Equal risk, unequal burden? Gender differentials in COVID-19 mortality in India

Why COVID-19 Symptomatic Patients Did Not Seek Healthcare Service at the Early Phase of the Pandemic in Bangladesh: Evidence From a Cross-Sectional Study

Objective The health-seeking behavior (HSB) of patients during an outbreak is crucial in mitigating the spread of disease. Poor HSB can increase mortality and make contact tracing more difficult. In this study, we aimed to examine the status of HSB among Bangladeshi educated individuals during the early phase of the COVID-19 pandemic when infection was spreading quickly, and social distancing measures were tightened across the country. Methods We conducted a cross-sectional survey online among Bangladeshi individuals using a virtual snowball sampling method to capture suspected COVID-19 patients who did not undergo COVID-19 diagnostic testing. Descriptive and inferential analyses were performed with statistical significance defined as p<0.05. Results The study consisted of 390 participants with 44.9% having a bachelor's degree, followed by 25.9% with a master's or PhD degree. Commonly reported symptoms among the participants included fever (77.7%), cough (50.5%), headache (46.2%), body pain (36.4%), sore throat (35.6%), anosmia (31.3%), anorexia (13.8%), diarrhea (11.4%), and dyspnea (11.3%). The most common reasons for not taking the COVID-19 test were limited testing facilities (48%), the risk of infection from the test center (46%), fear of social stigma (19%), considering COVID-19 infection as innocuous (18%), and fear of forced quarantine (5%). In regression analysis, participants who lived in rural areas were found to be 2.5 times more likely to buy medications from nearby pharmacies. Males were more likely to self-medicate, with male participants being 3.2 times more likely than female participants to consider COVID-19 infection as harmless (AOR: 3.2, CI: 1.28-7.98). Smokers were more likely to seek help from government hotlines and to use drugs at home. Respondents with higher monthly income were less likely to fear forced quarantine (AOR: 0.27, CI: 0.4-2.02) but more likely to consider the risk of infection at the test center (AOR: 1.75, CI: 0.88-3.49). Conclusion Our study highlights that non-compliance with public health guidelines by educated people during an epidemic indicates a general lack of health literacy and distrust in the healthcare system. Along with improved infrastructure, efforts to enhance public health risk communication and health literacy are necessary to rebuild public trust in the healthcare service.

IFNL3/4 polymorphisms as a two-edged sword: An association with COVID-19 outcome

Coronavirus Disease 2019 (COVID-19) has been ranked among the most fatal infectious diseases worldwide, with host's immune response significantly affecting the prognosis. With an aim to timely predict the most likely outcome of SARS-CoV-2 infection, we investigated the association of IFNL3 and IFNL4 polymorphisms, as well as other potentially relevant factors, with the COVID-19 mortality. This prospective observational case-control study involved 178 COVID-19 patients, hospitalized at Corona Center or Clinic for Infectious Diseases of University Clinical Centre Kragujevac, Serbia, followed up until hospital discharge or in-hospital death. Demographic and clinical data on all participants were retrieved from the electronic medical records, and TaqMan assays were employed in genotyping for IFNL3 and IFNL4 single nucleotide polymorphisms (SNPs), namely rs12980275, rs8099917, rs12979860, and rs368234815. 21.9% and 65.0% of hospitalized and critically ill COVID-19 patients, respectively, died in-hospital. Multivariable logistic regression analysis revealed increased Charlson Comorbidity Index (CCI), N/L, and lactate dehydrogenase (LDH) level to be associated with an increased likelihood of a lethal outcome. Similarly, females and the carriers of at least one variant allele of IFNL3 rs8099917 were almost 36-fold more likely not to survive SARS-CoV-2 infection. On the other hand, the presence of at least one ancestral allele of IFNL4 rs368234815 decreased more than 15-fold the likelihood of mortality from COVID-19. Our results suggest that, in addition to LDH level, N/L ratio, and CCI, IFNL4 rs368234815 and IFNL3 rs8099917 polymorphisms, but also patients' gender, significantly affect the outcome of COVID-19.

Epidemiological Context and Risk Factors Associated with the Evolution of the Coronavirus Disease (COVID-19): A Retrospective Cohort Study

Since its initial appearance in December 2019, COVID-19 has posed a serious challenge to healthcare authorities worldwide. The purpose of the current study was to identify the epidemiological context associated with the respiratory illness propagated by the spread of COVID-19 and outline various risk factors related to its evolution in the province of Debila (Southeastern Algeria). A retrospective analysis was carried out for a cohort of 612 COVID-19 patients admitted to hospitals between March 2020 and February 2022. The results were analyzed using descriptive statistics. Further, logistic regression analysis was employed to perform the odds ratio. In gendered comparison, males were found to have a higher rate of incidence and mortality compared to females. In terms of age, individuals with advanced ages of 60 years or over were typically correlated with higher rates of incidence and mortality in comparison toindividuals below this age. Furthermore, the current research indicated that peri-urban areas were less affected that the urban regions, which had relatively significant incidence and mortality rates. The summer season was marked with the highest incidence and mortality rate in comparison with other seasons. Patients who were hospitalized, were the age of 60 or over, or characterized by comorbidity, were mainly associated with death evolution (odds ratio [OR] = 8.695; p = 0.000), (OR = 6.192; p = 0.000), and (OR = 2.538; p = 0.000), respectively. The study identifies an important relationship between the sanitary status of patients, hospitalization, over-age categories, and the case severity of the COVID-19 patient.

Seroprevalence of SARS-CoV-2-specific anti-spike IgM, IgG, and anti-nucleocapsid IgG antibodies during the second wave of the pandemic: A population-based cross-sectional survey across Kashmir, India

Background

Within Kashmir, which is one of the topographically distinct areas in the Himalayan belt of India, a total of 2,236 cumulative deaths occurred by the end of the second wave. We aimed to conduct this population-based study in the age group of 7 years and above to estimate the seropositivity and its attributes in Kashmir valley.

Methods

We conducted a community-based household-level cross-sectional study, with a multistage, population-stratified, probability-proportionate-to-size, cluster sampling method to select 400 participants from each of the 10 districts of Kashmir. We also selected a quota of healthcare workers, police personnel, and antenatal women from each of the districts. Households were selected from each cluster and all family members with age 7 years or more were invited to participate. Information was collected through a standardized questionnaire and entered into Epicollect 5 software. Trained healthcare personnel were assigned for collecting venous blood samples from each of the participants which were transferred and processed for immunological testing. Testing was done for the presence of SARS-CoV-2-specific anti-spike IgM, IgG antibodies, and anti-nucleocapsid IgG antibodies. Weighted seropositivity was estimated along with the adjustment done for the sensitivity and specificity of the test used.

Findings

The data were collected from a total of 4,229 participants from the general population within the 10 districts of Kashmir. Our results showed that 84.84% (95% CI 84.51-85.18%) of the participants were seropositive in the weighted imputed data among the general population. In multiple logistic regression, the variables significantly affecting the seroprevalence were the age group 45-59 years (odds ratio of 0.73; 95% CI 0.67-0.78), self-reported history of comorbidity (odds ratio of 1.47; 95% CI 1.33-1.61), and positive vaccination history (odds ratio of 0.85; 95% CI 0.79-0.90) for anti-nucleocapsid IgG antibodies. The entire assessed variables showed a significant role during multiple logistic regression analysis for affecting IgM anti-spike antibodies with an odds ratio of 1.45 (95% CI 1.32-1.57) for age more than 60 years, 1.21 (95% CI 1.15-1.27) for the female gender, 0.87 (95% CI 0.82-0.92) for urban residents, 0.86 (95% CI 0.76-0.92) for self-reported comorbidity, and an odds ratio of 1.16 (95% CI 1.08-1.24) for a positive history of vaccination. The estimated infection fatality ratio was 0.033% (95% CI: 0.034-0.032%) between 22 May and 31 July 2021 against the seropositivity for IgM antibodies.

Interpretation

During the second wave of the SARS-CoV-2 pandemic, 84.84% (95% CI 84.51-85.18%) of participants from this population-based cross-sectional sample were seropositive against SARS-CoV-2. Despite a comparatively lower number of cases reported and lower vaccination coverage in the region, our study found such high seropositivity across all age groups, which indicates the higher number of subclinical and less severe unnoticed caseload in the community.

Pandemics, past and present: The role of biological anthropology in interdisciplinary pandemic studies

Biological anthropologists are ideally suited for the study of pandemics given their strengths in human biology, health, culture, and behavior, yet pandemics have historically not been a major focus of research. The COVID‐19 pandemic has reinforced the need to understand pandemic causes and unequal consequences at multiple levels. Insights from past pandemics can strengthen the knowledge base and inform the study of current and future pandemics through an anthropological lens. In this paper, we discuss the distinctive social and epidemiological features of pandemics, as well as the ways in which biological anthropologists have previously studied infectious diseases, epidemics, and pandemics. We then review interdisciplinary research on three pandemics–1918 influenza, 2009 influenza, and COVID‐19–focusing on persistent social inequalities in morbidity and mortality related to sex and gender; race, ethnicity, and Indigeneity; and pre‐existing health and disability. Following this review of the current state of pandemic research on these topics, we conclude with a discussion of ways biological anthropologists can contribute to this field moving forward. Biological anthropologists can add rich historical and cross‐cultural depth to the study of pandemics, provide insights into the biosocial complexities of pandemics using the theory of syndemics, investigate the social and health impacts of stress and stigma, and address important methodological and ethical issues. As COVID‐19 is unlikely to be the last global pandemic, stronger involvement of biological anthropology in pandemic studies and public health policy and research is vital.

Characterization of Clinical Features of Hospitalized Patients Due to the SARS-CoV-2 Infection in the Absence of Comorbidities Regarding the Sex: An Epidemiological Study of the First Year of the Pandemic in Brazil

The male sex, due to the presence of genetic, immunological, hormonal, social, and environmental factors, is associated with higher severity and death in Coronavirus Disease (COVID)-19. We conducted an epidemiological study to characterize the COVID-19 clinical profile, severity, and outcome according to sex in patients with the severe acute respiratory syndrome (SARS) due to the fact of this disease. We carried out an epidemiological analysis using epidemiological data made available by the OpenDataSUS, which stores information about SARS in Brazil. We recorded the features of the patients admitted to the hospital for SARS treatment due to the presence of COVID-19 (in the absence of comorbidities) and associated these characteristics with sex and risk of death. The study comprised 336,463 patients, 213,151 of whom were men. Male patients presented a higher number of clinical signs, for example, fever (OR = 1.424; 95%CI = 1.399−1.448), peripheral arterial oxygen saturation (SpO2) < 95% (OR = 1.253; 95%CI = 1.232−1.274), and dyspnea (OR = 1.146; 95%CI = 1.125−1.166) as well as greater need for admission in intensive care unit (ICU, OR = 1.189; 95%CI = 1.168−1.210), and the use of invasive ventilatory support (OR = 1.306; 95%CI = 1.273−1.339) and noninvasive ventilatory support (OR = 1.238; 95%CI = 1.216−1.260) when compared with female patients. Curiously, the male sex was associated only with a small increase in the risk of death when compared with the female sex (OR = 1.041; 95%CI = 1.023−1.060). We did a secondary analysis to identify the main predictors of death. In that sense, the multivariate analysis enabled the prediction of the risk of death, and the male sex was one of the predictors (OR = 1.101; 95%CI = 1.011−1.199); however, with a small effect size. In addition, other factors also contributed to this prediction and presented a great effect size, they are listed below: older age (61−72 years old (OR = 15.778; 95%CI = 1.865−133.492), 73−85 years old (OR = 31.978; 95%CI = 3.779−270.600), and +85 years old (OR = 68.385; 95%CI = 8.164−589.705)); race (Black (OR = 1.247; 95%CI = 1.016−1.531), Pardos (multiracial background; OR = 1.585; 95%CI = 1.450−1.732), and Indigenous (OR = 3.186; 95%CI = 1.927−5.266)); clinical signs (for instance, dyspnea (OR = 1.231; 95%CI = 1.110−1.365) and SpO2 < 95% (OR = 1.367; 95%CI = 1.238−1.508)); need for admission in the ICU (OR = 3.069; 95%CI = 2.789−3.377); and for ventilatory support (invasive (OR = 10.174; 95%CI = 8.803−11.759) and noninvasive (OR = 1.609; 95%CI = 1.438−1.800)). In conclusion, in Brazil, male patients tend to present the phenotype of higher severity in COVID-19, however, with a small effect on the risk of death.

The Importance of Behavioral and Native Factors on COVID-19 Infection and Severity: Insights from a Preliminary Cross-Sectional Study

The COVID-19 pandemic has had a major impact on a global scale. Understanding the innate and lifestyle-related factors influencing the rate and severity of COVID-19 is important for making evidence-based recommendations. This cross-sectional study aims at establishing a potential relationship between human characteristics and vulnerability/resistance to SARS-CoV-2. We hypothesize that the impact of the virus is not the same due to cultural and ethnic differences. A cross-sectional study was performed using an online questionnaire. The methodology included the development of a multi-language survey, expert evaluation, and data analysis. Data were collected using a 13-item pre-tested questionnaire based on a literature review between 9 December 2020 and 21 July 2021. Data were statistically analyzed using logistic regression. For a total of 1125 respondents, 332 (29.5%) were COVID-19 positive; among them, 130 (11.5%) required home-based treatment, and 14 (1.2%) intensive care. The significant and most influential factors on infection included age, physical activity, and health status (p < 0.05), i.e., better physical activity and better health status significantly reduced the possibility of infection, while older age significantly increased it. The severity of infection was negatively associated with the acceptance (adherence and respect) of preventive measures and positively associated with tobacco (p < 0.05), i.e., smoking regularly significantly increases the severity of COVID-19 infection. This suggests the importance of behavioral factors compared to innate ones. Apparently, individual behavior is mainly responsible for the spread of the virus. Therefore, adopting a healthy lifestyle and scrupulously observing preventive measures, including vaccination, would greatly limit the probability of infection and prevent the development of severe COVID-19.

Generalized Susceptible-Exposed-Infectious-Recovered model and its contributing factors for analysing the death and recovery rates of the COVID-19 pandemic

COVID-19 is a highly contagious disease that has infected over 136 million people worldwide with over 2.9 million deaths as of 11 April 2021. In March 2020, the WHO declared COVID-19 as a pandemic and countries began to implement measures to control the spread of the virus. The spread and the death rates of the virus displayed dramatic differences among countries globally, showing that there are several factors affecting its spread and mortality. By utilizing the cumulative number of cases from John Hopkins University, the recovery rate, death rate, and the number of active, recovered, and death cases were simulated to analyse the trends and patterns within the chosen countries. 10 countries from 3 different case severity categories (high cases, medium cases, and low cases) and 5 continents (Asia, North America, South America, Europe, and Oceania) were studied. A generalized SEIR model which considers control measures such as isolation, and preventive measures such as vaccination is applied in this study. This model is able to capture not only the dynamics between the states, but also the time evolution of the states by using the fourth-order-Runge-Kutta process. This study found no significant patterns in the countries under the same case severity category, suggesting that there are other factors contributing to the pattern in these countries. One of the factors influencing the pattern in each country is the population's age. COVID-19 related deaths were found to be notably higher among older people, indicating that countries comprising of a larger proportion of older age groups have an increased risk of experiencing higher death rates. Tighter governmental control measures led to fewer infections and eventually reduced the number of death cases, while increasing the recovery rate, and early implementations were found to be far more effective in controlling the spread of the virus and produced better outcomes.

The Spatial Association of Demographic and Population Health Characteristics with COVID-19 Prevalence Across Districts in India

In less-developed countries, the lack of granular data limits the researcher's ability to study the spatial interaction of different factors on the COVID-19 pandemic. This study designs a novel database to examine the spatial effects of demographic and population health factors on COVID-19 prevalence across 640 districts in India. The goal is to provide a robust understanding of how spatial associations and the interconnections between places influence disease spread. In addition to the linear Ordinary Least Square regression model, three spatial regression models-Spatial Lag Model, Spatial Error Model, and Geographically Weighted Regression are employed to study and compare the variables explanatory power in shaping geographic variations in the COVID-19 prevalence. We found that the local GWR model is more robust and effective at predicting spatial relationships. The findings indicate that among the demographic factors, a high share of the population living in slums is positively associated with a higher incidence of COVID-19 across districts. The spatial variations in COVID-19 deaths were explained by obesity and high blood sugar, indicating a strong association between pre-existing health conditions and COVID-19 fatalities. The study brings forth the critical factors that expose the poor and vulnerable populations to severe public health risks and highlight the application of geographical analysis vis-a-vis spatial regression models to help explain those associations.

Coronavirus disease 2019 in Saudi Arabia: A nationwide real-world characterization study

Background

On March 11th, 2020, The World Health Organization (WHO) declared that the COVID-19 is a pandemic due to its worldwide spread. The COVID-19 pandemic has extended its impact to Saudi Arabia. By mid-February 2021, The Kingdom of Saudi Arabia has reported more than 373,000 COVID-19 cases impacting different population categories (i.e., male, female, different age groups, comorbidities status). The objective of this nationwide study was to describe and explore the characteristics of hospitalized patients diagnosed with COVID-19 in Saudi Arabia.

Methods

This study was an observational epidemiological study based on collected clinical data from ten health institutions across all regions in Saudi Arabia. The study was conducted during the period from March 2nd, 2020, to January 31st, 2021. The data were collected included demographics, medical information, medications, and laboratory and diagnostic. More detailed information on usually missing factors such as smoking status, comorbidities, length of hospital stay were also collected. Both descriptive and inferential analyses were conducted using the statistical analysis software "SAS®" version 9.4.

Results

During the study period, 5286 patients were included in this study. Of these, (79.15%) were male. Of all 5286 patients, quite a high number of the studied population 2010 (38.02%) were smokers. The majority of the patients 3436 (65%) were reported to have comorbidities, with hypertension being the most common disease 1725 (32.6%), followed by diabetes 1641(31.04%). A high proportion of the patients, 2220 patients (41.99%), were admitted to the intensive care unit; of these, (33.52%) were on mechanical ventilation. Most patients received anticoagulant prophylaxis medications (n = 4414, 83.5%). All patients were given more than one antibiotic prophylaxis. Overall, the median hospital stay was 5.5 days, and the median length in the intensive care unit was 4.26 days. Around (89.14%) of patients were discharged from the hospital, and (10.8%) died.

Conclusion

In this real-world study utilizing a large sample size, this study provides confirmatory results on the COVID-19 patients characteristics that are similar to other populations. Healthcare professionals need to give COVID-19 patients with specific characteristics including smoking, diabetes mellitus and cardiac disease more care to avoid losing these patients.

Just breathe: a review of sex and gender in chronic lung disease

Chronic lung diseases are the third leading cause of death worldwide and are increasing in prevalence over time. Although much of our traditional understanding of health and disease is derived from study of the male of the species - be it animal or human - there is increasing evidence that sex and gender contribute to differences in disease risk, prevalence, presentation, severity, treatment approach, response and outcomes. Chronic obstructive pulmonary disease, asthma and bronchiectasis represent the most prevalent and studied chronic lung diseases and have key sex- and gender-based differences which are critical to consider and incorporate into clinical and research approaches. Mechanistic differences present opportunities for therapeutic development whereas behavioural and clinical differences on the part of patients and providers present opportunities for greater education and understanding at multiple levels. In this review, we seek to summarise the sex- and gender-based differences in key chronic lung diseases and outline the clinical and research implications for stakeholders.

Outcome, Severity, and Risk of Mortality in Patients with COVID-19 and Chronic Underlying Diseases: A Prospective Study

Background: The novel coronavirus pandemic, severe acute respiratory syndrome CoV-2 (SARS COV-2), has become a global threat and rapidly spread worldwide. The COVID-19 pandemic has posed a number of challenges, the most notable of which is the management of patients with chronic underlying diseases. Objectives: The present study aimed to evaluate the risk of COVID-19 severity and mortality in patients with chronic underlying diseases. Methods: In this retrospective cohort study, the data on the disease severity and morality of confirmed COVID-19 patients admitted to Baharloo Hospital, Tehran, Iran, from February 2020 to March 2020 were analyzed and reported. Patients’ characteristics, including age, gender, and underlying diseases, were also considered. Results: The study encompassed 1244 patients with the mean age of 53.29 years, among whom there were 573 patients with at least one co-existing chronic disease. Hypertension, diabetes mellitus (DM), and ischemic heart disease (IHD) were the most common co-existing chronic diseases. The findings revealed that underlying diseases were significantly associated with disease mortality and severity. Conclusions: The findings showed that patients with comorbidities were significantly at higher risk of death and severe forms of COVID-19. In this regard, patients with underlying diseases should be of concern.

COVID-19 mortality in women and men in sub-Saharan Africa: a cross-sectional study

INTRODUCTION

Since sex-based biological and gender factors influence COVID-19 mortality, we wanted to investigate the difference in mortality rates between women and men in sub-Saharan Africa (SSA).

METHOD

We included 69 580 cases of COVID-19, stratified by sex (men: n=43 071; women: n=26 509) and age (0-39 years: n=41 682; 40-59 years: n=20 757; 60+ years: n=7141), from 20 member nations of the WHO African region until 1 September 2020. We computed the SSA-specific and country-specific case fatality rates (CFRs) and sex-specific CFR differences across various age groups, using a Bayesian approach.

RESULTS

A total of 1656 deaths (2.4% of total cases reported) were reported, with men accounting for 70.5% of total deaths. In SSA, women had a lower CFR than men (mean [Formula: see text] = -0.9%; 95% credible intervals (CIs) -1.1% to -0.6%). The mean CFR estimates increased with age, with the sex-specific CFR differences being significant among those aged 40 years or more (40-59 age group: mean [Formula: see text] = -0.7%; 95% CI -1.1% to -0.2%; 60+ years age group: mean [Formula: see text] = -3.9%; 95% CI -5.3% to -2.4%). At the country level, 7 of the 20 SSA countries reported significantly lower CFRs among women than men overall. Moreover, corresponding to the age-specific datasets, significantly lower CFRs in women than men were observed in the 60+ years age group in seven countries and 40-59 years age group in one country.

CONCLUSIONS

Sex and age are important predictors of COVID-19 mortality globally. Countries should prioritise the collection and use of sex-disaggregated data so as to design public health interventions and ensure that policies promote a gender-sensitive public health response.

SARS-CoV-2 infection in India bucks the trend: Trained innate immunity?

SARS-CoV-2, the causative agent of COVID-19 pandemic caught the world unawares by its sudden onset in early 2020. Memories of the 1918 Spanish Flu were rekindled raising extreme fear for the virus, but in essence, it was the host and not the virus, which was deciding the outcome of the infection. Age, gender, and preexisting conditions played critical roles in shaping COVID-19 outcome. People of lower socioeconomic strata were disproportionately affected in industrialized countries such as the United States. India, a developing country with more than 1.3 billion population, a large proportion of it being underprivileged and with substandard public health provider infrastructure, feared for the worst outcome given the sheer size and density of its population. Six months into the pandemic, a comparison of COVID-19 morbidity and mortality data between India, the United States, and several European countries, reveal interesting trends. While most developed countries show curves expected for a fast-spreading respiratory virus, India seems to have a slower trajectory. As a consequence, India may have gained on two fronts: the spread of the infection is unusually prolonged, thus leading to a curve that is "naturally flattened"; concomitantly the mortality rate, which is a reflection of the severity of the disease has been relatively low. I hypothesize that trained innate immunity, a new concept in immunology, may be the phenomenon behind this. Biocultural, socioecological, and socioeconomic determinants seem to be influencing the outcome of COVID-19 in different regions/countries of the world.

The legacy of public action and gender-sensitivity of the pandemic response in Kerala State, India

Kerala State, India has received global attention in its response to the Covid-19 pandemic. Its response effectively attended to the health pandemic and focussed on economic relief. This paper attempts to understand how gender-responsive Kerala's policies were. Kerala's success was due to its historical preparedness and contemporary policy innovations. Over the years, public action was able to ensure that the state and the society were equipped to meet the challenges of a disaster, such as of the pandemic. In the 1990s, when India sought to limit state intervention and promote market-based solutions, public policy in Kerala shifted gears to deepen state intervention by promoting community participation and empowering women. As in other Indian States, the pandemic in Kerala too led to losses of female employment, rise in gender-based violence, a deterioration of women's mental health and rise in unequal care burdens. But Kerala's response was distinctive. Several policy interventions had foregrounded women's needs, which helped ensure gender-sensitivity in Kerala's pandemic response. Kerala's economic relief package included cash support, employment, free food provision and zero-interest loans to women. Through helplines, the government reached out and helped women report instances of violence and mental stress. The gender-sensitivity of Kerala's pandemic response is a rich guide as a demonstration of its possibilities and a reminder of the essential pre-requisites to achieve it.

ABO Blood Group and Outcomes in Patients with COVID-19 Admitted in the Intensive Care Unit (ICU): A Retrospective Study in a Tertiary-Level Hospital in Bangladesh

PURPOSE

The world is heavily suffering from the COVID-19 pandemic for more than a year, with over 191 million confirmed cases and more than 4.1 million deaths to date. Previous studies have explored several risk factors for coronavirus disease 2019 (COVID-19), but there is still a lack of association with ABO blood type. This study aimed to find out the relationship between the ABO blood group and COVID-19 outcomes in Bangladesh.

SUBJECTS AND METHODS

This retrospective cross-sectional study was conducted in the intensive care unit (ICU) of a tertiary-level COVID-dedicated hospital in Dhaka city, Bangladesh, between April 2020 and November 2020. Records from 771 critically ill patients were extracted who were confirmed for COVID-19 by reverse transcriptase-polymerase chain reaction (RT-PCR) assay, and blood grouping records were available in the health records.

RESULTS

The blood groups were 37.35%, 17.38%, 26.46%, and 18.81% for A, B, AB, and O type, respectively. Clinical symptoms were significantly more common in patients with blood type A (p < 0.05). Patients with blood type A had higher WBC counts and peak serum ferritin levels and both were statistically significant (p < 0.001). Patients with blood type A had a greater need for supplemental oxygen, and they were more likely to die in comparison to the patients with other blood types (p < 0.05). In multivariable analysis, our primary outcome death was significantly associated with blood type A (AOR: 3.49, 95% CI: 1.57-7.73) while adjusting for age, male gender, and non-communicable diseases.

CONCLUSION

Based on this study results, it can be concluded that the COVID-19 patients with blood type A have a higher chance of death and other complications. The authors recommend blood grouping before treating the COVID-19 patients, and healthcare workers should prioritize treating the patients based on that result.

Combination therapy of Tocilizumab and steroid for management of COVID-19 associated cytokine release syndrome: A single center experience from Pune, Western India

ABSTRACT

Cytokine release syndrome (CRS) or cytokine storm is thought to be the cause of inflammatory lung damage, worsening pneumonia and death in patients with COVID-19. Steroids (Methylprednislone or Dexamethasone) and Tocilizumab (TCZ), an interleukin-6 receptor antagonist, are approved for treatment of CRS in India. The aim of this study was to evaluate the efficacy and safety of combination therapy of TCZ and steroid in COVID-19 associated CRS.This retrospective cohort study was conducted at Noble hospital and Research Centre (NHRC), Pune, India between April 2 and November 2, 2020. All patients administered TCZ and steroids during this period were included. The primary endpoint was incidence of all cause mortality. Secondary outcomes studied were need for mechanical ventilation and incidence of systemic and infectious complications. Baseline and time dependent risk factors significantly associated with death were identified by Relative risk estimation.Out of 2831 admitted patients, 515 (24.3% females) were administered TCZ and steroids. There were 135 deaths (26.2%), while 380 patients (73.8%) had clinical improvement. Mechanical ventilation was required in 242 (47%) patients. Of these, 44.2% (107/242) recovered and were weaned off the ventilator. Thirty seven percent patients were managed in wards and did not need intensive care unit (ICU) admission. Infectious complications like hospital acquired pneumonia, blood stream bacterial and fungal infections were observed in 2.13%, 2.13% and 0.06% patients respectively. Age ≥ 60 years (P = .014), presence of co-morbidities like hypertension (P = .011), IL-6 ≥ 100 pg/ml (P = .002), D-dimer ≥ 1000 ng/ml (P < .0001), CT severity index ≥ 18 (P < .0001) and systemic complications like lung fibrosis (P = .019), cardiac arrhythmia (P < .0001), hypotension (P < .0001) and encephalopathy (P < .0001) were associated with increased risk of death.Combination therapy of TCZ and steroids is likely to be safe and effective in management of COVID-19 associated cytokine release syndrome. Efficacy of this anti-inflammatory combination therapy needs to be validated in randomized controlled trials.

Finding the real COVID-19 case-fatality rates for SAARC countries

The crude case fatality rate (CFR), because of the calculation method, is the most accurate when the pandemic is over since there is a possibility of the delay between disease onset and outcomes. Adjusted crude CFR measures can better explain the pandemic situation by improving the CFR estimation. However, no study has thoroughly investigated the COVID-19 adjusted CFR of the South Asian Association For Regional Cooperation (SAARC) countries. This study estimated both survival interval and underreporting adjusted CFR of COVID-19 for these countries. Moreover, we assessed the crude CFR between genders and across age groups and observed the CFR changes due to the imposition of fees on COVID-19 tests in Bangladesh. Using the daily records up to October 9, we implemented a statistical method to remove the delay between disease onset and outcome bias, and due to asymptomatic or mild symptomatic cases, reporting rates lower than 50% (95% CI: 10%-50%) bias in crude CFR. We found that Afghanistan had the highest CFR, followed by Pakistan, India, Bangladesh, Nepal, Maldives, and Sri Lanka. Our estimated crude CFR varied from 3.708% to 0.290%, survival interval adjusted CFR varied from 3.767% to 0.296% and further underreporting adjusted CFR varied from 1.096% to 0.083%. Furthermore, the crude CFRs for men were significantly higher than that of women in Afghanistan (4.034% vs. 2.992%) and Bangladesh (1.739% vs. 1.337%) whereas the opposite was observed in Maldives (0.284% vs. 0.390%), Nepal (0.006% vs. 0.007%), and Pakistan (2.057% vs. 2.080%). Besides, older age groups had higher risks of death. Moreover, crude CFR increased from 1.261% to 1.572% after imposing the COVID-19 test fees in Bangladesh. Therefore, the authorities of countries with higher CFR should be looking for strategic counsel from the countries with lower CFR to equip themselves with the necessary knowledge to combat the pandemic. Moreover, caution is needed to report the CFR.

The COVID-19 Pandemic: Effects on Civil Registration of Births and Deaths and on Availability and Utility of Vital Events Data

The complex and evolving picture of COVID-19-related mortality highlights the need for data to guide the response. Yet many countries are struggling to maintain their data systems, including the civil registration system, which is the foundation for detailed and continuously available mortality statistics. We conducted a search of country and development agency Web sites and partner and media reports describing disruptions to the civil registration of births and deaths associated with COVID-19 related restrictions.We found considerable intercountry variation and grouped countries according to the level of disruption to birth and particularly death registration. Only a minority of the 66 countries were able to maintain service continuity during the COVID-19 restrictions. In the majority, a combination of legal and operational challenges resulted in declines in birth and death registration. Few countries established business continuity plans or developed strategies to deal with the backlog when restrictions are lifted.Civil registration systems and the vital statistics they generate must be strengthened as essential services during health emergencies and as core components of the response to COVID-19.

Preliminary Evidence from a Cross-sectional Study on Epidemiology and Early Transmission Dynamics of COVID-19 in Karnataka State of India

Introduction Coronavirus disease 2019 (COVID-19) is an emerging infection and quickly disseminated around the world. This article studies the epidemiology and early transmission dynamics of COVID-19 in Karnataka, which would be useful for effective epidemic management and policy formulation.

Materials and Methods All COVID-19 cases reported in the state of Karnataka, India, till June 12, 2020, are included in the study. The epidemiology and transmission dynamics of COVID-19 in Karnataka is studied through descriptive statistical analysis.

Results The findings illustrate a gender-, age-, and region-based disparity in the susceptibility and fatality. There appears to be a male preponderance in the susceptibility, but a female preponderance in fatality. It is also found that the adults are more susceptible to the infection, while the elderly have the risk of high fatality. Further, infected individuals in the region with urbanization have a higher risk of fatality than other regions. The study shows that the chances of recovery for females are lower than males, and further, the chances of recovery are positively related to the age of the infected person. The chances of recovery are higher if the infected individual is younger and they diminish if the individual is older. The study also explores that the chances of recovery are affected by the patient’s geographical location. It is also noted that individuals who returned from foreign travel have better chances of recovery than the locally transmitted individuals.

Conclusion Though the risk of susceptibility to COVID-19 infection is equal to all, the burden of getting infected and the burden of fatality is unequally distributed among different demographic categories. To manage the contagious spread of epidemic, to reduce fatality, and to increase the chances of recovery, targeted policy actions are suggested to benefit the vulnerable demographic categories.

Does BMI predict the early spatial variation and intensity of Covid-19 in developing countries? Evidence from India

This paper studies BMI as a correlate of the early spatial distribution and intensity of Covid-19 across the districts of India and finds that conditional on a range of individual, household and regional characteristics, adult BMI significantly predicts the likelihood that the district is a hotspot, the natural log of the confirmed number of cases, the case fatality rate, and the propensity that the district is a red zone. Controlling for air-pollution, rainfall, temperature, demographic factors that measure population density, the proportion of the elderly, and health infrastructure including per capita health spending and the proportion of respiratory cases, does not diminish the predictive power of BMI in influencing the spatial incidence and spread of the virus. The association between adult BMI and measures of spatial outcomes is especially pronounced among educated populations in urban settings, and impervious to conditioning on differences in testing rates across states. We find that among women, BMI proxies for a range of comorbidities (hemoglobin, high blood pressure and high glucose levels) that affects the severity of the virus while among men, these health indicators are also important, as is exposure to risk of contracting the virus as measured by work propensities. We conduct sensitivity checks and control for differences that may arise due to variations in timing of onset. Our results provide a readily available health marker that may be used to identify and protect especially at-risk populations in developing countries like India.

Severity of the COVID-19 pandemic in India

The main objective of this study is to identify the socioeconomic, meteorological, and geographical factors associated with the severity of COVID-19 pandemic in India. The severity is measured by the cumulative severity ratio (CSR)-the ratio of the cumulative COVID-related deaths to the deaths in a pre-pandemic year-its first difference and COVID infection cases. We have found significant interstate heterogeneity in the pandemic development and have contrasted the trends of the COVID-19 severities between Maharashtra, which had the largest number of COVID deaths and cases, and the other states. Drawing upon random-effects models and Tobit models for the weekly and monthly panel data sets of 32 states/union territories, we have found that the factors associated with the COVID severity include income, gender, multi-morbidity, urbanization, lockdown and unlock phases, weather including temperature and rainfall, and the retail price of wheat. Brief observations from a policy perspective are made toward the end.

Pandemics and maternal health: the indirect effects of COVID-19

Infectious diseases can directly affect women and men differently. During the COVID-19 pandemic, higher case fatality rates have been observed in men in most countries. There is growing evidence, however, that while organisational changes to healthcare delivery have occurred to protect those vulnerable to the virus (staff and patients), these may lead to indirect, potentially harmful consequences, particularly to vulnerable groups including pregnant women. These encompass reduced access to antenatal and postnatal care, with a lack of in-person clinics impacting the ability to screen for physical, psychological and social issues such as elevated blood pressure, mental health issues and sex-based violence. Indirect consequences also encompass a lack of equity when considering the inclusion of pregnant women in COVID-19 research and their absence from vaccine trials, leading to a lack of safety data for breastfeeding and pregnant women. The risk-benefit analysis of these changes to healthcare delivery remains to be fully evaluated, but the battle against COVID-19 cannot come at the expense of losing existing quality standards in other areas of healthcare, especially for maternal health.

Gender disparity in COVID-19: Role of sex steroid hormones

The emerging pandemic of COVID-19 caused by the novel pathogenic human coronavirus SARS-CoV-2 has caused significant morbidity and mortality across the globe, prompting the scientific world to search for preventive measures to interrupt the disease process. Demographic data indicates gender-based differences in COVID-19 morbidity with better outcome amongst females. Disparity in sex-dependent morbidity and mortality in COVID-19 patients may be attributed to difference in levels of sex steroid hormones -androgens and estrogens. Evidence suggests that apart from the regulation of viral host factors, immunomodulatory and cardioprotective roles exerted by estrogen and progesterone may provide protection to females against COVID-19. Exploring the underlying mechanisms and beneficial effects of these hormones as an adjuvant to existing therapy may be a step towards improving the outcomes. This article aims to review studies demonstrating the role of sex steroidal hormones in modulating SARS-CoV-2 host factors and summarize plausible biological reasons for sex-based differences seen in COVID-19 mortality.

Magnitude and Predictors of Health Care Workers Depression During the COVID-19 Pandemic: Health Facility-Based Study in Eastern Ethiopia

Background: Depression of health care workers was related to work absences, resignations, and poor work performance, affecting the quality of patient care and the health care system. The Coronavirus disease pandemic has had an effect on the mental health of health care workers. Health care workers are facing challenges that can be stressful, overwhelming, and cause strong emotions, may put them at higher risk to develop depression. There is limited evidence that assesses health care workers' depression and its associated factors in the study area during the Coronavirus disease pandemic. Therefore this study aimed to assess depression and associated factors among health care workers in eastern Ethiopia. Method: The cross-sectional study design was conducted from October 26th to November 15, 2020. A total of 265 health care workers from 10 health facilities participated. Patient Health Questionnaire was used for the collection of depressive symptoms. The data were analyzed by using STATA version 14 software. To assess the association between depression and the predictors Adjusted Odds Ratio along with a 95% confidence interval was estimated by using logistic regression analysis. A statistical significance was declared at p-value ≤ 0.05. Results: Of the total 265 study participant, 176 (66.4%) and 95% CI: 60.4%, 71.8% of them reported depressive symptoms. Of 176 reported symptoms of depression 27.9, 24.1, 9.4, 3.7, and 1.1% were had minimal, mild, moderate, moderate-severe, and severe depressive symptoms respectively. The multivariable logistic regression analysis revealed the odds of depression were 2.34 times higher among female participants compared to male participants (AOR: 2.34, 95%CI: 1.09-5.02). In addition, the odds of depression for participants who perceived susceptibility to COVID-19 was 4.05 times higher among their counterpart (AOR: 4.05, 95%CI: 1.12-14.53). Conclusions: Health care workers who experienced depression in the study was high. Health care workers' mental health needs to be protected during the COVID-19 pandemic. Female health care workers and health care workers perceived susceptibility of COVID-19 need attention.

Effects of the COVID-19 pandemic in India: An analysis of policy and technological interventions

Objectives

Following a surge in cases of coronavirus disease 2019 (COVID-19) in June 2020, India became the third-worst affected country worldwide. This study aims to analyse the underlying epidemiological situation in India and explain possible impacts of policy and technological changes.

Methods

Secondary data were utilized, including recently published literature from government sources, the COVID-19 India website and local media reports. These data were analysed, with a focus on the impact of policy and technological interventions.

Results

The spread of COVID-19 in India was initially characterized by fewer cases and lower case fatality rates compared with numbers in many developed countries, primarily due to a stringent lockdown and a demographic dividend. However, economic constraints forced a staggered lockdown exit strategy, resulting in a spike in COVID-19 cases. This factor, coupled with low spending on health as a percentage of gross domestic product (GDP), created mayhem because of inadequate numbers of hospital beds and ventilators and a lack of medical personnel, especially in the public health sector. Nevertheless, technological advances, supported by a strong research base, helped contain the damage resulting from the pandemic.

Conclusions

Following nationwide lockdown, the Indian economy was hit hard by unemployment and a steep decline in growth. The early implementation of lockdown initially decreased the doubling rate of cases and allowed time to upscale critical medical infrastructure. Measures such as asymptomatic testing, public–private partnerships, and technological advances will be essential until a vaccine can be developed and deployed in India.

Public interest summary

The spread of COVID-19 in India was initially characterized by lower case numbers and fewer deaths compared with numbers in many developed countries. This was mainly due to a stringent lockdown and demographic factors. However, economic constraints forced a staggered lockdown exit strategy, resulting in a spike in COVID-19 cases in June 2020. Subsequently, India became the third-worst affected country worldwide. Low spending on health as a percentage of gross domestic product (GDP) meant there was a shortage of hospital beds and ventilators and a lack of medical personnel, especially in the public health sector. Nevertheless, technological advances, supported by a strong research base, helped contain the health and economic damage resulting from the pandemic. In the future, measures such as asymptomatic testing, public–private partnerships, and technological advances will be essential until a vaccine against COVID-19 can be developed and rolled-out in India.