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Jo HJ, Choe PG, Kim JS, Lee M, Lee M, Bae J, Lee CM, Kang CK, Park WB, Kim NJ. Risk of nosocomial coronavirus disease 2019: comparison between single- and multiple-occupancy rooms. Antimicrob Resist Infect Control 2024; 13:95. [PMID: 39215349 PMCID: PMC11365205 DOI: 10.1186/s13756-024-01454-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND There is an ongoing controversy regarding whether single-occupancy rooms are superior to multiple-occupancy rooms in terms of infection prevention. We investigated whether treatment in a multiple-occupancy room is associated with an increased incidence of nosocomial coronavirus disease 2019 (COVID-19) compared with treatment in a single-occupancy room. METHODS In this retrospective cohort study, every hospitalization period of adult patients aged ≥ 18 years at a tertiary hospital in Korea from January 1, 2022, to December 31, 2022, was analyzed. If COVID-19 was diagnosed more than 5 days after hospitalization, the case was classified as nosocomial. We estimated the association between the number of patients per room and the risk of nosocomial COVID-19 using a Cox proportional hazards regression model. RESULTS In total, 25,143 hospitalizations per room type were analyzed. The incidence rate of nosocomial COVID-19 increased according to the number of patients per room; it ranged from 3.05 to 38.64 cases per 10,000 patient-days between single- and 6-bed rooms, respectively. Additionally, the hazard ratios of nosocomial COVID-19 showed an increasing trend according to the number of patients per room, ranging from 0.14 (95% confidence interval 0.001-1.03) to 2.66 (95% confidence interval 1.60-4.85) between single- and 6-bed rooms, respectively. CONCLUSIONS We demonstrated that the incidence of nosocomial COVID-19 increased according to the number of patients per room. To reduce nosocomial infections by respiratory viruses, the use of multiple-occupancy rooms should be minimized.
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Affiliation(s)
- Hyeon Jae Jo
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
- Infection Control Office, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Seon Kim
- Infection Control Office, Seoul National University Hospital, Seoul, Republic of Korea
| | - Mimi Lee
- Infection Control Office, Seoul National University Hospital, Seoul, Republic of Korea
| | - Minkyeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jiyeon Bae
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chan Mi Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea.
- Infection Control Office, Seoul National University Hospital, Seoul, Republic of Korea.
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Koo HY, Lee JR, Lee JY, Lee H. Metabolic health is more strongly associated with the severity and mortality of coronavirus disease 2019 than obesity. Arch Public Health 2024; 82:131. [PMID: 39180113 PMCID: PMC11342616 DOI: 10.1186/s13690-024-01372-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 08/13/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Obesity has been suggested to be associated with the coronavirus disease 2019 (COVID-19); however, it is unclear whether obesity or metabolic abnormalities accompanied by obesity have a stronger association with COVID-19 risk. METHODS This study used the Korea Disease Control and Prevention Agency database, which includes information about the COVID-19 diagnosis and mortality dates of the entire Korean population between October 2020 and December 2021 (for diagnosis) or March 2022 (for mortality). A total of 24,310,283 adults were included and classified into four metabolic obesity phenotypes: (1) metabolically healthy and normal weight (MHNW), (2) metabolically unhealthy and normal weight (MUNW), (3) metabolically healthy and obese (MHO), and (4) metabolically unhealthy and obese (MUO). COVID-19 mortality and severity were compared according to metabolic obesity phenotypes in the total population and in each age group (20-<50 years, 50-<70 years, and ≥ 70 years). Additionally, major adverse cardiovascular events (MACE) after COVID-19 infection were compared according to metabolic obesity phenotypes. RESULTS A total of 3, 956, 807 participants (16.3%) were diagnosed with COVID-19 during the study period. Among them, metabolically unhealthy subjects had higher mortality rates than metabolically healthy subjects (0.81% for MUNW, 0.40% for MUO, 0.23% for MHNW, and 0.19% for MHO). The rates of severe hospitalized disease were also higher in metabolically unhealthy subjects than in healthy subjects (0.59% for MUNW, 0.55% for MUO, 0.19% for MHNW, and 0.31% for MHO). In the subgroup analyses by age, similar trends were observed in subjects aged 20-50 and 50-70 years, respectively. Additionally, the incidence of total MACE was increased in metabolically unhealthy individuals. CONCLUSIONS The study shows that metabolic health is more strongly associated with COVID-19 mortality and severity than obesity, particularly in adults aged < 70 years.
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Affiliation(s)
- Hye Yeon Koo
- Department of Family Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Ryun Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea
| | - Jin Yong Lee
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Public Healthcare Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Republic of Korea.
| | - Hyejin Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea.
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Khorram-Manesh A, Burkle FM, Goniewicz K. Pandemics: past, present, and future: multitasking challenges in need of cross-disciplinary, transdisciplinary, and multidisciplinary collaborative solutions. Osong Public Health Res Perspect 2024; 15:267-285. [PMID: 39039818 PMCID: PMC11391372 DOI: 10.24171/j.phrp.2023.0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 06/03/2024] [Indexed: 07/24/2024] Open
Abstract
The extensive history of pandemics has spanned many centuries, profoundly impacting societies, economies, and public health, and thereby shaping the course of history in various ways. Advances in medicine, science, and public health practices have played a pivotal role in mitigating the effects of pandemics over time. This review explores the scientific landscape of contemporary pandemics, examining their diverse and complex nature. It goes beyond the biological aspects of pandemics to consider socioeconomic, environmental, and technological factors. Through a scientific lens, this study aims to understand the complexities of pandemics and contribute to the expanding knowledge base that helps humanity strengthen its defenses against global health threats. By elucidating the enigmas of pandemics, the study hopes to foster a more resilient and prepared global health environment. Highlighting the importance of a multidisciplinary, cross-disciplinary, and transdisciplinary approach, this exploration emphasizes the critical need to integrate biological, socioeconomic, environmental, and technological domains to develop more robust defenses against these global health challenges.
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Affiliation(s)
- Amir Khorram-Manesh
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska University Hospital, Gothenburg, Sweden
- Center for Disaster Medicine, Gothenburg University, Gothenburg, Sweden
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Kwon O, Wallace M, Messina P, Szende A, Choi JW, Newson RS, Koo DH, Lee JH. Treatment patterns and healthcare resource utilization among patients with alopecia areata: A real-world chart review in South Korea. J Dermatol 2024. [PMID: 39044416 DOI: 10.1111/1346-8138.17380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/28/2024] [Accepted: 06/27/2024] [Indexed: 07/25/2024]
Abstract
Alopecia areata (AA) is a clinically heterogeneous, immune-mediated, non-scarring hair loss disorder. This real-world chart review sought to characterize treatment patterns and healthcare resource use among patients with severe AA in South Korea. A web-based chart review of 40 dermatologists was conducted in which the medical charts of 151 adult patients diagnosed with severe AA between May 2019 and April 2021 were reviewed. Anonymized data on patient characteristics, treatment patterns, healthcare resource use, and clinical outcomes were extracted from the date of severe disease diagnosis until the date of data collection (September-November 2022). Sixty-six percent of patients were diagnosed with severe disease at initial presentation, while 34% were re-classed to severe during the disease course. Mean estimated patient age at the time of diagnosis of severe AA was 37.1 (range 22-68) years. Fifty-three percent of patients were male. Most patients (93.4%) received pharmacological treatment for their condition; 45.5% received ≥2 lines of treatment with a mean duration of 24 months. First-line treatment discontinuation due to lack of efficacy occurred in 46.0% of cases. Hair regrowth occurred in 71.0% of patients, 59.2% of whom experienced major regrowth (≥60%) during the follow-up period. Median (95% confidence interval) time to regrowth was 13.7 (11.0-20.6) months. Treatment visit rates per person-year ranged from two (phototherapy) to 10 (topical treatment), dermatologist visits occurred at a rate of 12.9 per person-year and 6.0% of patients were hospitalized due to alopecia areata. The majority of hospitalizations were related to treatment and occurred in patients who received pulse systemic corticosteroid therapy. The patient and economic burden of AA in South Korea is high and there remains a critical unmet need among patients with severe AA with respect to the effectiveness of commonly used treatment strategies.
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Affiliation(s)
- Ohsang Kwon
- College of Medicine, Seoul National University, Seoul, Korea
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Liu S, Anzai A, Nishiura H. Evaluation of the exit screening policy among travelers arriving from Asian and pacific nations. BMC Infect Dis 2024; 24:464. [PMID: 38698328 PMCID: PMC11067274 DOI: 10.1186/s12879-024-09327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/16/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND The Japanese government has instituted border control measures against COVID-19, including entry and exit screening of people arriving from overseas. We sought to evaluate the effectiveness of the exit screening policy in Japan in reducing the risk of importing COVID-19 cases among travelers from Asian and Pacific countries. METHODS The study period was stratified based on the timing of exit screening: (i) the control period (the pre-exit screening period from 25 October 2020 to 16 January 2021), (ii) the time period with the Alpha variant from 17 January to 10 April 2021, and (iii) the time period with the Delta variant from 2 May to 2 October 2021. Incidence data in the countries of origin were used to adjust for the risk of infection among travelers. The positivity rate of entry screening in Japan was compared among the three different study periods, adjusting for the risk of infection in the country of origin. RESULTS The adjusted relative risk of positivity was greatly reduced and substantially below the value of 1 during the Alpha variant period compared with the control period. Although the relative risks increased when comparing the Delta variant period against control, the estimate remained below 1, except for among travelers from India and Myanmar. The relative risk reduction was greatest in high-income countries, with estimates of 100% and 96% risk reduction during the Alpha and Delta variant periods, respectively, followed by upper-middle-income countries with estimates of 90% and 76%, respectively. CONCLUSIONS Even in the presence of the Alpha and Delta variants, exit screening clearly reduced the risk of infection among travelers arriving from Asian and Pacific nations. As the testing relies on the country of origin, the effectiveness varied greatly by the socioeconomic income status and epidemiological situation of those countries. Test standardization and quality assurance may be required in low- and middle-income countries.
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Affiliation(s)
- Shiqi Liu
- Kyoto University School of Public Health, Yoshidakonoe cho, Sakyo-ku, Kyoto City, 6068501, Japan
| | - Asami Anzai
- Kyoto University School of Public Health, Yoshidakonoe cho, Sakyo-ku, Kyoto City, 6068501, Japan
| | - Hiroshi Nishiura
- Kyoto University School of Public Health, Yoshidakonoe cho, Sakyo-ku, Kyoto City, 6068501, Japan.
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Oh TK, Kim S, Kim DH, Song IA. Long-Term Particulate Matter Exposure and Mortality in Hospitalized Patients with COVID-19 in South Korea. Ann Am Thorac Soc 2024; 21:759-766. [PMID: 38330170 PMCID: PMC11109913 DOI: 10.1513/annalsats.202307-607oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/08/2024] [Indexed: 02/10/2024] Open
Abstract
Rationale: Particulate matter (PM) exposure exacerbates health outcomes by causing lung damage. Objectives: To investigate whether prior exposure to particulate matter ⩽10 μm and ⩽2.5 μm in aerodynamic diameter (PM10 and PM2.5) was associated with clinical outcomes among patients with coronavirus disease (COVID-19). Methods: Data from the nationwide registration database of the National Health Insurance and Korea Disease Control and Prevention Agency in South Korea were used. The study included adult patients who were admitted to monitoring centers or hospitals between October 8, 2020 and December 31, 2021, after COVID-19 confirmation. AirKOREA database, which compiles air pollutant data from 642 stations in 162 cities and counties across South Korea, was used to extract data on PM levels. Average values of monthly exposure to PM10 and PM2.5 from the year previous to hospital admission because of COVID-19 to the date of confirmation of COVID-19 were calculated and used to define PM exposures of patients with COVID-19. Results: In total, 322,289 patients with COVID-19 were included, and 4,633 (1.4%) died during hospitalization. After adjusting for covariates, a 1-μg/m3 increase in PM10 and PM2.5 exposure was associated with 4% (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.03-1.05; P < 0.001) and 6% (OR, 1.06; 95% CI, 1.04-1.07; P < 0.001) increase in the risk of in-hospital mortality, respectively. In addition, a 1-μg/m3 increase in PM10 and PM2.5 was associated with 5% (OR, 1.05; 95% CI, 1.04-1.07; P < 0.001) and 8% (OR, 1.08; 95% CI, 1.06-1.10; P < 0.001) increase in the risks of requiring intensive care unit (ICU) admission and mechanical ventilation, respectively. Conclusions: PM10 and PM2.5 exposure was associated with increased in-hospital mortality and the need for ICU admission and mechanical ventilation among patients with COVID-19 in South Korea.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea; and
| | - Saeyeon Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dong Hyun Kim
- Department of Occupational and Environmental Medicine, Shihwa Medical Center, Siheumg-si, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea; and
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Lee S, Yuh C, Shin YB, Lee HJ, Lee YM, Lee J, Cho CH. Effects of a Rice-Farming Simulation Video Game on Nature Relatedness, Nutritional Status, and Psychological State in Urban-Dwelling Adults During the COVID-19 Pandemic: Randomized Waitlist Controlled Trial. J Med Internet Res 2024; 26:e51596. [PMID: 38252464 PMCID: PMC10845032 DOI: 10.2196/51596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/23/2023] [Accepted: 11/30/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, urban inhabitants faced significant challenges in maintaining connections with nature, adhering to nutritional guidelines, and managing mental well-being. OBJECTIVE Recognizing the urgent need for innovative approaches, this study was designed to explore the potential benefits of a specific digital intervention, the rice-farming simulation game Sakuna: Of Rice and Ruin, for nature relatedness, nutritional behaviors, and psychological well-being. METHODS A total of 66 adults without any prior major psychiatric disorders residing in an urban area were recruited for the study. They were randomly assigned to 2 groups through block randomization: the immediate intervention group (IIG; 34/66, 52%) and the waitlist group (32/66, 48%). Participants in the IIG were instructed to play the game for at least 4 days per week for 3 weeks, with each session lasting from 30 minutes to 3 hours. Assessments were performed at baseline, week 1, and week 3. The Nature Relatedness Scale (NR) and Nutrition Quotient Scale were used to evaluate nature relatedness and nutritional state, respectively. Furthermore, psychological state was assessed using the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF), Brief Fear of Negative Evaluation Scale, Social Avoidance and Distress Scale, Toronto Alexithymia Scale, State-Trait Anxiety Inventory, Center for Epidemiologic Studies Depression Scale Revised, and Korean Resilience Quotient. RESULTS This study's results revealed significant time interactions between the IIG and waitlist group for both the total NR score (P=.001) and the score of the self subdomain of NR (P<.001), indicating an impact of the game on nature relatedness. No group×time interactions were found for the total Nutrition Quotient Scale and subdomain scores, although both groups showed increases from baseline. For psychological state, a significant group×time interaction was observed in the total WHOQOL-BREF score (P=.049), suggesting an impact of the game on quality of life. The psychological (P=.01), social (P=.003), and environmental (P=.04) subdomains of the WHOQOL-BREF showed only a significant time effect. Other psychological scales did not display any significant changes (all P>.05). CONCLUSIONS Our findings suggest that the rice-farming game intervention might have positive effects on nature relatedness, nature-friendly dietary behaviors, quality of life, anxiety, depression, interpersonal relationships, and resilience among urban adults during the COVID-19 pandemic. The impact of pronature games in confined urban environments provides valuable evidence of how digital technologies can be used to enhance urban residents' affinity for nature and psychological well-being. This understanding can be extended in the future to other digital platforms, such as metaverses. TRIAL REGISTRATION Clinical Research Information Service (CRIS) KCT0007657; http://tinyurl.com/yck7zxp7.
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Affiliation(s)
- Seulki Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chisung Yuh
- Department of Medical Education, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yu-Bin Shin
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young-Mee Lee
- Department of Medical Education, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jungsil Lee
- Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Chul-Hyun Cho
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Informatics, Korea University College of Medicine, Seoul, Republic of Korea
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Mao Y. Why do democracies respond differently to COVID-19? A comparison of the United States and South Korea. Front Public Health 2024; 11:1285552. [PMID: 38288425 PMCID: PMC10822946 DOI: 10.3389/fpubh.2023.1285552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/28/2023] [Indexed: 01/31/2024] Open
Abstract
Background COVID-19 has posed severe challenges to crisis management in democracies. Different democracies respond to the crisis differently. This article proposes an analytical framework to explain why democracies respond differently to the public health crisis and how different contextual factors affect crisis response in democracies. Methods By comparing COVID-19 responses in the US and South Korea, this article conducts a comparative case study with a most similar system design. The two countries have been selected as cases because they are both developed democracies with a robust healthcare system. However, different contextual factors in the two countries have created different crisis responses by shaping different crisis leadership and political and social solidarity. This study collected data from different sources, including government documents, official websites, leaders' speeches, research reports, academic articles and news media. We tried to enhance the reliability of the data by comparing different data sources. Results We found that individual, institutional and cultural dimensions of contextual factors can influence different crisis responses of democratic countries by shaping crisis leadership and political and social solidarity. On the individual and institutional dimensions, leadership style and governance structure shape crisis leadership (sense making, decision making and coordinating, and meaning making), which in turn influences crisis management. On the cultural dimension, political and social solidarity measured by political polarization and social cooperation are shaped by cultural and social norms. Conclusion Our findings indicate that democracies require strong crisis leadership and a high degree of political and social solidarity to tackle public health crises. A centralized and coordinated system, as well as a political elite leadership style shaped by rich crisis response experience, expertise and high sensitivity to crises are conducive to crisis management. Fostering a cultural and social norm that facilitates state-society collaboration can promote crisis management. These findings provide valuable insights for decision-makers to effectively respond to future pandemics.
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Fukuda Y, Togashi A, Hirakawa S, Yamamoto M, Fukumura S, Nawa T, Honjo S, Kunizaki J, Nishino K, Tanaka T, Kizawa T, Yamamoto D, Takeuchi R, Sasaoka Y, Kikuchi M, Ito T, Nagai K, Asakura H, Kudou K, Yoshida M, Nishida T, Tsugawa T. Resurgence of human metapneumovirus infection and influenza after three seasons of inactivity in the post-COVID-19 era in Hokkaido, Japan, 2022-2023. J Med Virol 2023; 95:e29299. [PMID: 38081792 DOI: 10.1002/jmv.29299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/19/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023]
Abstract
Following the coronavirus disease 2019 (COVID-19) outbreak in February 2020, incidences of various infectious diseases decreased notably in Hokkaido Prefecture, Japan. However, Japan began gradually easing COVID-19 infection control measures in 2022. Here, we conducted a survey of children hospitalized with human metapneumovirus (hMPV), influenza A and B, and respiratory syncytial virus infections in 18 hospitals across Hokkaido Prefecture, Japan, spanning from July 2019 to June 2023. From March 2020 to June 2022 (28 months), only 13 patients were hospitalized with hMPV, and two patients had influenza A. However, in October to November 2022, there was a re-emergence of hMPV infections, with a maximum of 27 hospitalizations per week. From July 2022 to June 2023 (12 months), the number of hMPV-related hospitalizations dramatically increased to 317 patients, with the majority aged 3-6 years (38.2%, [121/317]). Influenza A also showed an increase from December 2022, with a peak of 13 hospitalizations per week in March 2023, considerably fewer than the pre-COVID-19 outbreak in December 2019, when rates reached 45 hospitalizations per week. These findings suggest the possibility of observing more resurgences in infectious diseases in Japan after 2023 if infection control measures continue to be relaxed. Caution is needed in managing potential outbreaks.
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Affiliation(s)
- Yuya Fukuda
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
- Department of Pediatrics, Japan Red Cross Urakawa Hospital, Hokkaido, Japan
| | - Atsuo Togashi
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoshi Hirakawa
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masaki Yamamoto
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shinobu Fukumura
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomohiro Nawa
- Department of Pediatric Cardiology and Pediatric Intensive Care, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Saho Honjo
- Department of Pediatrics, Iwamizawa Municipal General Hospital, Hokkaido, Japan
| | - Jun Kunizaki
- Department of Pediatrics, NTT EC Sapporo Medical Center, Sapporo, Japan
| | - Kouhei Nishino
- Department of Pediatrics, Otaru Kyokai Hospital, Hokkaido, Japan
| | - Toju Tanaka
- Department of Pediatrics, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Toshitaka Kizawa
- Department of Pediatrics, Japan Community Health Care Organization Sapporo Hokushin Hospital, Sapporo, Japan
| | - Dai Yamamoto
- Department of Pediatrics, Kushiro City General Hospital, Hokkaido, Japan
| | - Ryoh Takeuchi
- Department of Pediatrics, Nemuro City Hospital, Hokkaido, Japan
| | - Yuta Sasaoka
- Department of Pediatrics, Hakodate Municipal Hospital, Hokkaido, Japan
| | - Masayoshi Kikuchi
- Department of Pediatrics, Sunagawa City Medical Center, Hokkaido, Japan
| | - Takuro Ito
- Department of Pediatrics, Steel Memorial Muroran Hospital, Hokkaido, Japan
| | - Kazushige Nagai
- Department of Pediatrics, Takikawa Municipal Hospital, Hokkaido, Japan
| | - Hirofumi Asakura
- Department of Pediatrics, Hokkaido Esashi Hospital, Hokkaido, Japan
| | - Katsumasa Kudou
- Department of Pediatrics, Tomakomai City Hospital, Hokkaido, Japan
| | - Masaki Yoshida
- Department of Pediatrics, Yakumo General Hospital, Hokkaido, Japan
| | - Takeshi Nishida
- Department of Pediatrics, Rumoi City Hospital, Hokkaido, Japan
| | - Takeshi Tsugawa
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
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Kim RK, Choe YJ, Jang EJ, Chae C, Hwang JH, Lee KH, Shim JA, Kwon GY, Lee JY, Park YJ, Lee SW, Kwon D. Comparative Effectiveness of COVID-19 Bivalent Versus Monovalent mRNA Vaccines in the Early Stage of Bivalent Vaccination in Korea: October 2022 to January 2023. J Korean Med Sci 2023; 38:e396. [PMID: 38013649 PMCID: PMC10681846 DOI: 10.3346/jkms.2023.38.e396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/24/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND This retrospective observational matched-cohort study of 2,151,216 individuals from the Korean coronavirus disease 2019 (COVID-19) vaccine effectiveness cohort aimed to evaluate the comparative effectiveness of the COVID-19 bivalent versus monovalent vaccines in providing additional protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, critical infection, and death in Korea. METHODS Among individuals, those vaccinated with COVID-19 bivalent vaccines were matched in a 1:1 ratio with those who were vaccinated with monovalent vaccines (bivalent vaccines non-recipients) during the observation period. We fitted a time-dependent Cox proportional-hazards model to estimate hazard ratios (HRs) of COVID-19 outcomes for infection, critical infection, and death, and we defined vaccine effectiveness (VE) as 1-HR. RESULTS Compared with the bivalent vaccination group, the incidence proportions in the monovalent vaccination group were approximately three times higher for infection, nine times higher for critical infection, and 11 times higher for death. In the early stage of bivalent vaccination, relative VE of bivalent vaccine against monovalent vaccine was 42.4% against SARS-CoV-2 infection, 81.3% against critical infection, and 85.3% against death. In addition, VE against critical infection and death according to the elapsed period after bivalent vaccination was maintained at > 70%. CONCLUSION The bivalent booster dose provided additional protection against SARS-CoV-2 infections, critical infections, and deaths during the omicron variant phase of the COVID-19 pandemic.
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Affiliation(s)
- Ryu Kyung Kim
- Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Young June Choe
- Korea University Anam Hospital and Allergy and Immunology Center, Korea University, Seoul, Korea
| | - Eun Jung Jang
- Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Chungman Chae
- Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Ji Hae Hwang
- Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Kil Hun Lee
- Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Ji Ae Shim
- Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Geun-Yong Kwon
- Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Jae Young Lee
- Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Young-Joon Park
- Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Sang Won Lee
- Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Donghyok Kwon
- Korea Disease Control and Prevention Agency, Cheongju, Korea.
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Kim YK, Kim JY, Jung JI, Park JK, Lee EY, Lee EB, Park JW. COVID-19 infection and efficacy of vaccination in patients with rheumatic diseases during Omicron outbreak in South Korea: a prospective cohort study. RMD Open 2023; 9:e003398. [PMID: 37973535 PMCID: PMC10660437 DOI: 10.1136/rmdopen-2023-003398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/16/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES This study aims to investigate COVID-19 epidemiological data in patients with autoimmune inflammatory rheumatic diseases (AIRDs) during Omicron wave and to identify clinical factors associated with infection, including COVID-19 vaccination. METHODS This prospective longitudinal study was performed between January and October 2022 in South Korea. Patients were classified into AIRD and non-AIRD groups according to their underlying diseases. COVID-19 status, date of confirmed infection and vaccination status were captured from the patient survey and national database. The COVID-19 incidence during the study period was examined and compared between the two groups. The effect of clinical factors on the infection rate was analysed in the AIRD group. RESULTS A total of 1814 patients (1535 and 279 in the AIRD and non-AIRD groups, respectively) were analysed. During the study period, 857 COVID-19 cases were reported in 834 patients (46.0%). The infection rates in the AIRD and non-AIRD groups were comparable. In the AIRD group, older age (≥70 years) and glucocorticoid use were significantly associated with a lower rate of COVID-19 infection. The third booster vaccination significantly lowered the incidence of COVID-19 (adjusted HR 0.85 (95% CI 0.73 to 0.99)), and the prophylactic effect was more evident in patients aged <70 years (0.81 (95% CI 0.69 to 0.95), p value for interaction 0.036). CONCLUSION The risk of SARS-CoV-2 infection with the Omicron variant did not increase in patients with AIRDs. The third booster vaccination regimen decreased the infection rate in patients aged <70 years.
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Affiliation(s)
- Yun Kyu Kim
- Rheumatology, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
| | - Ju Yeon Kim
- Rheumatology, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
| | - Ji In Jung
- Rheumatology, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
| | - Jin Kyun Park
- Rheumatology, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
- Rheumatology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Eun Young Lee
- Rheumatology, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
- Rheumatology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Eun-Bong Lee
- Rheumatology, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
- Rheumatology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Jun Won Park
- Rheumatology, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
- Rheumatology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
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Jeon J, Park J, Choi MH, Choi H, Kim MH. Unequal burdens of COVID-19 infection: a nationwide cohort study of COVID-19-related health inequalities in Korea. Epidemiol Health 2023; 45:e2023068. [PMID: 37536718 PMCID: PMC10667578 DOI: 10.4178/epih.e2023068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/18/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVES While the Korean government's response to the coronavirus disease 2019 (COVID-19) pandemic is considered effective given the relatively low mortality rate, issues of inequality have been insufficiently addressed. This study explored COVID-19-related health inequalities in Korea. METHODS Age standardization for various health inequality indices was derived using data from the Korean National Health Insurance Service, the Korea Disease Control and Prevention Agency, and the Microdata Integrated Service of Statistics Korea. The slope index of inequality (SII) and relative index of inequality (RII) were calculated for socioeconomic variables, while absolute difference (AD) and relative difference (RD) were used for gender and disability inequalities. RESULTS We observed a number of COVID-19-related health outcome inequalities. Gender inequality was particularly noticeable in infection rates, with the rate of women 1.16 times higher than that of men. In contrast, socioeconomic inequality was evident in vaccination rates, with a 4.5-fold (SII, -4.519; 95% confidence interval, -7.403 to -1.634) difference between the highest and lowest household income groups. Regarding clinical progression post-infection, consistent findings indicated higher risk for men (RD for hospitalization, 0.90; severe cases, 0.54; and fatality, 0.65), individuals with disabilities (RD for hospitalization, 2.27; severe cases, 2.29; and fatality, 2.37), and those from lower socioeconomic groups (SII for hospitalization, 1.778; severe cases, 0.089; and fatality, 0.451). CONCLUSIONS While the infection risk was nearly ubiquitous, not everyone faced the same level of risk post-infection. To prevent further health inequalities, it is crucial to develop a thoughtful policy acknowledging individual health conditions and resources.
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Affiliation(s)
- Jeangeun Jeon
- Department of Sociology, Yonsei University, Seoul, Korea
| | - Jieun Park
- Department of Sociology, Yonsei University, Seoul, Korea
| | - Min-Hyeok Choi
- Department of Preventive and Occupational & Environmental Medicine, Pusan National University Medical College, Yangsan, Korea
- Office of Public Healthcare Service, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hongjo Choi
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Myoung-Hee Kim
- Center for Public Health Data Analytics, National Medical Center, Seoul, Korea
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Beck NS, Song S, Park T, Hong SH, Jeong-Eun J, Kim KH, Im JI, Hong SY. Clinical features of COVID-19 among patients with end-stage renal disease on hemodialysis in the context of high vaccination coverage during the omicron surge period: a retrospective cohort study. BMC Nephrol 2023; 24:191. [PMID: 37370006 DOI: 10.1186/s12882-023-03219-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND We determined the clinical presentation and outcomes of the Omicron variant of severe acute respiratory syndrome coronavirus 2 infection in hemodialysis patients and identified the risk factors for severe coronavirus disease (COVID-19) and mortality in the context of high vaccination coverage. METHODS This was a retrospective cohort study involving hemodialysis patients who were vaccinated against COVID-19 during March-September 2022, when the Omicron variant was predominant, and the COVID-19 vaccination rate was high. The proportion of people with severe COVID-19 or mortality was evaluated using univariate logistic regression. RESULTS Eighty-three (78.3%) patients had asymptomatic/mild symptoms, 10 (9.4%) had moderate symptoms, and 13 (12.3%) had severe symptoms. Six (5.7%) patients required intensive care admission, two (1.9%) required mechanical ventilation, and one (0.9%) was kept on high-flow nasal cannula. Of the five (4.7%) mortality cases, one was directly attributed to COVID-19 and four to pre-existing comorbidities. Risk factors for both severe COVID-19 and mortality were advanced age; number of comorbidities; cardiovascular diseases; increased levels of aspartate transaminase, lactate dehydrogenase, blood urea nitrogen/creatinine ratio, brain natriuretic peptide, and red cell distribution; and decreased levels of hematocrit and albumin. Moreover, the number of COVID-19 vaccinations wasa protective factor against both severe disease and mortality. CONCLUSIONS Clinical features of hemodialysis patients during the Omicron surge with high COVID-19 vaccination coverage were significant for low mortality. The risk features for severe COVID-19 or mortality were similar to those in the pre-Omicron period in the context of low vaccination coverage.
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Affiliation(s)
- Nam-Seon Beck
- Department of Pediatrics, Chung-Ang Jeil Hospital, Chungbuk, South Korea
| | - Soomin Song
- Department of Statistics, Seoul National University, Seoul, South Korea
| | - Taesung Park
- Department of Statistics, Seoul National University, Seoul, South Korea
| | - So-Hyeon Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ewha Woman's University, School of Medicine, Seoul, South Korea
| | - Jang Jeong-Eun
- Department of Nursing, Chung-Ang Jeil Hospital, Chungbuk, South Korea
| | - Kyoung-Hwan Kim
- Department of Family Medicine, Chung-Ang Jeil Hospital, Chungbuk, South Korea
| | - Joung-Il Im
- Department of Orthopedic Surgery, Chung-Ang Jeil Hospital, Chungbuk, South Korea
| | - Sae-Yong Hong
- Department of Nephrology, Chung-angJeil General Hospital, 24 Jungang-Bukro, Jincheon County, Chungbuk, 27832, South Korea.
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Lim SH, Choi SH, Kim JY, Kim B, Kim HJ, Kim SH, Kim CK, Park SK, Yun J. Eight-Month Follow-up After the Third Dose of BNT162b2 Vaccine in Healthcare Workers: The Question of a Fourth Dose. J Korean Med Sci 2023; 38:e139. [PMID: 37158775 PMCID: PMC10166699 DOI: 10.3346/jkms.2023.38.e139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/18/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND A fourth dose of vaccination is known to help reduce the severity and mortality rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The South Korean vaccination guidelines for the fourth dose do not include healthcare workers (HCWs) as priority candidates. We investigated the necessity of the fourth dose in South Korean HCWs based on an 8-month follow-up period after the third vaccination. METHODS Changes in the surrogate virus neutralization test (sVNT) inhibition (%) score were measured at one month, four months and eight months after the third vaccination. The sVNT values were analyzed between infected and uninfected groups, and their trajectories were compared. RESULTS A total of 43 HCWs were enrolled in this study. In total, 28 cases (65.1%) were confirmed to be infected with SARS-CoV-2 (presumed omicron variant), and all had mild symptoms. Meanwhile, 22 cases (78.6%) were infected within four months of the third dose (median, 97.5 days). Eight months after the third dose, the SARS-CoV-2 (presumed omicron variant)-infected group showed significantly higher sVNT inhibition than that in the uninfected group (91.3% vs. 30.7%; P < 0.001). The antibody response due to hybrid immunity, provided by a combination of infection and vaccination, was maintained at sufficient levels for more than four months. CONCLUSION For HCWs who had coronavirus disease 2019 infection after completing a third vaccination, a sufficient antibody response was maintained until eight months after the third dose. The recommendation of the fourth dose may not be prioritized in subjects with hybrid immunity.
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Affiliation(s)
- Sung Hee Lim
- Division of Hematology-Oncology, Department of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, Korea
| | - Seong Hyeok Choi
- Division of Hematology-Oncology, Department of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, Korea
| | - Ji Youn Kim
- Division of Hematology-Oncology, Department of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, Korea
| | - Bora Kim
- Division of Hematology-Oncology, Department of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, Korea
| | - Han Jo Kim
- Division of Hematology-Oncology, Department of Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, Korea
| | - Se Hyung Kim
- Division of Hematology-Oncology, Department of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, Korea
| | - Chan Kyu Kim
- Division of Hematology-Oncology, Department of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, Korea
| | - Seong Kyu Park
- Division of Hematology-Oncology, Department of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, Korea
| | - Jina Yun
- Division of Hematology-Oncology, Department of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, Korea.
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Kang YR, Huh JY, Oh JY, Lee JH, Lee D, Kwon HS, Kim TB, Choi JC, Cho YS, Chung KF, Park SY, Song WJ. Clinical Characteristics of Post-COVID-19 Persistent Cough in the Omicron Era. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2023; 15:395-405. [PMID: 37075801 DOI: 10.4168/aair.2023.15.3.395] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/19/2023] [Accepted: 01/30/2023] [Indexed: 05/17/2023]
Abstract
Cough is one of the most common symptoms of acute coronavirus disease 2019, but cough may persist for weeks or months. This study aimed to examine the clinical characteristics of patients with post-coronavirus disease (COVID) persistent cough in the Omicron era. We conducted a pooled analysis comparing 3 different groups: 1) a prospective cohort of post-COVID cough (> 3 weeks; n = 55), 2) a retrospective cohort of post-COVID cough (> 3 weeks; n = 66), and 3) a prospective cohort of non-COVID chronic cough (CC) (> 8 weeks; n = 100). Cough and health status was assessed using patient-reported outcomes (PROs). Outcomes, including PROs and systemic symptoms, were longitudinally evaluated in the prospective post-COVID cough registry participants receiving usual care. A total of 121 patients with post-COVID cough and 100 with non-COVID CC were studied. Baseline cough-specific PRO scores did not significantly differ between post-COVID cough and non-COVID CC groups. There were no significant differences in chest imaging abnormality or lung function between groups. However, the proportions of patients with fractional exhaled nitric oxide (FeNO) ≥ 25 ppb were 44.7% in those with post-COVID cough and 22.7% in those with non-COVID CC, which were significantly different. In longitudinal assessment of the post-COVID registry (n = 43), cough-specific PROs, such as cough severity or Leicester Cough Questionnaire (LCQ) scores, significantly improved between visits 1 and 2 (visit interval: median 35 [interquartile range, IQR: 23-58] days). In the LCQ score, 83.3% of the patients showed improvement (change ≥ +1.3), but 7.1% had worsened (≤ -1.3). The number of systemic symptoms was median 4 (IQR: 2-7) at visit 1 but decreased to median 2 (IQR: 0-4) at visit 2. In summary, post-COVID persistent cough was similar in overall clinical characteristics to CC. Current cough guideline-based approaches may be effective in most patients with post-COVID cough. Measurement of FeNO levels may also be useful for cough management.
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Affiliation(s)
- Yu Ri Kang
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Young Huh
- Division of Pulmonary, Allergy and Critical Care medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ji-Yoon Oh
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Daegeun Lee
- Division of Pulmonary, Allergy and Critical Care medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Hyouk-Soo Kwon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Chol Choi
- Division of Pulmonary, Allergy and Critical Care medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London, UK
| | - So-Young Park
- Division of Pulmonary, Allergy and Critical Care medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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