Clinical characteristics of coronavirus disease 2019 in patients aged 80 years and older

Relationship between COVID-19 vaccine hesitancy and willingness to pay for the booster dose of COVID-19 vaccine of oncology patients in Taizhou, China

OBJECTIVE

This population-based study aimed to determine the hesitancy and willingness to pay (WTP) for the booster dose of a coronavirus disease (COVID-19) vaccine among patients with cancer in Taizhou, China.

PATIENTS AND METHODS

A self-administered online questionnaire was administered to patients with cancer in Taizhou, China. The chi-square test, binary logistic regression model were used to evaluate the WTP for the booster dose of a COVID-19 vaccine. The minimum sample size was 218, determined by G*Power software (latest ver. 3.1.9.7). A total of 354 patients received the survey, and 256 (72.3%) patients responded.

RESULTS

Overall, 69.9% (179/256) of respondents were willing to pay for the booster dose, and 78.8% (141/179) of these patients were willing to pay 1-99 CNY. Furthermore, 50.4% (129/256) of respondents were hesitant to receive a COVID-19 vaccine. Being unhesitant was significantly associated with WTP for the booster dose (aOR: 3.040; 95% CI: 1.669-5.540).

CONCLUSION

Hesitant patients with cancer had a lower WTP for the booster dose against COVID-19 than non-hesitant participants. These results imply that further health education programmes are essential to decrease the hesitancy of patients with cancer and enhance booster dose vaccination rates for public health improvements.KEY MESSAGESOur research showed that 70% of patients with cancer are willing to pay for the booster dose of the COVID-19 vaccine, and most are willing to pay less than 100 CNY, and this result reflects the economic value and affordability of the third dose of vaccination.COVID-19 vaccine-hesitant patients with cancer had a lower willingness to pay for a booster dose against COVID-19 than non-hesitant participants and few patients are still unwilling to pay among patients do not hesitate to receive the third dose.Therefore, promoting willingness to pay among oncology patients and addressing vaccine hesitancy remains key.

Complementary and Alternative Medicines Used by Middle-Aged to Older Taiwanese Adults to Cope with Stress during the COVID-19 Pandemic: A Cross-Sectional Survey

Background: This study aimed to investigate the factors influencing the use of complementary and alternative medicines (CAMs) to manage stress during the COVID-19 pandemic in Taiwan. Methods: A cross-sectional survey was administered to community-dwelling adults between the ages of 46 and 75 years, and a total of 351 participants completed the questionnaire. Log-binominal regression analyses were fitted to explore the factors associated with the use of CAMs. Results: The mean age of the participants was 57.0 years, and 67.0% reported that they had used CAMs within the past three months. Middle-aged adults were more likely to use CAMs than late middle-aged adults and older adults (p < 0.001). Overall, the major CAMs utilized to relieve psychological stress were music therapies (37.6%), massage (31.1%), spinal manipulation (25.1%), relaxing therapies (24.2%), and reading scriptures or The Bible (23.9%). Religion and vegetarian diets were the most important factors influencing participants to use CAMs, especially music therapies, massage, and reading scriptures/The Bible. Conclusions: CAM use was very prevalent among middle-aged adults in Taiwan; in particular, music therapies were the most favored activities for reducing stress. Population-specific mental health interventions using music can be developed to improve stress management outcomes during public health emergencies.

Parameter estimation of the COVID-19 transmission model using an improved quantum-behaved particle swarm optimization algorithm

The outbreak of coronavirus disease (COVID-19) and its accompanying pandemic have created an unprecedented challenge worldwide. Parametric modeling and analyses of the COVID-19 play a critical role in providing vital information about the character and relevant guidance for controlling the pandemic. However, the epidemiological utility of the results obtained from the COVID-19 transmission model largely depends on accurately identifying parameters. This paper extends the susceptible-exposed-infectious-recovered (SEIR) model and proposes an improved quantum-behaved particle swarm optimization (QPSO) algorithm to estimate its parameters. A new strategy is developed to update the weighting factor of the mean best position by the reciprocal of multiplying the fitness of each best particle with the average fitness of all best particles, which can enhance the global search capacity. To increase the particle diversity, a probability function is designed to generate new particles in the updating iteration. When compared to the state-of-the-art estimation algorithms on the epidemic datasets of China, Italy and the US, the proposed method achieves good accuracy and convergence at a comparable computational complexity. The developed framework would be beneficial for experts to understand the characteristics of epidemic development and formulate epidemic prevention and control measures.

The associations of life quality, depression, and cognitive impairment with mortality in older adults with COVID-19: a prospective, observational study

AIM

Associations of depression, dementia, and poor life quality with mortality of COVID-19have not been studied yet. We aimed to identify the risk factors for mortality and analyze the associations with patients' physiological and mental well-being, as reflected by comorbidities, life quality, depression, and cognitive impairment.

METHODS

: Older patients receiving inpatient hospital care for COVID-19 were included.Demographic data, medical history, symptoms at admission, laboratory findings, and treatment outcomes were recorded.

RESULTS

: There were 122 patients with a median age of 73.0 years. The mortality rate was 9.0% (n = 11 patients). Patients with mortality were significantly active smokers, obese, and having comorbidities using polypharmacy. Weight loss ≥of 10% during hospitalization was significantly associated with mortality.Poor life quality and a higher risk of depression, cognitive impairment, and falling were more frequently seen in non-survived patients. (p < 0.05). High ferritin was the only independent risk factor for mortality (OR = 15.61, 95% CI:1.08-226.09, p = 0.044).

CONCLUSION

: The presence of comorbidities, depression, cognitive impairment, higher falling risk, and poor life quality were significantly associated with higher mortality rates in older adults with COVID-19. High ferritin level was an independent risk factor for mortality.

The Spectrum of Antibiotic Prescribing During COVID-19 Pandemic: A Systematic Literature Review

Objectives: Over the last decades, there has been a significant increase in antimicrobial prescribing and consumption associated with the development of patients' adverse events and antimicrobial resistance (AMR) to the point of becoming a global priority. This study aims at evaluating antibiotic prescribing during COVID-19 pandemic from November 2019 to December 2020. Materials and Methods: A systematic review was conducted primarily through the NCBI database, using PRISMA guidelines to identify relevant literature for the period between November 1, 2019 and December 19, 2020, using the keywords: COVID-19 OR SARS-Cov-2 AND antibiotics restricted to the English language excluding nonclinical articles. Five hundred twenty-seven titles were identified; all articles fulfilling the study criteria were included, 133 through the NCBI, and 8 through Google Scholar with a combined total of 141 studies. The patient's spectrum included all ages from neonates to elderly with all associated comorbidities, including immune suppression. Results: Of 28,093 patients included in the combined studies, 58.7% received antibiotics (16,490/28,093), ranging from 1.3% to 100% coverage. Antibiotics coverage was less in children (57%) than in adults with comorbidities (75%). Broad-spectrum antibiotics were prescribed presumptively without pathogen identifications, which might contribute to adverse outcomes. Conclusions: During the COVID-19 pandemic, there has been a significant and wide range of antibiotic prescribing in patients affected by the disease, particularly in adults with underlying comorbidities, despite the paucity of evidence of associated bacterial infections. The current practice might increase patients' immediate and long-term risks of adverse events, susceptibility to secondary infections as well as aggravating AMR.

Do inflammaging and coagul-aging play a role as conditions contributing to the co-occurrence of the severe hyper-inflammatory state and deadly coagulopathy during COVID-19 in older people?

The coronavirus disease 2019 (COVID-19) is a new infectious respiratory disease, which has caused a pandemic that has become the world's leading public health emergency, threatening people of all ages worldwide, especially the elderly. Complications of COVID-19 are closely related to an upregulation of the inflammatory response revealed by the pro-inflammatory profile of plasma cytokines (to the point of causing a cytokine storm), which is also a contributing cause of the associated coagulation disorders with venous and arterial thromboembolisms, causing multiple organ dysfunction and failure. In severe fulminant cases of COVID-19, there is an activation of coagulation and consumption of clotting factors leading to a deadly disseminated intravascular coagulation (DIC). It is well established that human immune response changes with age, and also that the pro-inflammatory profile of plasma cytokines is upregulated in both healthy and diseased elderly people. In fact, normal aging is known to be associated with a subclinical, sterile, low-grade, systemic pro-inflammatory state linked to the chronic activation of the innate immune system, a phenomenon known as “inflammaging”. Inflammaging may play a role as a condition contributing to the co-occurrence of the severe hyper-inflammatory state (cytokine storm) during COVID-19, and also in other severe infections (sepsis) in older people. Moreover, we must consider the impact of inflammation on coagulation due to the crosstalk between inflammation and coagulation. The systemic inflammatory state and coagulation disorders are closely related, a phenomenon that here we call “coagul-aging” (Giunta S.). In this review, we discuss the various degrees of inflammation in older adults after being infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the adverse effects of aging on the inflammatory response and coagulation system.

It is important to note that although there is no gender difference in susceptibility to COVID-19 infection, however, due to differences in angiotensin-converting enzyme 2 (ACE2) expression, innate immunity, and comorbidities, older men exhibit more severe disease and higher mortality than older women.

There are currently no FDA-approved specific antiviral drugs that can be used against the virus. Therapies used in patients with COVID-19 consist of remdesivir, dexamethasone, low-molecular-weight heparin, in addition to monoclonal antibodies against the spike protein of SARS-CoV-2 in the early phase of the disease. Future pharmacological research should also consider targeting the possible role of the underlying scenario of inflammaging in healthy older people to prevent or mitigate disease complications. It is worth mentioning that some specific cytokine antagonists and traditional Chinese medicine preparations can reduce the elderly's inflammatory state.

Epidemiological and Clinical Characteristics of 217 Cases of COVID-19 in Jiangsu Province, China

BACKGROUND COVID-19 has become a worldwide epidemic disease and is a public health crisis. We aim to provide evidence for clinical diagnosis and assessment of severity by analyzing patients' clinical data and early laboratory results and exploring the correlation between laboratory results and clinical classification. MATERIAL AND METHODS We enrolled 283 cases of suspected and diagnosed COVID-19 from 16 hospitals in Jiangsu Province from January to April 2020. The routine laboratory blood examinations, T lymphocyte subsets, and biochemical and coagulation function among different populations were contrasted by t test and chi-square (χ²) test. RESULTS Cough, fever, and dyspnea could be helpful to diagnose COVID-19 infection (P<0.05). Patients who were older or had comorbidities tended to become severe and critical cases. Among all the patients, the most obvious abnormal laboratory results were higher neutrophil count, CRP, total bilirubin, BUN, CRE, APTT, PT, and D-dimer, and lower blood platelet and lymphocyte count. CD3⁺ T cell, CD4⁺ T cell, and CD8⁺ T cell counts gradually decreased with exacerbation of the disease (P<0.05). CONCLUSIONS Cough and fever were the most common symptom. Patients with comorbidities were in more serious condition. The detection of inflammatory indexes, coagulation function, lymphocyte subsets, and renal function can help diagnose and assess the severity of COVID-19.

Impact of Corticosteroids in Coronavirus Disease 2019 Outcomes: Systematic Review and Meta-analysis

BACKGROUND

Since its appearance in late 2019, infections caused by severe acute respiratory syndrome coronavirus 2 have created unprecedented challenges for health systems worldwide. Multiple therapeutic options have been explored, including corticosteroids. Preliminary results of corticosteroids in coronavirus disease 2019 (COVID-19) are encouraging; however, the role of corticosteroids remains controversial.

RESEARCH QUESTION

What is the impact of corticosteroids in mortality, ICU admission, mechanical ventilation, and viral shedding in COVID-19 patients?

STUDY DESIGN AND METHODS

We conducted a systematic review of literature on corticosteroids and COVID-19 in major databases (PubMed, MEDLINE, and EMBASE) of published literature through July 22, 2020, that report outcomes of interest in COVID-19 patients receiving corticosteroids with a comparative group.

RESULTS

A total of 73 studies with 21,350 COVID-19 patients were identified. Corticosteroid use was reported widely in mechanically ventilated patients (35.3%), ICU patients (51.3%), and severe COVID-19 patients (40%). Corticosteroids showed mortality benefit in severelly ill COVID-19 patients (OR, 0.65; 95% CI, 0.51-0.83; P = .0006); however, no beneficial or harmful effects were noted among high-dose or low-dose corticosteroid regimens. Emerging evidence shows that low-dose corticosteroids do not have a significant impact in the duration of SARS-CoV-2 viral shedding. The analysis was limited by highly heterogeneous literature for high-dose and low-dose corticosteroids regimens.

INTERPRETATION

Our results showed evidence of mortality benefit in severely ill COVID-19 patients treated with corticosteroids. Corticosteroids are used widely in COVID-19 patients worldwide, and a rapidly developing global pandemic warrants further high-quality clinical trials to define the most beneficial timing and dosing for corticosteroids.