Special Issue : Advancements in COVID 19 – 2nd

SPECIAL ISSUE

Advancements in COVID-19 2nd issue

This Special issue will highlight recent developments in our understanding of COVID-19 and possible paths towards new therapies.

RESEARCH ARTICLES

Tiffany Field1, 2 , Samantha Poling2, Shantay Mines2, Debra Bendell2 and Connie Veazey2

1.University of Miami/Miller School of Medicine

2.Fielding Graduate University

Abstract

Worries about getting the virus and worrying about finances have been associated with negative mood states including anxiety and depression during COVID-19 lockdowns.  In this Survey Monkey study conducted during a COVID-19 lockdown (N= 260 respondents), 88% reported worrying about getting the virus and 72% worrying about their finances. Correlation analyses suggested that worries about the virus and about finances were related to each other and were, in turn, positively related to scores on scales measuring COVID-related stress, negative mood states including anxiety and depression, fatigue, sleep disturbances, and posttraumatic stress symptoms. These problems were common to both types of worries as was the lack of health activities including exercise, self-care, and touching partners and children. Some findings were unique to each of the worries. Worrying about the virus was related to being active on social media, connecting with friends, and housekeeping and paperwork. Worrying about finances was correlated with caregiving, unemployment, less schooling, and alcohol use. The results of this survey are limited by the self-reported data from a non-representative sample that is cross-sectional. Nonetheless, they highlight the negative effects of worries about the virus and about finances during a COVID-19 lockdown.

Ben J.M. Ale1, David H. Slater2, Des N.D. Hartford3

1.Technical University Delft, Mekelweg 5, 2628 CD Delft, The Netherlands.

2.Carey Dene, Carey, Herefordshire HR2 6NG, United Kingdom

3.4-1338 Foster Street, White Rock, B.C. V4B 3X4, Canada

Abstract

COVID-19 has the potential to re-frame the whole debate about individual and societal risk, risk balancing, benefit-cost analysis, individual rights, societal responsibilities of individuals and responsibilities of Governments within the overall context that there are limits to what can be achieved in particular instances, and in totality across society.


There has been considerable discussion and debate globally about the real and perceived risks of having a vaccination against COVID-19. This might be interpreted as having contributed to the uncertainty in the vaccine debate and contributed to doubt and even erosion of trust in some of the population. Some of this has been due to an understandable demand for immediate answers, before the necessary and detailed data were available and verified. The recent publication of unexpected negative side effects from the Astra Zeneca version of the vector-type vaccine, “vaccine induced prothrombotic immune thrombocytopenia” (VIPIT), has been the latest complicating development, which has caused further concerns, uncertainties and confusion.


The risk figures that Governments use are derived from whole population data and processed to give a smeared out average “societal” risk. But to the individuals having to make the choice, these figures may, or may not, be relevant.


The corresponding societal estimate of an individual’s chance of being stuck by lightning is the well-known 1 in a million. But individuals know intuitively that for someone who never goes out in bad weather, this is way too high. Conversely someone who goes out to fly a kite in a thunderstorm has an almost certain chance of being fried.


In this paper we discuss the current arguments put forward, which accept the 1 in a 100,000 as acceptable collateral damage for societal exposure. It then contrasts them against the numbers that could be derived, if it is approached from the point of view of a particular individual’s risk benefit calculations. Subsequently we discuss how communication and information by policy makers and media may influence the decisions of individuals to have or not have themselves vaccinated.  While the current debate about vaccinations provides data and the central focus of this paper, the issue is a general matter, it is symptomatic of a much wider risk question which the vaccine debate has brought into focus; and not just for other vaccines and medical interventions.

Abstract

Since the first reports of a novel corona virus appearing in Wuhan, China, the expanding pandemic has been treated as an almost unique, unprecedented event. Both academic and popular reports have called it “unprecedented” and at best, “the worst in a century.” A brief glance at history argues, however, that there is little unusual about COVID-19 except, perhaps, the rapidity of its global spread. Otherwise its clinical and social realities are familiar, similar to a host of epidemic and pandemic experiences throughout our history. What may be most notable is that our failure to recognize recurring patterns of infectious disease introduction and expansion has caused a general failure to recognize the root sources of microbial evolution and population invasion. And assuming its uniqueness today may prevent us from systemic changes to prepare for the next.

Cassandra M Vanderwall1, Jens Eickhoff2, R Randall Clark3, Aaron L Carrel2

1.Clinical Nutrition Services, UW Health, Madison, WI

2.University of Wisconsin- Madison, Wisconsin

3.UW Health Department of Sports Medicine, Madison, Wisconsin

Abstract

The COVID-19 pandemic has significantly altered children’s daily routines. The health impacts of our obesogenic environment are exacerbated by COVID-19. Many clinicians have concerns that the lack of structured activity, increased stress and altered eating behaviors would lead to increases in adiposity in children. The present study examined changes in body composition as a result of the COVID-19 pandemic in pediatric patients in larger bodies and demonstrates significant increases in total body fat, percent body fat (%fat), and BMI z-score, as well as markers of insulin resistance. In this retrospective, longitudinal study, body composition was measured by dual energy x-ray absorptiometry (DXA) within a multidisciplinary pediatric fitness clinic at an academic medical center. Visit dates were categorized into Pre-COVID-19 (before 4/1/2020) and Peri-COVID-19 (on or after 4/1/2020). Linear mixed effects modeling was conducted to evaluate changes in clinical and laboratory outcomes from Pre- to Peri-COVID-19.

Baseline assessment was obtained from 650 patients with higher BMI scores (52% male) with a mean (SD) age of 12.3 (3.2) years. The adjusted mean BMI z-score (BMIz) was significantly higher in the Peri-COVID-19 sample when compared to the Pre-COVID-19 samples (2.31 vs. 2.25, P < 0.0001) which can be attributed to greater total fat mass (TFM) of 93.0 (90.0-96.4) lbs. (P = 0.007) and %FAT of 40.2% (39.2-41.2) as compared to the Pre-COVID-19 patients. The COVID-19 pandemic influenced social determinants and lifestyle factors. Most notable changes observed were negative changes in physical activity and screen time. The need for social isolation in a pandemic has resulted in worsening obesity and its comorbidities, and pediatricians need to be aware of this issue. The COVID-19 pandemic exerts disproportionate burden on children and families, magnifying their vulnerability to changes in body composition and chronic disease risk.

Angela Tsiang, Magda Havas1

 

Abstract

COVID-19-attributed case and death rates for the U.S.A. were analyzed through May 2020 in three ways – for all 50 states, the country’s largest counties, and the largest counties in California – and found to be statistically significantly higher for states and counties with compared to those without 5G millimeter wave (mmW) technology. 5G mmW index was a statistically significant factor for the higher case and rates in all three analyses, while population density, air quality and latitude were significant for only one or two of the analyses. For state averages, cases per million were 79% higher (p = 0.012), deaths per million were 94% higher (p = 0.049), cases per test were 68% higher (p = 0.003) and deaths per test were 81% higher (p = 0.025) for states with vs. without mmW. For county averages, cases per million were 87% higher (p = 0.005) and deaths per million were 165% higher (p = 0.012) for counties with vs. without mmW. While higher population density contributed to the higher mean case and death rates in the mmW states and counties, exposure to mmW had about the same impact as higher density of mmW states on mean case and death rates and about three times as much impact as higher density for mmW counties on mean case and death rates. Based on multiple linear regression, if there was no mmW exposure, case and death rates would be 18-30% lower for 5G mmW states and 39-57% lower for 5G mmW counties. This assessment clearly shows exposure to 5G mmW technology is statistically significantly associated with higher COVID-19 case and death rates in the U.S.A. The mechanism–should this be a causal relationship–may relate to changes in blood chemistry, oxidative stress, an impaired immune response, an altered cardiovascular and/or neurological response.

Ryan Shoemaker1, S. McMahon2, A. Heyman3, D. Lark4, M. van der Westhuizen5, J. Ryan6

1.Center for Research on Biotoxin Associated Illnesses, Pocomoke, MD

2.Whole World Health Care, Roswell, NM

3.School of Medicine and Health Sciences, George Washington University

4.NSJ EnviroSciences Pty Ltd, Newcastle, NSW, Australia

5.Lynne Murfin, MD, Calgary, AB, Canada

6.ProgeneDx LLC, Bedford, MA

Abstract

Within three months of the onset of acute SARS-CoV-2 (COVID-19) infections, new and persistent symptoms were noted in survivors. While the world’s medical and research communities focus on saving lives following COVID-19 infection, a relentless march of new cases of Post-COVID Syndrome (PCS) continues to spread around the globe as a second COVID-related pandemic. Efforts to define the physiology of PCS, a multisystem, multi-symptom illness, continue without success, in part due to the markedly different case presentations.

Using a transcriptomic assessment of persistently ill cases of PCS, we show the presence of (i) molecular hypometabolism (MHM) and proliferative physiology; (ii) elevated levels of ribosomal stress responses and a concomitant increase in gene activation of TGFBR; and (iii) common co-expression of CD14 and Toll Receptor 4, correlated to exposure of amplified microbial growth in a water-damaged environment, specifically Actinobacteria and endotoxin, respectively, compared to recovered PCS cases. Total symptom scores and visual contrast sensitivity (VCS) results showed statistically significant differences. 

The data reported here supports the concept that PCS occurs in patients with additional environmental exposures and enhanced TGF signaling. In a strikingly similar condition called Chronic Inflammatory Response Syndrome (CIRS), named in 2010, the transcriptomic abnormalities were identified to respond to treatment with FDA-cleared medications, with salutary benefits for affected cases. Though sparsely reported, PCS cases share proteomic findings with CIRS. While additional studies are indicated, a new approach to the treatment of PCS is suggested.

Kunal Saha, MD, PhD
 

Abstract

Building better trust between doctors and patients is key to improving the standard of healthcare delivery system in rich and poor countries alike. Trust between doctors and patients depends on a variety of ill-defined factors that include physician behavior, skill, cost of healthcare and societal perception of integrity of the medical community. Mode of practice of medicine has undergone radical changes during the COVID-19 pandemic with frequent use of PPE and long-distance video consultancy. COVID-19 pandemic has caused enormous pain, suffering and death across the globe.  While many morbidities and mortalities due to COVID-19 were inevitable, gross medical mismanagements of COVID-19 have also contributed to increased rate of death of COVID-19 patients in many countries.  Most importantly, shocking political intrusion of medical science during the COVID-19 pandemic has caused unprecedented erosion of public trust in the medical profession in several countries, particularly in USA and India.  Top medical leaders in the Center for Disease Control (CDC) and Food and Drug Administration (FDA) in USA, the “gold standard” medical authorities, stood speechless next to the USA president, Donald Trump, as he brazenly made numerous false, unscientific and dangerous claims to prevent and cure COVID-19.  Top government healthcare authorities in India also spread misinformation and baseless claims about COVID-19 morbidities and mortalities to misguide ordinary people.  While some devious medical leaders shamelessly supported the bogus claims under sinister pressure from their political leaders, other doctors around the world made tremendous selfless sacrifice and stepped forward to save the victims of COVID-19 even at the risks to their own lives.  Although there is little doubt that experience during the COVID-19 pandemic may have significant impact on public trust in the medical profession in the future, whether doctor-patient relationship will improve or deteriorate in the post-COVID world remains uncertain at this juncture.  But it is imperative that the medical community must send a strong and clear message now disparaging any exploitation of the scientific evidence on COVID-19 pandemic in fear of any political or medical retribution.

Bianca Magro, MD1, Matteo Tacelli, MD2, Luisa Pasulo, MD1, Massimo De Giorgio, MD1

Filippo Leonardi, MD1, Lucà Maria Grazia, MD1,Giovanna Gaffuri, MD1, Michela Triolo, MD, PhD1, Giampaolo Mangia, MD1, Domenico Nobile, MD3, Marco Rizzi, MD4, Fabiano Di Marco, MD, PhD5, Roberto Cosentini, MD6, Andrea Gianatti, MD7, Stefano Fagiuoli, MD, PhD1

1.Gastroenterology, Hepatology and Liver Transplantation, Department of Medicine – Papa Giovanni, XXIII Hospital, Bergamo, Italy

2.Pancreato-biliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy

3.Department of Cardiology, V.Cervello Hospital, Palermo, Italy

4.Infectious Diseases Unit – Papa Giovanni XXIII Hospital, Bergamo, Italy

5.Dipartimento di Scienze della Salute, Università degli Studi di Milano, Respiratory Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy

6.Emergency Department, ASST Papa Giovanni XXIII, Bergamo, Italy

7.Pathology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy

Abstract

BACKGROUND: Sars-Cov-2 pneumonia is a pandemic disease with high morbidity and mortality. In literature transaminases, CRP and LDH were frequently found abnormal but their role has not been clarified.


OBJECTIVES: Aim of this retrospective study is to explore the role of transaminases, CRP and LDH on short-term prognosis of hospitalized COVID-19 patients.


METHODS: patients admitted in hospital for COVID-19 were consecutively recruited. Primary endpoint: evaluate role of transaminases, CRP and LDH on disease progression (DP). Secondary endpoints: find possible risk factors for (1) mortality and (2) CPAP ventilation at day 7. We also analyzed patients without respiratory failure at admission, also a subgroup of patients with liver disease.


RESULTS: 342 patients were included. Median age of patients was 64 years (IQR 55-74), and 35.1% (n=120) was female. At multivariate analysis moderate ALT elevation at Day 1 (p=0.001, OR 2,42, CI95% 1.23-4,73) and CRP at Day 7 (p=0.001, OR 1, CI95% 1-1,1) were predictors of DP; LDH at admission (p=0.05, OR 1, CI95% 1.23-1,1) and moderate AST elevation at day 7 (p=0.04, OR 4,5, CI95% 1.05-19,4) were predictors of CPAP at day 7. At multivariate analysis age (p<0,001, OR 1,12, CI95% 1-1,2) and sex (p=0.01, OR 14, CI95% 1,7-116,7) were predictors of death. Mortality rate of patients with liver disease was 25%(n=3/12).


CONCLUSIONS: Moderate ALT elevation at day 1 and moderate AST elevation at day 7 were respectively, predictors of DP and CPAP at day 7. For patients without respiratory failure, transaminases are not significative for anyone of our outcomes. Age, sex and CRP at day 1 are death risk factors.

Breanna Davidson Wisseman1, Christian Jones1, Nia Golembe2, Edward R Newton3,

Christy Isler3, James deVente3, Samantha McDonald4, Cody Strom5, Devon Kuehn6, Linda E May1,3,7

1.Department of Kinesiology, East Carolina University

2.Department of Public Health, East Carolina University

3.Department of Obstetrics and Gynecology, East Carolina University

4.School of Kinesiology and Recreation, Illinois State University

5.Department of Kinesiology and Sport, University of Southern Indiana

6.Department of Pediatrics, East Carolina University

7.Department of Foundational Science and Research, East Carolina University

Abstract

Background. The COVID-19 pandemic led to decreased physical activity, as well as increased stress, especially for pregnant women. Exercise is effective for decreasing stress and improving overall maternal and infant health. To date, research has not determined whether an at-home exercise program during pregnancy elicits similar results to in-person exercise.

Objective. To examine the effect of in-person vs at-home moderate-intensity exercise training during pregnancy on maternal cardiovascular and birth outcomes during the COVID-19 pandemic.

Methods. Pregnant women were recruited between 13-16 weeks’ gestation and randomized to either an exercise or control group. No control subjects were included in this analysis; exercisers were asked to complete at least 50-minutes of moderate-intensity activity 3 times each week either in-person (n=20) or at-home (n-17). Both groups were provided individualized exercise prescriptions including a 5-minute warm-up, 50-minutes of exercise related to group allocation, and a cool-down period. Maternal resting heart rate and blood pressure (BP) were recorded at 16- and 36-weeks’ gestation. Gestational weight gain and birth outcomes were obtained via electronic health record at delivery.

Results. From enrollment to late pregnancy, at-home exercisers have significant increases in systolic and diastolic BP (SBP and DBP, p<0.001 and 0.0003, respectively) whereas the in-person group did not (p=0.30 and 0.78, respectively). In-person exercisers had lower SBP and DBP in late pregnancy (p=0.04 and 0.01, respectively) relative to at-home exercisers. At-home exercise was correlated with higher late pregnancy SBP (r=-0.34, p=0.04), DBP (r=-0.42,p=0.01), and SBP change (r=-0.496, p=0.002). Group allocation was a predictor for late pregnancy DBP (p=0.007) and SBP change (0.036). There were no differences in infant birth outcomes.

Conclusion. Supervised in-person exercise training with the proper precautions has similar birth outcomes and may be more beneficial for maternal cardiovascular health relative to at-home training.

Ashaq Parrey, Abir Aijaz,Mohd Ismail,Mir Sadaqat, Manzoor Koka, Murtaza Noor, Basharat Ahmad, Hilal Bhat, Yasmeen Amin.
 

Abstract

Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. The outbreak of SARS-CoV-2 was considered to have originally started via a zoonotic transmission associated with the seafood market in Wuhan, China. Later it was recognized that human to human transmission played a major role in the subsequent outbreak. The Inflammatory responses caused by  viral replication of SARS-CoV-2 with cellular destruction can recruit macrophages and monocytes and lead to the release of cytokines and chemokines.These  inflammatory markers then attract immune cells and activate immune responses, leading to cytokine storms .Many such inflammatory markers have been attributed to determine the severity of SARS-CoV-2 disease   and mortality associated with it. The Inflammatory markers such as   serum ferritin, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and interleukin-6 (IL-6) have been reported to be significantly associated with the high risks of the development of severe COVID-19 disease.  

Aims and objectives

The aim of the study was to find out correlation between inflammatory markers and HRCT chest severity in hospitalised COVID-19 patients.

 Results and conclusion.

The study supported the existing data that high load of inflammatory markers is associated with more severe COVID-19 lung disease and indirectly high mortality ,out of four inflammatory markers which included D Dimer ,IL6,Serum ferritin and LDH we found three markers  IL6,Serum ferritin and LDH has significant relation with CT severity

Ravindra Mehta1,Sameer Bansal1, Ashwin Kumar1, Anmol Thorbole1, Chakravarthi Loknath1, Hariprasad Kalpakam1

1.Apollo Super Speciality Hospital, Bangalore

Abstract

Alternative splicing enables the generation of different proteins from a single gene, greatly increasing the use of genetic information. The resultant protein isoforms often have different biological properties effecting the phenotype of the cell in which it is expressed. Dysregulation of alternative splicing is a common occurrence in cancer and may lead to the formation of truncated or degraded proteins through the introduction of immature stop codons or nonsense mediated decay. Increasing evidence indicates that cancer-associated splicing variants play an important role in tumor initiation and progression. In this review, we summarize the evidence supporting the relevance of alternative splicing in glioblastoma multiforme (GBM). Specifically, we focus on the role of alternative splicing in GBM pathogenesis with an emphasis on the effect of aberrant alternative splicing of FGFR, GLI-1, and EGFR. The significance of exploiting alternatively spliced isoforms as potential biomarkers which may contribute to the development of diagnostic and prognostic methods, in addition to serving as molecular targets in GBM, will be discussed.

Masafumi Seki, MD, PhD
 

Abstract

The presence of secondary bacterial infection is important in viral infectious disease. Influenza is known to become more severe with secondary bacterial pneumonia in particular when the Streptococcus pneumoniae and Haemophilus influenzae are co-infected, but with COVID-19, there are thought to be few concomitant bacterial infections. However, mortality in COVID-19 patients also increases with secondary bacterial infections, mainly Staphylococcus aureus such as MRSA and Gram-negative bacilli, and vigilance is needed. Consequently, there is a rising trend in prescriptions for antibiotics, but more appropriate diagnosis and antimicrobial stewardship are needed to suppress antimicrobial resistance, and vaccination will be the key strategy to prevent the severe viral infections related with secondary bacterial infection.

Abibatou SALL1, Baye Diam SANON1, Mba Bamboo DIAKHABY2, Assane DRAME1, Diama SAMB1, Louise FORTES3, Moussa SECK4, Blaise Félix Faye4, Awa Oumar TOURE4, Saliou DIOP4

1.Laboratory of Hematology, Dalal Jamm Hospital. Dakar-Senegal

2.Laboratory of Virology, Dalal Jamm Hospital. Dakar-Senegal

3.Epidemic Treatment Center, Dalal Jamm Hospital. Dakar-Senegal

4.National Blood Transfusion Center. Dakar-Senegal

Abstract

Background

SARS-CoV-2 infection is characterized by high contagiousness, morbidity and mortality which are accompanied by various biological changes, particularly hematological changes. Its association with blood groups has been revealed by several authors. Our overall goal was to find a link between ABO blood groups and COVID-19 in African population

Patients and Methods

We conducted a prospective, descriptive and analytical study carried out in the epidemic treatment center and the hematology laboratory of the Dalal Jamm hospital in Dakar. All patients aged over 18 years, and tested positive for SARS-CoV-2 infection by molecular biology, were included. Clinical data was provided by attending physicians.

The complete blood count was performed on NX1500 (Sysmex Japan) and blood grouping was done on the Ortho device (Ortho, Clinical Diagnostic, USA).

The data were compiled using the Microsoft Excel. Statistical analyses were performed on SPSS. The confidence interval of 95% was used for the estimations and statistical tests were considered significant when the p-value was below 0.05

Results

A total of 259 patients were recruited including 157 males and 102 females with a mean age of 56.7 years. The comorbidities were dominated by high blood pressure (28.46%) and diabetes (13.08%). The non-severe forms represented almost three-quarters of our population. The distribution of ABO groups in our population showed a predominance of group O (49.57%) followed by groups A (28.21%), B (17.09%) and AB (5.13%) (O> A> B> AB). This same formula was found in our reference sample. However, blood group A was more represented in our population compared to that of reference with a difference at the limit of significance (p = 0.055). Regarding blood groups according to clinical forms, we found that group A had twice the risk of developing a severe form [OR = 1.95; CI = 1.06-3.57; p-0.032] while the O group would be protective [OR = 0.76; CI = 0.59-0.89; p-0.02]. This trend was however lost on multivariate analysis.

Conclusion

Our study revealed that blood group A was linked to the severity of COVID-19 but this result remains to be confirmed with much larger sampling.

Joyce Wangui Kiarie1, Samuel Musili Mwalili2, Rachel Waema Mbogo1

1.Institute of Mathematical Sciences, Strathmore University, Nairobi, Kenya

2.School of Mathematics, Jomo Kenyatta University of Agriculture and Technology, Machakos, Kenya; Institute of Mathematical Sciences, Strathmore University, Nairobi, Kenya.

Abstract

Background: COVID-19 disease has persisted since it was declared a global pandemic by the World health organization (WHO) in February 2020. Kenya had notified a total of 203,213 cases, reported 3,931 deaths by July 26, 2021. Currently, Kenya is experiencing the fourth wave of the pandemic that is driven by the delta variant which has become dominant in the country. Non-pharmaceutical and vaccination interventions have been ongoing in the country. With the emergence of new variants, it’s challenging to know the future of the pandemic and its effects on the healthcare systems, vaccination plans, public readiness, and social behavior. To attain realistic predictions, data-driven modeling approaches are paramount. The goal of this study was to model COVID-19 cases in Kenya using the already available data to estimate parameters

Methods: An SEIR compartmental model was developed to predict the daily new cases, severe, critically ill, and death cases of COVID-19. The model had 8 compartments containing sub-populations of: Susceptible, Exposed, Symptomatic Infectious, Asymptomatic Infectious, Hospitalized, Intensive Care Unit, Deaths and Recovered. The model equations were then solved to obtain the number of cases that would be infected on a daily basis beginning March 14th to July 2021.

Results: The results demonstrated evidence of three peaks, first in mid July 2020, second in mid-October 2020 and third in early March of 2021. The number of daily cases in wave 1 was 1128 then increased to 1344 in the second wave and finally a decline was observed in wave 3 with 1057 number of daily of infections. The number of severely, critical and deaths followed a similar pattern. This therefore means that with the absence of herd immunity in the general human population, relaxation of the mitigation measures will eventually result to progression of COVID-19 cases.

Conclusion: Increased vigilance on the COVID-19 curve is indispensable. Continued interventions such as testing, social distancing measures, vaccination, and health facilities preparedness are imperative to ensure that new infections are isolated in real-time. Use of real time data to estimate the pandemic trends is a more realistic way of informing new and appropriate interventions amidst the ongoing pandemic.

Amr kamel Ahmed1, Ghareeb Alshuwaier2, Randa Mohamed M.A. Farag3, Abdulrahman I. Alaqil4, Asmaa Houjak5, Mahmoud Elkazzaz6

1.Director of the tuberculosis program Ghubera, public health department, First health cluster, Ministry of Health, Riyadh, Saudi Arabia

2.Assistant Professor of Sports Nutrition – Sports Nutritionist – Head of Exercise Physiology Department – Researcher, King Saud University, Riyadh, KSA

3.Virology and Molecular biology, Health Sciences Research Center (HSCR), Princess Nourah bint Abdulrahman University (PNU), Kingdom Saudi Arabia, KSA

4.Department of Physical Education, College of Education, King Faisal University, Al-Ahsa P.O. BOX 31982 ZIP 400, Saudi Arabia

5.Department of Chemistry, Faculty of Science, Princess Nourah bint Abdulrahman University (PNU), Riyadh, Saudia Arabia

6.Department of Chemistry and Biochemistry, Faculty of Science, Damietta University, Egypt

Abstract

Many studies pointed to il-6 as hall marker for severity and prognosis of covid-19 patients and represent the most important cornerstone at the discovery of many drugs for inhibition of it for switch-off of cytokine storm which is the concern of all scientists and patients together and a new disease at future medicine as covid-19 begin at last of December 2019. The sources of il-6 after viral stimulation are from macrophages and monocytes at many inflammatory sites or from stimulation of the HPA axis (endocrine il-6 ACTH stimulated) or respiratory il-6 stimulated by strenuous resistive breathing because contracting of respiratory muscles is considered like exercise and produce cytokines due to glycogen depletion

The Discovery of a non-invasive and easy method to examine il-6  which is the most important marker for severity and cytokine storm represent a new horizon for future viruses and modern medicine and that accelerates the intervention and depression of cytokine storm as early as possible and open the door for the discovery of many drugs work on this exhaled il-6 so our method for examination of il-6 at exhaled of covid and postcovid-19 patients help doctors for rapid categorization of patients and suspicion of severity. So, our study is a novel method for examination of il-6 Herein we intend to investigate the level of IL-6 in a breath of COVID-19 patients for the diagnosis of the early stages of lung inflammation and fibrosis. LTB4 is a potent chemoattractant and stimulator of neutrophils, without any significant effect on airway muscle. And increased in exhaled of children with mild and moderate to severe persistent asthma.

Don Albrecht

Utah State Univeristy

Abstract

Analysis of U.S. counties revealed that political views were strongly related to COVID-19 deaths per 100,000 residents. Death rates were much higher in counties that strongly supported Trump in the 2020 presidential election than in counties where he received a lower proportion of the vote. The relationship between political views and COVID-19 deaths remained strong in regression models after other relevant variables were statistically controlled. The relationship between political views and COVID-19 deaths rates was especially strong after vaccines were generally available to the general public. Results from this study indicate that persons in Trump leaning counties tended to not follow the advice of health experts, including wearing masks, social distancing, and getting vaccinated against the COVID-19 virus. Such actions resulted in thousands of unnecessary deaths.

Gabriel Johnson, PharmD1, Sarah Lim, MBBCh2, Daniel O Griffin, MD, PhD1,3,4, Xiong Wang, PhD2, Lida R Etemad, PharmD3

1.OptumLabs, UnitedHealth Group, Minnetonka, Minnesota

2.Minnesota Department of Health

3.OptumLabs, UnitedHealth Group, Minnetonka, Minnesota; ProHealth NY Lake Success, NY;

4.Department of Medicine, Division of Infectious Diseases, Columbia University, College of Physicians and Surgeons, New York, NY 10032

 

Abstract

Objective: Several investigational monoclonal antibody (mAb) therapies have Emergency Use Authorizations (EUA) for the treatment of mild to moderate coronavirus disease 2019 (COVID-19). In well-designed randomized clinical trials (RCTs), mAb therapies have demonstrated a reduction in the progression to hospitalization and death in high-risk individuals. This study assessed the real-world efficacy of treatment with mAb therapy during a time with a high percentage of the Alpha variant circulating.

Methods: We performed a prospective study looking at the progression to hospitalization in a high-risk treatment population that qualified for mAb therapy under the current EUA and that consented to have their viral isolates undergo whole genome sequencing (WGS) to assess for the presence of genetic variants. A total of 125 patients consented to participate and ultimately 81 participants that both had obtainable sequence data and completed follow-up were included in the final analysis. Based on the risk profile of these participants we anticipated a >10% hospitalization without therapy and a 70-80% reduction based on prior RCTs. Five of the 81 patients (6%) were hospitalized despite monoclonal antibody therapy. The most common variant was Alpha (n=66, 81%), followed by other unknown variants (n=6, 7%), Iota (n=3, 4%), Epsilon (n=2, 2%), Gamma (n=2, 2%), and no variant detected (n=2, 2%).

Conclusion: Monitoring of the local variants, proper procurement decisions regarding specific mAb treatment effective against circulating variants and following real world efficacy has the potential to positively impact the use of mAb therapies. Future studies are needed to assess the efficacy of different mAb treatment results in real world settings with various SARS-CoV-2 variants, various treatment delays and various populations.

Willem van Aardt, BProc (Cum Laude), LLM (UP), LLD (NWU)
 

Abstract

The global fervor to develop and deliver a vaccine to protect people against COVID-19, the disease caused by SARS-CoV-2, has been extraordinary. COVID-19 vaccine development has been pursued at an unprecedented speed and scale; following the Emergency Use Authorization (EUA) of COVID-19 vaccines, rapid mass vaccination deployment efforts commenced in all earnest.  This fervor to get a needle into every arm has now led to the European Commission president calling on the EU’s 27 member states to consider mandatory vaccination across Europe.  With an intensification in COVID-19 vaccine hesitancy and many refusing to be vaccinated, an important question that arises is whether obligatory COVID-19 vaccination policies are ethical and legal in terms of international human rights norms and standards. Article 4(2) of the International Covenant on Civil and Political Rights which was ratified by 193 States Parties worldwide enumerates a specific list of human rights from which no derogation is allowed even in times of a public emergency. Included in this list of non-derogable rights is a sub-category of internationally recognized human rights known as “physical integrity rights” that includes the right to be free from medical or scientific experimentation. International human rights law is unambiguous that all people should be afforded their non-derogable fundamental human right to free and informed consent.  Normative ethical perspectives and legal obligations erga omnes dictate that States Parties should not make COVID-19 vaccination mandatory in breach of International Human Rights Law relating to non-derogable rights that are regarded as core human rights, jus cogens.  A bioethics perspective, rooted in fundamental human rights, should play a crucial role in the COVID-19 pandemic.

Mike Astorp1,2, Gustav V. Gade2,3, Jeppe Emmersen4, Alexander W. Erbs2,3, Sten Rasmussen2, Stig Andersen2,5

1.Department of Emergency Medicine and Trauma Care, Aalborg University Hospital

2Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;

3.Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark

4.Faculty of Medicine, Aalborg University, Niels Jernes Vej 10, 9000 Aalborg, Denmark

5.Department of Geriatric Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark.

Abstract

Background: The covid-19 pandemic hit healthcare systems globally, and demands on healthcare worker resources rose dramatically. Medical students are a potential resource to meet these demands, but to what extent can they be expected to step up, and where can they fill in.

Aims: To evaluate medical students’ contribution as healthcare workers during the pandemic and assess motivation and deterrence factors.

Methods: A cross-sectional survey questionnaire was distributed one year following the lockdown of the country and accessible from March 18th through April 14th 2021. All medical students enrolled at Aalborg University were asked about positions held, number of working hours, and factors of motivation and deterrence.

Results: The response rate was 69% (557 of 806), and 80.4% (448 of 557) of the respondents had performed paid work as healthcare workers during the pandemic. Students took up an array of jobs in the healthcare system, the most prevalent being Covid-19 test-personal (302, 54%), assistant nurse (149, 27%) and locum physician (115, 21%), with 42.2% (235 of 557) of medical students holding more than one position. The majority worked between 11 and 20 hours weekly, and the 448 medical students working in the pandemic reported filling in for 205 full-time jobs. Working students differed from non-working students by giving the most markedly higher scores to taking pride, participating in a historical event, receiving salary and improving job opportunities (all, p<0.001).

Conclusion: Medical students proved to be willing contributors and flexible resources. The 448 medical students worked an estimated 344,000 hours during the first year of the pandemic, and they supported several job types. Differences within domains for motivation and deterrence were identified.

REVIEW ARTICLES

Tiffany Field, PhD

Abstract

     COVID-19 pediatric problems have been similar to those for adults, including medical, neurological, sensory and psychological conditions, although they have typically been less prevalent and severe. The lesser severity in children may relate to their less mature viral receptors, less dysregulation of immune responses, and a lesser incidence of pre-existing comorbid conditions. This narrative review is a summary of publications found on PubMed for 2019-2021 on the prevalence of infection and the characteristics of the clinical condition that has predominated for children (multisystem inflammatory syndrome typically presenting with fever and cough in 1-5% of children between the ages of 1 and 14). Most of the extra-pulmonary symptom literature has focused on neurological, sensory and psychological conditions including headaches and loss of smell and taste as well as skin problems. The research on psychological symptoms has noted helplessness, worry and fear as well as more serious problems including anxiety, depression, PTSD symptoms and suicidal ideation. These problems have been attributed to less exercise, separation from schools and peers, over-exposure to social media, already existing psychiatric disorders and chronic illnesses that have been exacerbated by COVID-19. Methodological limitations of the literature include small sample, cross-sectional studies assessing single variables in countries that experienced lockdowns early in the pandemic. And, sequelae or post-COVID problems have rarely been researched.


This narrative review was intended to be a brief overview of publications on medical, neurological, sensory and psychological problems that children and adolescents have experienced during COVID-19. The review is based on some of the larger sample studies and systematic reviews that appeared on PubMed for the years 2019-2021. The terms pediatrics, children, adolescents and COVID-19 were entered and the search yielded 173 papers. Inclusion criteria were peer-reviewed studies and systematic reviews. Case reports and non-English papers were excluded. Following these criteria, 57 papers were selected. The resulting review that reflects the current literature includes prevalence data, clinical characteristics and potential underlying mechanisms. Consistent with the aims of this review, the paper is divided into sections on medical, neurological, sensory and psychological conditions as well as COVID-19 sequelae.

Al Giwa Pamela B. Teaster, Ph.D., M.A., M.S.

Abstract

Early into the COVID pandemic, epidemiologists and infectious disease experts warned that older adults were among those most vulnerable to the disease, as multiple studies from China, Italy, Washington State, and New York City showed that age greater than 65 significantly increased the risk of severe disease and/or death from the novel 2019 coronavirus. Centers for Disease Control data through June 2020 show that nearly 81% of deaths due to COVID-19 are of people 65 years of age and older. These breakdowns indicate that, primarily, persons with advanced age and most, often, those with multiple chronic conditions are those who have died. The effects of the virus led to public health measures aimed at reducing exposures of older people and other vulnerable populations.  The disease was amplified in rehabilitation centers, skilled nursing facilities, assisted living centers, group homes, and other long-term care facilities serving a primarily geriatric population. Even as parts of the country are opening up, the death toll is still climbing and affecting the older adult population disproportionately.  Duty to care, autonomy and self-determination, non-judgmental regard, justice, and futility are all significant ethical principles and constructs that have arisen in the intense and real-time application of healthcare as we continue to face the present global pandemic. We use an ethical lens to examine the medical response of the SARS-CoV-2 pandemic on the older adult population and explore if society is doing enough to protect older adults, or rather, engaging in and furthering collective and systematic elder abuse. 

Sage J Kim, PhD1, Karriem Watson1, DHS, MS, MPH2, Nidhi Khare3, Shreyas Shastri3, Carla Da Goia Pintpo, MBBS, MPH4, Noreen T Nazir, MD5

1.Associate Professor, University of Illinois at Chicago, School of Public Health, Division of Health Policy & Administration

2.Associate Executive Director, Mile Square Health Center, Research Assistant Professor, University of Illinois at Chicago, School of Public Health, Division of Community Health Science

3.Research Assistant, University of Illinois at Chicago, School of Public Health

4.Visiting Research Specialist, University of Illinois Cancer Center

5.Assistant Professor, University of Illinois at Chicago, College of Medicine

Abstract

Mile Square Health Center (MSHC), a network of Federally Qualified Health Centers (FQHCs) run by the University of Illinois Hospital (UIH) in Chicago, established Drive-Thru and Walk-Up COVID-19 testing sites.  The primary aim of the UIH/MSHC testing project was to increase testing capacity in the most affected, racial/ethnic minority communities.  More than 7,500 tests were performed over a six-month period.  Half of those who were tested were Black and Latinx residents.  The majority of those tested at the Walk-Up sites were Black, while “Other” race group tended to get tested in Drive Thru testing sites.  Latinx residents had the highest positivity rate, followed by Other race group.  Younger age groups were more likely to have higher positivity rates.  Overall, UH/MSHC testing results reflected the overall Chicago COVID-19 testing results.  Our findings substantiate the need to advocate for equitable resource allocation to counter the disproportionate burden of COVID-19 infection among minority communities.  FQHCs were shown to be an effective approach to reduce structural barriers to COVID-19 testing and subsequently reduce disparities.  Going forward, FQHCs can be key to ensuring COVID-19 vaccine outreach and dissemination. 

Godwin B. Turyasingura1, Everd B. Maniple1, Nathan Nhakira1

1.Kabila University

Abstract

The index case of COVID-19 in Uganda was reported on 20th March 2020.  The first confirmed imported case of COVID-19 in Kigezi sub- region South Western Uganda, where Kabale University is located, was reported on April 24th 2020. On August 2nd 2020 the first COVID-19 community case was recorded in the Kigezi Sub-region. Right from the early days of the threat of COVID-19 spread in Uganda, Kabale University put in place multiple mechanisms and interventions to contain the pandemic including:

A COVID-19 Study Group: set up in February 2020 to study the disease, carry out risk assessment and advise the University on how to be prepared to handle cases if the disease were to reach the environment of the University.

A multidisciplinary Kabale University COVID-19 Task Force: set up on 30th March 2020 to advise the University on preparations to ensure safe continuity of business at the university during a possible outbreak of COVID-2019 by designing and implementing appropriate infection prevention and control (IPC) measures, the Standard Operating Procedures (SOPs), for the University community.

COVID-19 Knowledge Attitudes & Practice (KAP) Study –to inform planning for safe maintenance of business continuity at the university in the face of the COVID-19 outbreak. Following a national lockdown, the purpose of the study was to guide development of necessary measures to be undertaken to minimize the spread of COVID-19 among students, staff and visitors when re-opening of the University became imminent. The study revealed high levels of knowledge (84% correct rate of response); an overall positive attitude (77% positive rate of response); but only moderate COVID-19 preventive practices (68.8% correct rate of preventive practice). Knowledge was higher among male students (p=0.033); students older than 20 years (p=0.000); and students taking health related courses such as Medicine or Nursing (p=0.019). Attitudes about COVID-19 were better among female students (p=0.034); and in students older than 20 years (p=0.000).  Age and sex are significant predictors of COVID-19 prevention practices (p=0.001, p=0.000 respectively).

These findings informed the need for:

    • Effective behavioral change communication: to alert the university and the neighboring communities about COVID-19. The strategies to be used to achieve this were; Internal memos to the university community through e-mail, social media and written notices placed in strategic areas, Radio talk shows through several FM radio stations in Kabale town and, Branded health literacy print-outs in form of posters, leaflets and brochures.
    • Promotion of good respiratory and oral and hand hygiene – to discourage; haphazard spitting, ejecting or smearing nasal mucus on public places, sneezing or coughing in public without protection, and promotion of frequent handwashing.
    • Random COVID-19 testing – One such test in June 2021 revealed positivity rate of 17.8%
    • Development of the Kabale University COVID-19 Standard Operating Procedures.

The order of personal prevention priorities emphasized in the SOPs were; face masking, hand washing with running water and soap or disinfectant, hand sanitizing with 70% alcohol and, keeping a physical distance of at least 2 meters from one another etc. With vaccination, this order has now been revised to give top priority to vaccination, although we still equally emphasize maintenance of the previous strategies.

CASE REPORTS

Priscilla Hirst, MD1, Benjamin Tate Fedeles, MD2, Joseph J. Schlesinger, MD, FCCM2

1.Montefiore Health System

2.Vanderbilt University Medical Center

Abstract

Various neurological manifestations have been observed throughout the SARS-CoV-2 disease (COVID-19) pandemic. However, few cases of Guillain-Barré syndrome (GBS) in association with COVID-19 have been described. We submit a unique case of a previously healthy 28-year-old woman who presented with ascending weakness including facial diplegia, areflexia and respiratory compromise consistent with GBS Miller Fisher variant in the setting of recent COVID-19 infection one month prior to symptom onset. 

I. Takorov1, Lukanova1, S. Simeonovski1, D. Vylcheva1, D. Dimitrov1, Ts. Stanimirov1, S. Arnaudov1, M. Abrasheva2

1.First Clinic of Abdominal Surgery, Military Medical Academy, Sofia, Bulgaria

2.Department of Anesthesiology and Intensive Care, Military Medical Academy, Sofia, Bulgaria

Abstract

Spontaneous pneumomediastinum is one of the few rare complications of coronavirus disease – 19 (COVID-19) pneumonia. We report a case of a male patient with COVID-19 disease, severe pneumonia and spontaneous pneumomediastinum, supported via high-flow nasal cannula (HFNC) oxygen supplementation. Factors causing pneumomediastinum are discussed, but further research is still necessary.

Ritwik Ghosh, MD1, Dipayan Roy, MD2, Adrija Ray, MBBS3, Shambaditya Das, MD, DM4, Amrita Mandal, MBBS5, Shambaditya Das, MD, DM4, Shyamal Kanti Pal, MD1, Julián Benito-León, MD, PhD6

1.Department of General Medicine, Burdwan Medical College &amp; Hospital, Burdwan, West Bengal, India

2.Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India; Indian Institute of Technology (IIT), Madras, Tamil Nadu, India

3.Department of Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India

4.Department of Neuromedicine, Bangur Institute of Neurosciences (BIN), Kolkata, West Bengal, India

5.Bankura Sammilani Medical College and Hospital, Bankura, West Bengal, India

6.Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Department of Medicine, Complutense University, Madrid, Spain.

Abstract

Background: Hemorrhagic cerebrovascular events, either due to aneurysmal rupture or spontaneous subarachnoid hemorrhage (SAH), are not rare in COVID-19. Several mechanisms such as coagulopathy, cytokine storm, viral endotheliopathy, hypertension, and immune modulation might play a role in the pathogenesis of SAH in COVID-19. This study aimed to report the first case of spontaneous non-aneurysmal SAH associated with SARS-CoV-2 from India. We briefly discussed the possible pathogenetic mechanisms underlying this process and succinctly reviewed the relevant literature.

Case report: We herein report a case of a non-comorbid young woman infected with SARS-CoV-2 presenting with thunderclap headache and eventually non-aneurysmal SAH,  who recovered with conservative management.

Conclusion: Headache, although a very common clinical feature of COVID-19 itself, must be investigated in detail to identify alternate causes that may be life-threatening. This case also incites further enquiry into the possible pathogenic mechanisms of neurovascular complications in COVID-19.