). In-hospital mortality was initially higher among LTCF residents (43.3% vs 39.7%), but lower after adjusting for sex, age, functional dependence, and comorbidities (aOR:0.74,95%CI:0.62-0.87;p<.001). CONCLUSION Basal functional status and COVID-19 severity are risk factors of mortality in LTCF residents. The lower adjusted mortality rate in LTCF residents may be explained by earlier identification, treatment, and hospitalization for COVID-19.
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Affiliation(s)
| | - Máximo Bernabeu-Whittel
- Internal Medicine Department. Virgen del Rocío University Hospital, Seville, Spain.,Medicine Department, University of Seville, Sevilla, Spain
| | | | - Almudena López-Sampalo
- Internal Medicine Department. Málaga Regional University Hospital- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Carmen López-Ríos
- Internal Medicine Department. Virgen del Rocío University Hospital, Seville, Spain
| | | | - Juan-José Mancebo-Sevilla
- Internal Medicine Department. Málaga Regional University Hospital- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Carlos Jiménez-Juan
- Internal Medicine Department. Virgen del Rocío University Hospital, Seville, Spain
| | - Marta Matía-Sanz
- Internal Medicine Department, Royo Villanova Hospital, Zaragoza, Spain
| | - Pablo López-Quirantes
- Internal Medicine Department. Málaga Regional University Hospital- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Manuel Rubio-Rivas
- Internal Medicine Department. Bellvitge University Hospital- -IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Diana Paredes-Ruiz
- Internal Medicine Department. 12 Octubre University Hospital, Madrid, Spain
| | | | - Rocío González-Vega
- Internal Medicine Department, Costa del Sol Hospital, Marbella (Malaga), Spain
| | - Pablo Sanz-Espinosa
- Internal Medicine Department. Rio Hortega University Hospital, Valladolid, Spain
| | | | - Amara Gonzalez-Noya
- Internal Medicine Department, Ourense University Hospital Complex, Ourense, Spain
| | | | - Ramon Boixeda
- Internal Medicine Department. Mataró Hospital, Mataró (Barcelona), Spain
| | | | - Marta Palop-Cervera
- Internal Medicine Department. Sagunto University Hospital, Sagunto (Valencia), Spain
| | | | | | - Carmen Mella-Pérez
- Internal Medicine Department, Ferrol University Hospital Complex, (Ferrol) A Coruna, Spain
| | - Ricardo Gómez-Huelgas
- Internal Medicine Department. Málaga Regional University Hospital- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain.,Medicine Department, University of Malaga, Malaga, Spain
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15
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Burgaña Agoües A, Serra Gallego M, Hernández Resa R, Joven Llorente B, Lloret Arabi M, Ortiz Rodriguez J, Puig Acebal H, Campos Hernández M, Caballero Ayala I, Pavón Calero P, Losilla Calle M, Bueno Nieto R, Oliver Messeguer L, Madridejos Mora R, Abellana Sangrà R, Perez-Porcuna TM. Risk Factors for COVID-19 Morbidity and Mortality in Institutionalised Elderly People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910221. [PMID: 34639522 PMCID: PMC8507792 DOI: 10.3390/ijerph181910221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/13/2021] [Accepted: 09/22/2021] [Indexed: 12/16/2022]
Abstract
Background: SARS-CoV-2 has caused a high mortality in institutionalised individuals. There are very few studies on the involvement and the real impact of COVID-19 in nursing homes. This study analysed factors related to morbidity and mortality of COVID-19 in institutionalised elderly people. Methods: This cohort study included 842 individuals from 12 nursing homes in Sant Cugat del Vallès (Spain) from 15 March to 15 May 2020. We evaluated individual factors (demographic, dependence, clinical, and therapeutic) and those related to the nursing homes (size and staff) associated with infection and mortality by SARS-CoV-2. Infection was diagnosed by molecular biology test. Results: Of the 842 residents included in the analysis, 784 underwent a Polymerase Chain Reaction (PCR) test; 74.2% were women, the mean age was 87.1 years, and 11.1% died. The PCR test was positive in 44%. A total of 33.4% of the residents presented symptoms compatible with COVID-19 and of these, 80.9% were PCR-positive for SARS-CoV-2. Infection by SARS-CoV-2 among residents was associated with the rate of staff infected in the homes. Mortality by SARS-CoV-2 was related to male sex and a greater grade of dependence measured with the Barthel index. Conclusions: SARS-Cov-2 infection in institutionalised people is associated with the infection rate in nursing home workers and mortality by SARS-Cov-2 with sex and greater dependency according to the Barthel index. Adequate management of nursing home staff and special attention to measures of infection control, especially of individuals with greater dependence, are keys for successful management of future pandemic situations.
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Affiliation(s)
- Ander Burgaña Agoües
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Marta Serra Gallego
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Raquel Hernández Resa
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Beatriz Joven Llorente
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Maria Lloret Arabi
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Jessica Ortiz Rodriguez
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Helena Puig Acebal
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Mireia Campos Hernández
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Itziar Caballero Ayala
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Pedro Pavón Calero
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Montserrat Losilla Calle
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Rosario Bueno Nieto
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Laura Oliver Messeguer
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Rosa Madridejos Mora
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Rosa Abellana Sangrà
- Departament Fonaments Clínics, Universitat de Barcelona, 08036 Barcelona, Spain
- Correspondence:
| | - Tomás M. Perez-Porcuna
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
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16
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Wood SN, Wit EC. Was R < 1 before the English lockdowns? On modelling mechanistic detail, causality and inference about Covid-19. PLoS One 2021; 16:e0257455. [PMID: 34550990 PMCID: PMC8457481 DOI: 10.1371/journal.pone.0257455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/01/2021] [Indexed: 12/15/2022] Open
Abstract
Detail is a double edged sword in epidemiological modelling. The inclusion of mechanistic detail in models of highly complex systems has the potential to increase realism, but it also increases the number of modelling assumptions, which become harder to check as their possible interactions multiply. In a major study of the Covid-19 epidemic in England, Knock et al. (2020) fit an age structured SEIR model with added health service compartments to data on deaths, hospitalization and test results from Covid-19 in seven English regions for the period March to December 2020. The simplest version of the model has 684 states per region. One main conclusion is that only full lockdowns brought the pathogen reproduction number, R, below one, with R ≫ 1 in all regions on the eve of March 2020 lockdown. We critically evaluate the Knock et al. epidemiological model, and the semi-causal conclusions made using it, based on an independent reimplementation of the model designed to allow relaxation of some of its strong assumptions. In particular, Knock et al. model the effect on transmission of both non-pharmaceutical interventions and other effects, such as weather, using a piecewise linear function, b(t), with 12 breakpoints at selected government announcement or intervention dates. We replace this representation by a smoothing spline with time varying smoothness, thereby allowing the form of b(t) to be substantially more data driven, and we check that the corresponding smoothness assumption is not driving our results. We also reset the mean incubation time and time from first symptoms to hospitalisation, used in the model, to values implied by the papers cited by Knock et al. as the source of these quantities. We conclude that there is no sound basis for using the Knock et al. model and their analysis to make counterfactual statements about the number of deaths that would have occurred with different lockdown timings. However, if fits of this epidemiological model structure are viewed as a reasonable basis for inference about the time course of incidence and R, then without very strong modelling assumptions, the pathogen reproduction number was probably below one, and incidence in substantial decline, some days before either of the first two English national lockdowns. This result coincides with that obtained by more direct attempts to reconstruct incidence. Of course it does not imply that lockdowns had no effect, but it does suggest that other non-pharmaceutical interventions (NPIs) may have been much more effective than Knock et al. imply, and that full lockdowns were probably not the cause of R dropping below one.
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Affiliation(s)
- Simon N. Wood
- School of Mathematics, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
| | - Ernst C. Wit
- Institute of Computing, Università della Svizzera italiana, Lugano, Switzerland
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17
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Domènech-Montoliu S, Pac-Sa MR, Vidal-Utrillas P, Latorre-Poveda M, Del Rio-González A, Ferrando-Rubert S, Ferrer-Abad G, Sánchez-Urbano M, Aparisi-Esteve L, Badenes-Marques G, Cervera-Ferrer B, Clerig-Arnau U, Dols-Bernad C, Fontal-Carcel M, Gomez-Lanas L, Jovani-Sales D, León-Domingo MC, Llopico-Vilanova MD, Moros-Blasco M, Notari-Rodríguez C, Ruíz-Puig R, Valls-López S, Arnedo-Pena A. "Mass gathering events and COVID-19 transmission in Borriana (Spain): A retrospective cohort study". PLoS One 2021; 16:e0256747. [PMID: 34437628 PMCID: PMC8389516 DOI: 10.1371/journal.pone.0256747] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/13/2021] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Mass gathering events (MGEs) are associated with the transmission of COVID-19. Between 6 and 10 March 2020, several MGEs related to the Falles festival took place in Borriana, a municipality in the province of Castellon (Spain). The aim of this study was to estimate the incidence of COVID-19 and its association with these MGEs, and to quantify the potential risk factors of its occurrence. METHODS During May and June 2020, a population-based retrospective cohort study was carried out by the Public Health Center of Castelló and the Hospital de la Plana in Vila-real. Participants were obtained from a representative sample of 1663 people with potential exposure at six MGEs. A questionnaire survey was carried out to obtain information about attendance at MGEs and COVID-19 disease. In addition, a serologic survey of antibodies against SARS-Cov-2 was implemented. Inverse probability weighted regression was used in the statistical analysis. RESULTS A total of 1338 subjects participated in the questionnaire survey (80.5%), 997 of whom undertook the serologic survey. Five hundred and seventy cases were observed with an attack rate (AR) of 42.6%; average age was 36 years, 62.3% were female, 536 cases were confirmed by laboratory tests, and 514 cases were found with SARS-CoV-2 total antibodies. Considering MGE exposure, AR was 39.2% (496/1264). A dose-response relationship was found between MGE attendance and the disease, (adjusted relative risk [aRR] = 4.11 95% confidence interval [CI]3.25-5.19). Two MGEs with a dinner and dance in the same building had higher risks. Associated risk factors with the incidence were older age, obesity, and upper and middle class versus lower class; current smoking was protective. CONCLUSIONS The study suggests the significance of MGEs in the COVID-19 transmission that could explain the subsequent outbreak in Borriana.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lorna Gomez-Lanas
- Emergency Service, Hospital de la Plana, Vila-real, Castellon, Spain
| | | | | | | | | | | | - Raquel Ruíz-Puig
- Emergency Service, Hospital de la Plana, Vila-real, Castellon, Spain
| | - Sonia Valls-López
- Emergency Service, Hospital de la Plana, Vila-real, Castellon, Spain
| | - Alberto Arnedo-Pena
- Public Health Center, Castelló de la Plana, Castellon, Spain
- Department of Health Science, Public University Navarra, Pamplona, Spain
- Epidemiology and Public Health (CIBERESP), Madrid, Spain
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18
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Lee DS, Ma S, Chu A, Wang CX, Wang X, Austin PC, McAlister FA, Kalmady SV, Kapral MK, Kaul P, Ko DT, Rochon PA, Schull MJ, Rubin BB, Wang B. Predictors of mortality among long-term care residents with SARS-CoV-2 infection. J Am Geriatr Soc 2021; 69:3377-3388. [PMID: 34409590 DOI: 10.1111/jgs.17425] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/03/2021] [Accepted: 08/08/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND While individuals living in long-term care (LTC) homes have experienced adverse outcomes of SARS-CoV-2 infection, few studies have examined a broad range of predictors of 30-day mortality in this population. METHODS We studied residents living in LTC homes in Ontario, Canada, who underwent PCR testing for SARS-CoV-2 infection from January 1 to August 31, 2020, and examined predictors of all-cause death within 30 days after a positive test for SARS-CoV-2. We examined a broad range of risk factor categories including demographics, comorbidities, functional status, laboratory tests, and characteristics of the LTC facility and surrounding community were examined. In total, 304 potential predictors were evaluated for their association with mortality using machine learning (Random Forest). RESULTS A total of 64,733 residents of LTC, median age 86 (78, 91) years (31.8% men), underwent SARS-CoV-2 testing, of whom 5029 (7.8%) tested positive. Thirty-day mortality rates were 28.7% (1442 deaths) after a positive test. Of 59,702 residents who tested negative, 2652 (4.4%) died within 30 days of testing. Predictors of mortality after SARS-CoV-2 infection included age, functional status (e.g., activity of daily living score and pressure ulcer risk), male sex, undernutrition, dehydration risk, prior hospital contacts for respiratory illness, and duration of comorbidities (e.g., heart failure, COPD). Lower GFR, hemoglobin concentration, lymphocyte count, and serum albumin were associated with higher mortality. After combining all covariates to generate a risk index, mortality rate in the highest risk quartile was 48.3% compared with 7% in the first quartile (odds ratio 12.42, 95%CI: 6.67, 22.80, p < 0.001). Deaths continued to increase rapidly for 15 days after the positive test. CONCLUSIONS LTC residents, particularly those with reduced functional status, comorbidities, and abnormalities on routine laboratory tests, are at high risk for mortality after SARS-CoV-2 infection. Recognizing high-risk residents in LTC may enhance institution of appropriate preventative measures.
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Affiliation(s)
- Douglas S Lee
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada.,Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.,Ted Rogers Centre for Heart Research, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Shihao Ma
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada.,Department of Computer Science, University of Toronto, Toronto, Canada.,Vector Institute of Artificial Intelligence, University of Toronto, Toronto, Canada
| | - Anna Chu
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Chloe X Wang
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada
| | - Xuesong Wang
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada
| | - Peter C Austin
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada
| | - Finlay A McAlister
- Alberta SPOR Unit, University of Alberta, Edmonton, Canada.,Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada.,Department of Medicine, University of Alberta, Edmonton, Canada
| | - Sunil V Kalmady
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
| | - Moira K Kapral
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of General Internal Medicine, University of Toronto, Toronto, Canada
| | - Padma Kaul
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada.,Department of Medicine, University of Alberta, Edmonton, Canada
| | - Dennis T Ko
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Paula A Rochon
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada.,Women's College Hospital, Toronto, Canada
| | - Michael J Schull
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Barry B Rubin
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Vascular Surgery, University Health Network, Toronto, Canada
| | - Bo Wang
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada.,Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.,Department of Computer Science, University of Toronto, Toronto, Canada.,Vector Institute of Artificial Intelligence, University of Toronto, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
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19
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Knock ES, Whittles LK, Lees JA, Perez-Guzman PN, Verity R, FitzJohn RG, Gaythorpe KAM, Imai N, Hinsley W, Okell LC, Rosello A, Kantas N, Walters CE, Bhatia S, Watson OJ, Whittaker C, Cattarino L, Boonyasiri A, Djaafara BA, Fraser K, Fu H, Wang H, Xi X, Donnelly CA, Jauneikaite E, Laydon DJ, White PJ, Ghani AC, Ferguson NM, Cori A, Baguelin M. Key epidemiological drivers and impact of interventions in the 2020 SARS-CoV-2 epidemic in England. Sci Transl Med 2021. [PMID: 34158411 DOI: 10.25561/85146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
We fitted a model of SARS-CoV-2 transmission in care homes and the community to regional surveillance data for England. Compared with other approaches, our model provides a synthesis of multiple surveillance data streams into a single coherent modeling framework, allowing transmission and severity to be disentangled from features of the surveillance system. Of the control measures implemented, only national lockdown brought the reproduction number (Rt eff) below 1 consistently; if introduced 1 week earlier, it could have reduced deaths in the first wave from an estimated 48,600 to 25,600 [95% credible interval (CrI): 15,900 to 38,400]. The infection fatality ratio decreased from 1.00% (95% CrI: 0.85 to 1.21%) to 0.79% (95% CrI: 0.63 to 0.99%), suggesting improved clinical care. The infection fatality ratio was higher in the elderly residing in care homes (23.3%, 95% CrI: 14.7 to 35.2%) than those residing in the community (7.9%, 95% CrI: 5.9 to 10.3%). On 2 December 2020, England was still far from herd immunity, with regional cumulative infection incidence between 7.6% (95% CrI: 5.4 to 10.2%) and 22.3% (95% CrI: 19.4 to 25.4%) of the population. Therefore, any vaccination campaign will need to achieve high coverage and a high degree of protection in vaccinated individuals to allow nonpharmaceutical interventions to be lifted without a resurgence of transmission.
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Affiliation(s)
- Edward S Knock
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Modelling and Health Economics, London, UK
| | - Lilith K Whittles
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Modelling and Health Economics, London, UK
- Modelling and Economics Unit, National Infection Service, Public Health England, London NW9 5EQ, UK
| | - John A Lees
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Pablo N Perez-Guzman
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Robert Verity
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Richard G FitzJohn
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Katy A M Gaythorpe
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Natsuko Imai
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Wes Hinsley
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Lucy C Okell
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Alicia Rosello
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Nikolas Kantas
- Faculty of Natural Sciences, Department of Mathematics, Imperial College London, London SW7 2BX, UK
| | - Caroline E Walters
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Sangeeta Bhatia
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Oliver J Watson
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Charlie Whittaker
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Lorenzo Cattarino
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Adhiratha Boonyasiri
- Department of Infectious Disease, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Bimandra A Djaafara
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Keith Fraser
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Han Fu
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Haowei Wang
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Xiaoyue Xi
- Faculty of Natural Sciences, Department of Mathematics, Imperial College London, London SW7 2BX, UK
| | - Christl A Donnelly
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
- Department of Statistics, University of Oxford, Oxford OX1 3LB, UK
- NIHR HPRU in Emerging and Zoonotic Infections, Liverpool, UK
| | - Elita Jauneikaite
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Daniel J Laydon
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Peter J White
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Modelling and Health Economics, London, UK
- Modelling and Economics Unit, National Infection Service, Public Health England, London NW9 5EQ, UK
| | - Azra C Ghani
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Neil M Ferguson
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK.
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Modelling and Health Economics, London, UK
| | - Anne Cori
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Modelling and Health Economics, London, UK
| | - Marc Baguelin
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK.
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Modelling and Health Economics, London, UK
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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20
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Knock ES, Whittles LK, Lees JA, Perez-Guzman PN, Verity R, FitzJohn RG, Gaythorpe KAM, Imai N, Hinsley W, Okell LC, Rosello A, Kantas N, Walters CE, Bhatia S, Watson OJ, Whittaker C, Cattarino L, Boonyasiri A, Djaafara BA, Fraser K, Fu H, Wang H, Xi X, Donnelly CA, Jauneikaite E, Laydon DJ, White PJ, Ghani AC, Ferguson NM, Cori A, Baguelin M. Key epidemiological drivers and impact of interventions in the 2020 SARS-CoV-2 epidemic in England. Sci Transl Med 2021; 13:eabg4262. [PMID: 34158411 PMCID: PMC8432953 DOI: 10.1126/scitranslmed.abg4262] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/14/2021] [Accepted: 06/16/2021] [Indexed: 01/06/2023]
Abstract
We fitted a model of SARS-CoV-2 transmission in care homes and the community to regional surveillance data for England. Compared with other approaches, our model provides a synthesis of multiple surveillance data streams into a single coherent modeling framework, allowing transmission and severity to be disentangled from features of the surveillance system. Of the control measures implemented, only national lockdown brought the reproduction number (Rt eff) below 1 consistently; if introduced 1 week earlier, it could have reduced deaths in the first wave from an estimated 48,600 to 25,600 [95% credible interval (CrI): 15,900 to 38,400]. The infection fatality ratio decreased from 1.00% (95% CrI: 0.85 to 1.21%) to 0.79% (95% CrI: 0.63 to 0.99%), suggesting improved clinical care. The infection fatality ratio was higher in the elderly residing in care homes (23.3%, 95% CrI: 14.7 to 35.2%) than those residing in the community (7.9%, 95% CrI: 5.9 to 10.3%). On 2 December 2020, England was still far from herd immunity, with regional cumulative infection incidence between 7.6% (95% CrI: 5.4 to 10.2%) and 22.3% (95% CrI: 19.4 to 25.4%) of the population. Therefore, any vaccination campaign will need to achieve high coverage and a high degree of protection in vaccinated individuals to allow nonpharmaceutical interventions to be lifted without a resurgence of transmission.
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Affiliation(s)
- Edward S Knock
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Modelling and Health Economics, London, UK
| | - Lilith K Whittles
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Modelling and Health Economics, London, UK
- Modelling and Economics Unit, National Infection Service, Public Health England, London NW9 5EQ, UK
| | - John A Lees
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Pablo N Perez-Guzman
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Robert Verity
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Richard G FitzJohn
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Katy A M Gaythorpe
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Natsuko Imai
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Wes Hinsley
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Lucy C Okell
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Alicia Rosello
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Nikolas Kantas
- Faculty of Natural Sciences, Department of Mathematics, Imperial College London, London SW7 2BX, UK
| | - Caroline E Walters
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Sangeeta Bhatia
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Oliver J Watson
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Charlie Whittaker
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Lorenzo Cattarino
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Adhiratha Boonyasiri
- Department of Infectious Disease, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Bimandra A Djaafara
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Keith Fraser
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Han Fu
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Haowei Wang
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Xiaoyue Xi
- Faculty of Natural Sciences, Department of Mathematics, Imperial College London, London SW7 2BX, UK
| | - Christl A Donnelly
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
- Department of Statistics, University of Oxford, Oxford OX1 3LB, UK
- NIHR HPRU in Emerging and Zoonotic Infections, Liverpool, UK
| | - Elita Jauneikaite
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Daniel J Laydon
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Peter J White
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Modelling and Health Economics, London, UK
- Modelling and Economics Unit, National Infection Service, Public Health England, London NW9 5EQ, UK
| | - Azra C Ghani
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
| | - Neil M Ferguson
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK.
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Modelling and Health Economics, London, UK
| | - Anne Cori
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Modelling and Health Economics, London, UK
| | - Marc Baguelin
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK.
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Modelling and Health Economics, London, UK
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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21
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Mercatelli D, Pedace E, Veltri P, Giorgi FM, Guzzi PH. Exploiting the molecular basis of age and gender differences in outcomes of SARS-CoV-2 infections. Comput Struct Biotechnol J 2021; 19:4092-4100. [PMID: 34306570 PMCID: PMC8271029 DOI: 10.1016/j.csbj.2021.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 12/15/2022] Open
Abstract
Motivation: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (coronavirus disease, 2019; COVID-19) is associated with adverse outcomes in patients. It has been observed that lethality seems to be related to the age of patients. While ageing has been extensively demonstrated to be accompanied by some modifications at the gene expression level, a possible link with COVID-19 manifestation still need to be investigated at the molecular level. Objectives: This study aims to shed out light on a possible link between the increased COVID-19 lethality and the molecular changes that occur in elderly people. Methods: We considered public datasets of ageing-related genes and their expression at the tissue level. We selected human proteins interacting with viral ones that are known to be related to the ageing process. Finally, we investigated changes in the expression level of coding genes at the tissue, gender and age level. Results: We observed a significant intersection between some SARS-CoV-2 interactors and ageing-related genes, suggesting that those genes are particularly affected by COVID-19 infection. Our analysis evidenced that virus infection particularly involves ageing molecular mechanisms centred around proteins EEF2, NPM1, HMGA1, HMGA2, APEX1, CHEK1, PRKDC, and GPX4. We found that HMGA1 and NPM1 have different expressions in the lung of males, while HMGA1, APEX1, CHEK1, EEF2, and NPM1 present changes in expression in males due to ageing effects. Conclusion: Our study generated a mechanistic framework to clarify the correlation between COVID-19 incidence in elderly patients and molecular mechanisms of ageing. We also provide testable hypotheses for future investigation and pharmacological solutions tailored to specific age ranges.
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Affiliation(s)
| | | | - Pierangelo Veltri
- University of Catanzaro, Department of Medical and Surgical Sciences, Italy
| | | | - Pietro Hiram Guzzi
- University of Catanzaro, Department of Medical and Surgical Sciences, Italy
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22
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Riccioni L, Ingravallo F, Grasselli G, Mazzon D, Cingolani E, Forti G, Zagrebelsky V, Zoja R, Petrini F. The Italian document: decisions for intensive care when there is an imbalance between care needs and resources during the COVID-19 pandemic. Ann Intensive Care 2021; 11:100. [PMID: 34189634 PMCID: PMC8241202 DOI: 10.1186/s13613-021-00888-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/16/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In early 2020, the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) published clinical ethics recommendations for the allocation of intensive care during COVID-19 pandemic emergency. Later the Italian National Institute of Health (ISS) invited SIAARTI and the Italian Society of Legal and Insurance Medicine to prepare a draft document for the definition of triage criteria for intensive care during the emergency, to be implemented in case of complete saturation of care resources. METHODS Following formal methods, including two Delphi rounds, a multidisciplinary group with expertise in intensive care, legal medicine and law developed 12 statements addressing: (1) principles and responsibilities; (2) triage; (3) previously expressed wishes; (4) reassessment and shifting to palliative care; (5) collegiality and transparency of decisions. The draft of the statements, with their explanatory comments, underwent a public consultation opened to Italian scientific or technical-professional societies and other stakeholders (i.e., associations of citizens, patients and caregivers; religious communities; industry; public institutions; universities and research institutes). Individual healthcare providers, lay people, or other associations could address their comments by e-mail. RESULTS Eight stakeholders (including scientific societies, ethics organizations, and a religious community), and 8 individuals (including medical experts, ethicists and an association) participated to the public consultation. The stakeholders' agreement with statements was on average very high (ranging from 4.1 to 4.9, on a scale from 1-full disagreement to 5-full agreement). The 4 statements concerning triage stated that in case of saturation of care resources, the intensive care triage had to be oriented to ensuring life-sustaining treatments to as many patients as possible who could benefit from them. The decision should follow full assessment of each patient, taking into account comorbidities, previous functional status and frailty, current clinical condition, likely impact of intensive treatment, and the patient's wishes. Age should be considered as part of the global assessment of the patient. CONCLUSIONS Lacking national guidelines, the document is the reference standard for healthcare professionals in case of imbalance between care needs and available resources during a COVID-19 pandemic in Italy, and a point of reference for the medico-legal assessment in cases of dispute.
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Affiliation(s)
- Luigi Riccioni
- Anesthesia and Intensive Care, San Camillo-Forlanini Hospital, Circonvallazione Gianicolense, 87, 00152, Rome, Italy.
| | - Francesca Ingravallo
- Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giacomo Grasselli
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Mazzon
- UOC Anesthesia and Intensive Care, Belluno Hospital, Belluno, Italy
| | - Emiliano Cingolani
- Anesthesia and Intensive Care, San Camillo-Forlanini Hospital, Circonvallazione Gianicolense, 87, 00152, Rome, Italy
| | - Gabrio Forti
- Criminal Law, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | - Riccardo Zoja
- Institute of Legal Medicine, Department of Biomedical Sciences of Health, University of Milan, President of SIMLA, Milan, Italy
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23
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Menéndez-Colino R, Argentina F, de Miguel AM, Barcons Marqués M, Chaparro Jiménez B, Figueroa Poblete C, Alarcón T, Martínez Peromingo FJ, González-Montalvo JI. [Liaison geriatrics with nursing homes in COVID time. A new coordination model arrived to stay]. Rev Esp Geriatr Gerontol 2021; 56:157-165. [PMID: 33642134 PMCID: PMC7836697 DOI: 10.1016/j.regg.2021.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 12/22/2020] [Accepted: 01/07/2021] [Indexed: 01/15/2023]
Abstract
Older people living in nursing homes fulfil the criteria to be considered as geriatric patients, but they often do not have met their health care needs. Current deficits appeared as a result of COVID-19 pandemic. The need to improve the coordination between hospitals and nursing homes emerged, and in Madrid it materialized with the implantation of Liaison Geriatrics teams or units at public hospitals. The Sociedad Española de Geriatría y Gerontología has defined the role of the geriatricians in the COVID-19 pandemic and they have given guidelines about prevention, early detection, isolation and sectorization, training, care homes classification, patient referral coordination, and the role of the different care settings, among others. These units and teams also must undertake other care activities that have a shortfall currently, like nursing homes-hospital coordination, geriatricians visits to the homes, telemedicine sessions, geriatric assessment in emergency rooms, and primary care and public health services coordination. This paper describes the concept of Liaison Geriatrics and its implementation at the Autonomous Community of Madrid hospitals as a result of COVID-19 pandemic. Activity data from a unit at a hospital with a huge number of nursing homes in its catchment area are reported. The objective is to understand the need of this activity in order to avoid the current fragmentation of care between hospitals and nursing homes. This activity should be consolidated in the future.
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Affiliation(s)
- Rocío Menéndez-Colino
- Servicio de Geriatría. Hospital Universitario La Paz, Madrid, España; Facultad de Medicina. Universidad Autónoma de Madrid, Madrid, España; Instituto de Investigación IdiPAZ, Hospital Universitario La Paz, Madrid, España; Unidad de Geriatría de Enlace, Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España.
| | - Francesca Argentina
- Servicio de Geriatría. Hospital Universitario La Paz, Madrid, España; Unidad de Geriatría de Enlace, Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España
| | - Ana Merello de Miguel
- Servicio de Geriatría. Hospital Universitario La Paz, Madrid, España; Unidad de Geriatría de Enlace, Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España
| | - Montserrat Barcons Marqués
- Servicio de Geriatría. Hospital Universitario La Paz, Madrid, España; Unidad de Geriatría de Enlace, Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España
| | - Blanca Chaparro Jiménez
- Servicio de Geriatría. Hospital Universitario La Paz, Madrid, España; Unidad de Geriatría de Enlace, Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España
| | - Carolina Figueroa Poblete
- Servicio de Geriatría. Hospital Universitario La Paz, Madrid, España; Unidad de Geriatría de Enlace, Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España
| | - Teresa Alarcón
- Servicio de Geriatría. Hospital Universitario La Paz, Madrid, España; Facultad de Medicina. Universidad Autónoma de Madrid, Madrid, España; Instituto de Investigación IdiPAZ, Hospital Universitario La Paz, Madrid, España; Unidad de Geriatría de Enlace, Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España
| | | | - Juan Ignacio González-Montalvo
- Servicio de Geriatría. Hospital Universitario La Paz, Madrid, España; Facultad de Medicina. Universidad Autónoma de Madrid, Madrid, España; Instituto de Investigación IdiPAZ, Hospital Universitario La Paz, Madrid, España; Unidad de Geriatría de Enlace, Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España
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24
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Hashan MR, Smoll N, King C, Ockenden-Muldoon H, Walker J, Wattiaux A, Graham J, Booy R, Khandaker G. Epidemiology and clinical features of COVID-19 outbreaks in aged care facilities: A systematic review and meta-analysis. EClinicalMedicine 2021; 33:100771. [PMID: 33681730 PMCID: PMC7917447 DOI: 10.1016/j.eclinm.2021.100771] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 outbreaks in aged care facilities (ACFs) often have devastating consequences. However, epidemiologically these outbreaks are not well defined. We aimed to define such outbreaks in ACFs by systematically reviewing literature published during the current COVID-19 pandemic. METHODS We searched 11 bibliographic databases for literature published on COVID-19 in ACFs between December 2019 and September 2020. Original studies reporting extractable epidemiological data as part of outbreak investigations or non-outbreak surveillance of ACFs were included in this systematic review and meta-analysis. PROSPERO registration: CRD42020211424. FINDINGS We identified 5,148 publications and selected 49 studies from four continents reporting data on 214,380 residents in 8,502 ACFs with 25,567 confirmed cases of COVID-19. Aged care residents form a distinct vulnerable population with single-facility attack rates of 45% [95% CI 32-58%] and case fatality rates of 23% [95% CI 18-28%]. Of the cases, 31% [95% CI 28-34%] were asymptomatic. The rate of hospitalization amongst residents was 37% [95% CI 35-39%]. Data from 21 outbreaks identified a resident as the index case in 58% of outbreaks and a staff member in 42%. Findings from the included studies were heterogeneous and of low to moderate quality in risk of bias assessment. INTERPRETATION The clinical presentation of COVID-19 varies widely in ACFs residents, from asymptomatic to highly serious cases. Preventing the introduction of COVID-19 into ACFs is key, and both residents and staff are a priority group for COVID-19 vaccination. Rapid diagnosis, identification of primary and secondary cases and close contacts plus their isolation and quarantine are of paramount importance. FUNDING Queensland Advancing Clinical Research Fellowship awarded to Prof. Gulam Khandaker by Queensland Health's Health Innovation, Investment and Research Office (HIRO), Office of the Director-General.
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Affiliation(s)
- Mohammad Rashidul Hashan
- Central Queensland University, Rockhampton, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Nicolas Smoll
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Catherine King
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Westmead, Australia
- The Children's Hospital at Westmead Clinical School, The faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Hannah Ockenden-Muldoon
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Jacina Walker
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Andre Wattiaux
- Gold Coast Public Health Unit, Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Julieanne Graham
- Medical Services Team, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Westmead, Australia
- The Children's Hospital at Westmead Clinical School, The faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Gulam Khandaker
- Central Queensland University, Rockhampton, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
- The Children's Hospital at Westmead Clinical School, The faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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25
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Kamle S, Ma B, He CH, Akosman B, Zhou Y, Lee CM, El-Deiry WS, Huntington K, Liang O, Machan JT, Kang MJ, Shin HJ, Mizoguchi E, Lee CG, Elias JA. Chitinase 3-like-1 is a Therapeutic Target That Mediates the Effects of Aging in COVID-19. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2021:2021.01.05.425478. [PMID: 33442679 PMCID: PMC7805436 DOI: 10.1101/2021.01.05.425478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
COVID-19 is caused by the SARS-CoV-2 (SC2) virus and is more prevalent and severe in the elderly and patients with comorbid diseases (CM). Because chitinase 3-like-1 (CHI3L1) is induced during aging and CM, the relationships between CHI3L1 and SC2 were investigated. Here we demonstrate that CHI3L1 is a potent stimulator of the SC2 receptor ACE2 and viral spike protein priming proteases (SPP), that ACE2 and SPP are induced during aging and that anti-CHI3L1, kasugamycin and inhibitors of phosphorylation, abrogate these ACE2- and SPP- inductive events. Human studies also demonstrated that the levels of circulating CHI3L1 are increased in the elderly and patients with CM where they correlate with COVID-19 severity. These studies demonstrate that CHI3L1 is a potent stimulator of ACE2 and SPP; that this induction is a major mechanism contributing to the effects of aging during SC2 infection and that CHI3L1 coopts the CHI3L1 axis to augment SC2 infection. CHI3L1 plays a critical role in the pathogenesis of and is an attractive therapeutic target in COVID-19.
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Franchini M, Glingani C, Morandi M, Corghi G, Cerzosimo S, Beduzzi G, Storti A, Di Stasi V, Rastrelli G, Vignozzi L, Mengoli C, Garuti M, Beccaria M, Inglese F, Caruso B, Petilino RA, Amato M, Nicchio M, Pagani M, Bellani A, Castelli G, Casari S, De Donno G. Safety and Efficacy of Convalescent Plasma in Elderly COVID-19 Patients: The RESCUE Trial. Mayo Clin Proc Innov Qual Outcomes 2021; 5:403-412. [PMID: 33585799 PMCID: PMC7869678 DOI: 10.1016/j.mayocpiqo.2021.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective To assess the safety and efficacy of convalescent plasma (CP) transfusion in elderly people with moderate to severe coronavirus disease 2019 (COVID-19) living in a long-term care facility (LTCF). Patients and Methods Twenty-two consecutive elderly patients with COVID-19 infection living in an LTCF in Lombardy, Italy, who were given CP during May 15 to July 31, 2020, were enrolled in a prospective cohort study. Their clinical, instrumental, and laboratory parameters were assessed following the CP treatment. The overall mortality rate in this group was compared with that recorded in other LTCFs in Lombardy during the 3-month period from March to May 2020. Results Of the 22 patients enrolled, 68.2% (n=15) received 1 CP unit, 27.3% (n=6) received 2 units, and 4.5% (n=1) received 3 units. Of the CP units transfused, 76.7% (23/30) had a neutralizing antibody titer of 1:160 or greater. No adverse reactions were recorded during or after CP administration. Improvements in clinical, functional, radiologic, and laboratory parameters during the 14 days after CP transfusion were observed in all 19 patients who survived. Viral clearance was achieved in all patients by the end of follow-up (median, 66 days; interquartile range, 48-80 days). The overall mortality rate was 13.6% (3/22), which compared favorably with that in the control group (38.3% [281/733]; P=.02) and corresponded to a 65% reduction in mortality risk. Conclusion Early administration of CP with an adequate anti-severe acute respiratory syndrome coronavirus 2 antibody titer to elderly symptomatic patients with COVID-19 infection in an LTCF was safe and effective in eliminating the virus, restoring patients' immunity, and blocking the progression of COVID-19 infection, thereby improving patients' survival. Trial Registration ClinicalTrials.gov: NCT04569188.
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Key Words
- COVID-19, coronavirus disease 2019
- CP, convalescent plasma
- CRP, C-reactive protein
- Fio2, fraction of inspired oxygen
- IL-6, interleukin 6
- IQR, interquartile range
- ISS, Italian National Institute of Health
- LTCF, long-term care facility
- NNT, number needed to treat
- NS, not significant
- PCR, polymerase chain reaction
- RESCUE, Real-time Evaluation of Safety and Efficacy of Convalescent Plasma Units Transfused to Elderly Patients With COVID-19
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
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Affiliation(s)
- Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
| | - Claudia Glingani
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
| | - Mario Morandi
- Green Park Residence, Mantova Salus Group, Mantova, Italy
| | | | - Sara Cerzosimo
- Green Park Residence, Mantova Salus Group, Mantova, Italy
| | - Gloria Beduzzi
- Green Park Residence, Mantova Salus Group, Mantova, Italy
| | - Andrea Storti
- Green Park Residence, Mantova Salus Group, Mantova, Italy
| | - Vincenza Di Stasi
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence-Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi Hospital, Florence, Italy
| | - Giulia Rastrelli
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence-Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi Hospital, Florence, Italy
| | - Linda Vignozzi
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence-Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi Hospital, Florence, Italy
| | - Carlo Mengoli
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
| | | | | | | | | | | | - Massimo Amato
- Emergency Department, Carlo Poma Hospital, Mantova, Italy
| | | | - Mauro Pagani
- Department of Medicine, Ospedale Destra Secchia, Carlo Poma Hospital, Mantova, Italy
| | - Angela Bellani
- Department of Frailty, Carlo Poma Hospital, Mantova, Italy
| | - Gianpaolo Castelli
- Department of Anesthesiology and Intensive Care, Carlo Poma Hospital, Mantova, Italy
| | - Salvatore Casari
- Unit of Infectious Diseases, Carlo Poma Hospital, Mantova, Italy
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Covino M, De Matteis G, Burzo ML, Russo A, Forte E, Carnicelli A, Piccioni A, Simeoni B, Gasbarrini A, Franceschi F, Sandroni C. Predicting In-Hospital Mortality in COVID-19 Older Patients with Specifically Developed Scores. J Am Geriatr Soc 2021; 69:37-43. [PMID: 33197278 PMCID: PMC7753731 DOI: 10.1111/jgs.16956] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/29/2020] [Accepted: 11/04/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVES Several scoring systems have been specifically developed for risk stratification in COVID-19 patients. DESIGN We compared, in a cohort of confirmed COVID-19 older patients, three specifically developed scores with a previously established early warning score. Main endpoint was all causes in-hospital death. SETTING This is a single-center, retrospective observational study, conducted in the Emergency Department (ED) of an urban teaching hospital, referral center for COVID-19. PARTICIPANTS We reviewed the clinical records of the confirmed COVID-19 patients aged 60 years or more consecutively admitted to our ED over a 6-week period (March 1st to April 15th, 2020). A total of 210 patients, aged between 60 and 98 years were included in the study cohort. MEASUREMENTS International Severe Acute Respiratory Infection Consortium Clinical Characterization Protocol-Coronavirus Clinical Characterization Consortium (ISARIC-4C) score, COVID-GRAM Critical Illness Risk Score (COVID-GRAM), quick COVID-19 Severity Index (qCSI), National Early Warning Score (NEWS). RESULTS Median age was 74 (67-82) and 133 (63.3%) were males. Globally, 42 patients (20.0%) deceased. All the score evaluated showed a fairly good predictive value with respect to in-hospital death. The ISARIC-4C score had the highest area under ROC curve (AUROC) 0.799 (0.738-0.851), followed by the COVID-GRAM 0.785 (0.723-0.838), NEWS 0.764 (0.700-0.819), and qCSI 0.749 (0.685-0.806). However, these differences were not statistical significant. CONCLUSION Among the evaluated scores, the ISARIC-4C and the COVID-GRAM, calculated at ED admission, had the best performance, although the qCSI had similar efficacy by evaluating only three items. However, the NEWS, already widely validated in clinical practice, had a similar performance and could be appropriate for older patients with COVID-19.
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Affiliation(s)
- Marcello Covino
- Emergency DepartmentFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Giuseppe De Matteis
- Department of Internal MedicineFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Maria Livia Burzo
- Department of Internal MedicineFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Andrea Russo
- Geriatrics DepartmentFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Evelina Forte
- Emergency DepartmentFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Annamaria Carnicelli
- Emergency DepartmentFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Andrea Piccioni
- Emergency DepartmentFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Benedetta Simeoni
- Emergency DepartmentFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Antonio Gasbarrini
- Department of Internal Medicine and GastroenterologyFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Università Cattolica del Sacro CuoreRomeItaly
| | - Francesco Franceschi
- Emergency DepartmentFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Università Cattolica del Sacro CuoreRomeItaly
| | - Claudio Sandroni
- Department of Anesthesiology and Intensive Care MedicineFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Università Cattolica del Sacro CuoreRomeItaly
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28
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Bielza R, Sanz J, Zambrana F, Arias E, Malmierca E, Portillo L, Thuissard IJ, Lung A, Neira M, Moral M, Andreu-Vázquez C, Esteban A, Ramírez MI, González L, Carretero G, Moreno RV, Martínez P, López J, Esteban-Ortega M, García I, Vaquero MA, Linares A, Gómez-Santana A, Gómez Cerezo J. Clinical Characteristics, Frailty, and Mortality of Residents With COVID-19 in Nursing Homes of a Region of Madrid. J Am Med Dir Assoc 2020; 22:245-252.e2. [PMID: 33417840 PMCID: PMC7833075 DOI: 10.1016/j.jamda.2020.12.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/25/2020] [Accepted: 12/06/2020] [Indexed: 01/08/2023]
Abstract
Objectives To describe the clinical characteristics, 30-day mortality, and associated factors of patients living in nursing homes (NH) with COVID-19, from March 20 to June 1, 2020. Design This is a retrospective study. A geriatric hospital-based team acted as a consultant and coordinated the care of older people living in NHs from the hospital. Setting and Participants A total of 630 patients aged 70 and older with Coronavirus Disease 2019 COVID-19 living in 55 NHs. Methods A logistic regression was performed to analyze the factors associated with mortality. In addition, Kaplan-Meier curves were applied according to mortality and its associated factors using the log-rank Mantel-Cox test. Results The diagnosis of COVID-19 was mainly made by clinical compatibility (N = 430). Median age was 87 years, 64.6% were women and 45.9% were transferred to be cared for at the hospital. A total of 282 patients died (44.7%) within the 30 days of first attention by the team. A severe form of COVID-19 occurred in 473 patients, and the most frequent symptoms were dyspnea (n = 332) and altered level of consciousness (n = 301). According to multiple logistic regression, male sex (P = .019), the Clinical Frailty Score (CFS) ≥6 (P = .004), dementia (P = .012), dyspnea (P < .001), and having a severe form of COVID-19 (P = .001), were associated with mortality, whereas age and care setting were not. Conclusions and Implications Mortality of the residents living in NHs with COVID-19 was almost 45%. The altered level of consciousness as an atypical presentation of COVID-19 should be considered in this population. A severe form of the disease, present in more than three-quarters of patients, was associated with mortality, apart from the male sex, CFS ≥6, dementia, and dyspnea, whereas age and care setting were not. These findings may also help to recognize patients in which the Advance Care Planning process is especially urgent to assist in the decisions about their care.
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Affiliation(s)
- Rafael Bielza
- Department of Geriatric Medicine, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain; Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain.
| | - Juan Sanz
- Department of Dermatology, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Francisco Zambrana
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain; Department of Oncology, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Estefanía Arias
- Department of Geriatric Medicine, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain; Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - Eduardo Malmierca
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain; Department of Internal Medicine, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Laura Portillo
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain; Department of Pharmacy, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Israel J Thuissard
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - Ana Lung
- Department of Geriatric Medicine, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain; Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - Marta Neira
- Department of Geriatric Medicine, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain; Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - María Moral
- Department of Palliative Care, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Cristina Andreu-Vázquez
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - Ana Esteban
- Department of Rheumatology, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Marcela Irma Ramírez
- Department of Endocrinology, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Laura González
- Department of Neurology, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Guillermo Carretero
- Department of Orthopedics, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Ricardo Vicente Moreno
- Department of Rehabilitation, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Pilar Martínez
- Department of Rehabilitation, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Javier López
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain; Department of Rehabilitation, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Mar Esteban-Ortega
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain; Department of Ophthalmology, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Isabel García
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain; Department of Ophthalmology, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - María Antonia Vaquero
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain; Department of General Surgery, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Ana Linares
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain; Department of Urology, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Ana Gómez-Santana
- Department of Preventive Medicine, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Jorge Gómez Cerezo
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain; Department of Internal Medicine, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
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29
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Wynants L, Van Calster B, Collins GS, Riley RD, Heinze G, Schuit E, Bonten MMJ, Dahly DL, Damen JAA, Debray TPA, de Jong VMT, De Vos M, Dhiman P, Haller MC, Harhay MO, Henckaerts L, Heus P, Kammer M, Kreuzberger N, Lohmann A, Luijken K, Ma J, Martin GP, McLernon DJ, Andaur Navarro CL, Reitsma JB, Sergeant JC, Shi C, Skoetz N, Smits LJM, Snell KIE, Sperrin M, Spijker R, Steyerberg EW, Takada T, Tzoulaki I, van Kuijk SMJ, van Bussel B, van der Horst ICC, van Royen FS, Verbakel JY, Wallisch C, Wilkinson J, Wolff R, Hooft L, Moons KGM, van Smeden M. Prediction models for diagnosis and prognosis of covid-19: systematic review and critical appraisal. BMJ 2020; 369:m1328. [PMID: 32265220 PMCID: PMC7222643 DOI: 10.1136/bmj.m1328] [Citation(s) in RCA: 1634] [Impact Index Per Article: 408.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review and appraise the validity and usefulness of published and preprint reports of prediction models for diagnosing coronavirus disease 2019 (covid-19) in patients with suspected infection, for prognosis of patients with covid-19, and for detecting people in the general population at increased risk of covid-19 infection or being admitted to hospital with the disease. DESIGN Living systematic review and critical appraisal by the COVID-PRECISE (Precise Risk Estimation to optimise covid-19 Care for Infected or Suspected patients in diverse sEttings) group. DATA SOURCES PubMed and Embase through Ovid, up to 1 July 2020, supplemented with arXiv, medRxiv, and bioRxiv up to 5 May 2020. STUDY SELECTION Studies that developed or validated a multivariable covid-19 related prediction model. DATA EXTRACTION At least two authors independently extracted data using the CHARMS (critical appraisal and data extraction for systematic reviews of prediction modelling studies) checklist; risk of bias was assessed using PROBAST (prediction model risk of bias assessment tool). RESULTS 37 421 titles were screened, and 169 studies describing 232 prediction models were included. The review identified seven models for identifying people at risk in the general population; 118 diagnostic models for detecting covid-19 (75 were based on medical imaging, 10 to diagnose disease severity); and 107 prognostic models for predicting mortality risk, progression to severe disease, intensive care unit admission, ventilation, intubation, or length of hospital stay. The most frequent types of predictors included in the covid-19 prediction models are vital signs, age, comorbidities, and image features. Flu-like symptoms are frequently predictive in diagnostic models, while sex, C reactive protein, and lymphocyte counts are frequent prognostic factors. Reported C index estimates from the strongest form of validation available per model ranged from 0.71 to 0.99 in prediction models for the general population, from 0.65 to more than 0.99 in diagnostic models, and from 0.54 to 0.99 in prognostic models. All models were rated at high or unclear risk of bias, mostly because of non-representative selection of control patients, exclusion of patients who had not experienced the event of interest by the end of the study, high risk of model overfitting, and unclear reporting. Many models did not include a description of the target population (n=27, 12%) or care setting (n=75, 32%), and only 11 (5%) were externally validated by a calibration plot. The Jehi diagnostic model and the 4C mortality score were identified as promising models. CONCLUSION Prediction models for covid-19 are quickly entering the academic literature to support medical decision making at a time when they are urgently needed. This review indicates that almost all pubished prediction models are poorly reported, and at high risk of bias such that their reported predictive performance is probably optimistic. However, we have identified two (one diagnostic and one prognostic) promising models that should soon be validated in multiple cohorts, preferably through collaborative efforts and data sharing to also allow an investigation of the stability and heterogeneity in their performance across populations and settings. Details on all reviewed models are publicly available at https://www.covprecise.org/. Methodological guidance as provided in this paper should be followed because unreliable predictions could cause more harm than benefit in guiding clinical decisions. Finally, prediction model authors should adhere to the TRIPOD (transparent reporting of a multivariable prediction model for individual prognosis or diagnosis) reporting guideline. SYSTEMATIC REVIEW REGISTRATION Protocol https://osf.io/ehc47/, registration https://osf.io/wy245. READERS' NOTE This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication. This version is update 3 of the original article published on 7 April 2020 (BMJ 2020;369:m1328). Previous updates can be found as data supplements (https://www.bmj.com/content/369/bmj.m1328/related#datasupp). When citing this paper please consider adding the update number and date of access for clarity.
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Affiliation(s)
- Laure Wynants
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, Netherlands
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, Netherlands
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Richard D Riley
- Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Georg Heinze
- Section for Clinical Biometrics, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Ewoud Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Marc M J Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Darren L Dahly
- HRB Clinical Research Facility, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Johanna A A Damen
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Valentijn M T de Jong
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Maarten De Vos
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Electrical Engineering, ESAT Stadius, KU Leuven, Leuven, Belgium
| | - Paul Dhiman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Maria C Haller
- Section for Clinical Biometrics, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ordensklinikum Linz, Hospital Elisabethinen, Department of Nephrology, Linz, Austria
| | - Michael O Harhay
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Palliative and Advanced Illness Research Center and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Liesbet Henckaerts
- Department of Microbiology, Immunology and Transplantation, KU Leuven-University of Leuven, Leuven, Belgium
- Department of General Internal Medicine, KU Leuven-University Hospitals Leuven, Leuven, Belgium
| | - Pauline Heus
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Michael Kammer
- Section for Clinical Biometrics, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Nina Kreuzberger
- Evidence-Based Oncology, Department I of Internal Medicine and Centre for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna Lohmann
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Kim Luijken
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Jie Ma
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Glen P Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - David J McLernon
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Constanza L Andaur Navarro
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Johannes B Reitsma
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Jamie C Sergeant
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Chunhu Shi
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Nicole Skoetz
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Luc J M Smits
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, Netherlands
| | - Kym I E Snell
- Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Matthew Sperrin
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - René Spijker
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Medical Library, Netherlands
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, Netherlands
| | - Toshihiko Takada
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Bas van Bussel
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, Netherlands
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht University, Maastricht, Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht University, Maastricht, Netherlands
| | - Florien S van Royen
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Jan Y Verbakel
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Christine Wallisch
- Section for Clinical Biometrics, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Jack Wilkinson
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Lotty Hooft
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
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