Comparing the Clinical Characteristics and Mortality of Residential and Non-Residential Older People with COVID-19: Retrospective Observational Study

Nursing homes have accounted for a significant part of SARS-CoV-2 mortality, causing great social alarm. Using data collected from electronic medical records of 1,319,839 institutionalised and non-institutionalised persons ≥ 65 years, the present study investigated the epidemiology and differential characteristics between these two population groups. Our results showed that the form of presentation of the epidemic outbreak, as well as some risk factors, are different among the elderly institutionalised population with respect to those who are not. In addition to a twenty-fold increase in the rate of adjusted mortality among institutionalised individuals, the peak incidence was delayed by approximately three weeks. Having dementia was shown to be a risk factor for death, and, unlike the non-institutionalised group, neither obesity nor age were shown to be significantly associated with the risk of death among the institutionalised. These differential characteristics should be able to guide the actions to be taken by the health administration in the event of a similar infectious situation among institutionalised elderly people.

Lessons from the past in the present: news from the Spanish flu pandemic to COVID-19

ABSTRACT Objective: to analyze the health conducts for combating the Spanish flu and its relationship with the COVID-19 pandemic in Rio de Janeiro. Methods: study from the perspective of microhistory, with analysis of articles published in Revista da Semana on the Spanish flu, having as criteria publications with the term "epidemic" referring to the Spanish flu or influenza in the period of the epidemic outbreak in Rio de Janeiro, Federal District. Results: 18 records, organized in three thematic axes: political, 4; social, 11; care, 3, were found. Final considerations: the lessons left by the Spanish flu epidemic in coronavirus times will be changes in the political, social and care field as marks of major epidemics.

Results of isolation and genotyping of measles viruses that circulated in 2012–2017 in the Odesa region

Background. The circulation of different strains of the measles virus is closely related to the region and the incidence rate since circulating strains can change during epidemic outbreaks and in interepidemic periods. According to the WHO, the B3 strain is most common during outbreaks worldwide. Therefore, typing of circulating strains of measles virus, especially during an epidemic outbreak, is an important process, inclu­ding for predicting the development of an epidemic. The study was aimed to identify and determine the genotype of measles virus types that circulate in Ukraine during 2012–2019. Materials and methods. Materials of the reporting documentation of the State Institution “Odessa Regional Laboratory Center of the Ministry of Health of Ukraine” in the Odessa region during 2012–2019 were used and analyzed. Materials from patients with suspected measles were used for molecular biological, genetic, analytical, and statistical approaches investigation. Following the standard WHO protocol for sequencing and phylogenetic analysis, circulating measles virus strains were isolated from the patient in a special culture of Vero/SLAM cells. Measles virus RNA was isolated from the resulting virus-containing material after cultivation and RT-PCR was performed. The resulting cDNA was sent for genotyping, which was carried out at the WHO reference labo­ratory for the diagnosis of measles and rubella in Luxembourg (WHO RRL). Results. Twenty strains of measles virus from 45 samples (urine and nasopharyngeal swabs) from patients diagnosed with measles were isolated during 2012–2014. Virus isolation was not carried out in 2015–2016 due to isolated cases of the disease. Twenty-four virus strains from 164 samples were isolated in 2017. Conclusions. The results obtained at the State Institution “Odessa Regional Laboratory Center” demonstrated that during the interepidemic period of 2012–2014, the D4 geno­type circulated in the region. But since 2017, when there was an increas of cases associated with a new epidemic outbreak, B3, genetic line MVs/Kabul.AFG/20.2014/3 B3 mainly circulates in the region of southern Ukraine. As you can see, these data completely coin­cide with the data about circulating genotypes that were found at a certain time in the European Region, according to the data from the literature.

Worldwide clustering and infection cycles as universal features of multiscale stochastic processes in the SARS-CoV-2 pandemic

Predicting the evolution of the current epidemic depends significantly on understanding the nature of the underlying stochastic processes. To unravel the global features of these processes, we analyse the world data of SARS-CoV-2 infection events, scrutinising two eight-month periods associated with the epidemic's outbreak and initial immunisation phase. Based on the correlation-network mapping, K-means clustering, and multifractal time series analysis, our results reveal universal patterns, suggesting potential predominant drivers of the pandemic. More precisely, the Laplacian eigenvectors localisation has revealed robust communities of different countries and regions that then cluster according to similar shapes of infection fluctuations. Apart from quantitative measures, the immunisation phase differs significantly from the epidemic outbreak by the countries and regions constituting each cluster. While the similarity grouping possesses some regional components, the appearance of large clusters spanning different geographic locations is persevering. Furthermore, cyclic trends are characteristic of the identified clusters, dominating large temporal fluctuations of infection evolution, which are prominent in the immunisation phase. Meanwhile, persistent fluctuations around the local trend occur in intervals smaller than 14 days. These results provide a basis for further research into the interplay between biological and social factors as the primary cause of infection cycles and a better understanding of the impact of socio-economical and environmental factors at different phases of the pandemic.

Worldwide clustering and infection cycles as universal features of multiscale stochastic processes in the SARS-CoV-2 pandemic

Predicting the evolution of the current epidemic depends significantly on understanding the nature of the underlying stochastic processes. To unravel the global features of these processes, we analyse the world data of SARS-CoV-2 infection events, scrutinising two eight-month periods associated with the epidemic’s outbreak and initial immunisation phase. Based on the correlation-network mapping, K-means clustering, and multifractal time series analysis, our results reveal universal patterns, suggesting potential predominant drivers of the pandemic. More precisely, the Laplacian eigenvectors localisation has revealed robust communities of different countries and regions that then cluster according to similar shapes of infection fluctuations. Apart from quantitative measures, the immunisation phase differs significantly from the epidemic outbreak by the countries and regions constituting each cluster. While the similarity grouping possesses some regional components, the appearance of large clusters spanning different geographic locations is persevering. Furthermore, cyclic trends are characteristic of the identified clusters, dominating large temporal fluctuations of infection evolution, which are prominent in the immunisation phase. Meanwhile, persistent fluctuations around the local trend occur in intervals smaller than 14 days. These results provide a basis for further research into the interplay between biological and social factors as the primary cause of infection cycles and a better understanding of the impact of socio-economical and environmental factors at different phases of the pandemic.

Impact of COVID-19 pandemic on outcome of acute appendicitis: a retrospective analysis

Background: Acute appendicitis is the most common abdominal surgical emergency. Lockdown and stay-at-home orders are strategies that were implemented globally during the acute pandemic period of COVID-19 to prevent disease dissemination, health system overload and mortality. However, there are concerns that patients did not seek necessary health care because of these rules.Methods: Retrospective observational study was conducted on patients who presented with acute appendicitis from January 2020 to May 2020. They were classified according to the time of presentation that is before declaration of the state of alarm (pre-COVID-19), and after its declaration (post-COVID-19) in India (24 March 2020). An evaluation was made of demographic variables, complications and duration of hospital stay in both the groups.Results: 45 patients were included, 20 in pre-COVID-19 group and 25 in post-COVID-19 group. In post-COVID-19 group, the interval from onset of symptoms to admission was 65.0 hour, which is significantly longer than the 17.3 hour interval noted in pre-COVID-19 group (p<0.001). The prevalence of complicated appendicitis after the epidemic outbreak was significantly higher than before the outbreak (52% versus 20%, p<0.001).The mean hospital stay was longer in post-COVID-19 group (5.6±5.9 versus 3.2±4.3 days; p=0.041).Conclusions: COVID-19 pandemic influenced the time of diagnosis of appendicitis, as well as its course, and mean hospital stay. Complicated appendicitis was more common in patients with acute appendicitis after the outbreak of COVID-19 pandemic.

Game Analysis on Epidemic Prevention and Resuming Production: Based on China’s Experience With COVID-19

Since the outbreak of COVID-19, it became urgent to deal with the relationship between the prevention and control of the epidemic and the resumption of work and production. The purpose of this study is to observe and describe which approach seemed more important for the Chinese government and people, and how this trend evolved through time. To this end, a game model of resuming production and preventing the epidemic is constructed, using the evolutionary stable strategy (ESS). By combing China’s measures on epidemic prevention and resuming production during critical periods of epidemic outbreak, it is clarified that the present stage is considered a period of equal emphasis on both epidemic prevention and resuming production. Based on the dynamic between these two strategies and further theoretical research, present policies should equally focus on both preventive and controlling measures as well as on the socioeconomic development for most countries in the world.

Herb-Drug Interaction Between Xiyanping Injection and Lopinavir/Ritonavir, Two Agents Used in COVID-19 Pharmacotherapy

The global epidemic outbreak of the coronavirus disease 2019 (COVID-19), which exhibits high infectivity, resulted in thousands of deaths due to the lack of specific drugs. Certain traditional Chinese medicines (TCMs), such as Xiyanping injection (XYPI), have exhibited remarkable benefits against COVID-19. Although TCM combined with Western medicine is considered an effective approach for the treatment of COVID-19, the combination may result in potential herb-drug interactions in the clinical setting. The present study aims to verify the effect of XYPI on the oral pharmacokinetics of lopinavir (LPV)/ritonavir (RTV) using an in vivo rat model and in vitro incubation model of human liver microsomes. After being pretreated with an intravenous dose of XYPI (52.5 mg/kg) for one day and for seven consecutive days, the rats received an oral dose of LPV/RTV (42:10.5 mg/kg). Except for the t1/2 of LPV is significantly prolonged from 4.66 to 7.18 h (p &lt; 0.05) after seven consecutive days pretreatment, the pretreatment resulted in only a slight change in the other pharmacokinetic parameters of LPV. However, the pharmacokinetic parameters of RTV were significantly changed after pretreatment with XYPI, particularly in treatment for seven consecutive days, the AUC0-∞ of RTV was significantly shifted from 0.69 to 2.72 h μg/mL (p &lt; 0.05) and the CL exhibited a tendency to decrease from 2.71 L/h to 0.94 L/h (p &lt; 0.05), and the t1/2 of RTV prolonged from 3.70 to 5.51 h (p &lt; 0.05), in comparison with the corresponding parameters in untreated rats. After administration of XYPI, the expression of Cyp3a1 protein was no significant changed in rats. The in vitro incubation study showed XYPI noncompetitively inhibited human CYP3A4 with an apparent Ki value of 0.54 mg/ml in a time-dependent manner. Our study demonstrated that XYPI affects the pharmacokinetics of LPV/RTV by inhibiting CYP3A4 activity. On the basis of this data, patients and clinicians can take precautions to avoid potential drug-interaction risks in COVID-19 treatment.

Positivity Rate as a Performance Indicator for COVID-19 Response in Edo State, Nigeria

Background: Positivity rate is a very reliable indicator in determining the effectiveness of public health interventions of infectious disease magnitude. Aim: To use positivity rate as performance indicator of effectiveness of COVID-19 Control measures in Edo State, Southern Nigeria. Materials and Methods: Laboratory based record review of 20,220 Polymerase Chain Reaction (PCR) based laboratory results from COVID-19 line-list analysed from the four (4) NCDC accredited molecular laboratory within Edo State. The weekly COVID-19 test positivity was computed in relation to the total samples tested between 23rd March to 30th November, 2020. Data collected were analysed using IBM SPSS version 20.0 software with statistical significance set at p˂0.050 and 95% Confidence Interval. Results: A total of 20,220 PCR results reviewed with 2696 (13.3%) COVID-19 cases identified while 17,524 (86.7%) were negative. The average weekly sample collection and testing was 552.28 ± 369.98, with average weekly COVID-19 case yield and positivity rate (%) of 77.89 ±106.23 and 12.20±13.75% respectively. A statistically significant positive correlation was identified between sample tested and COVID-19 case yield (R = 0.569; < 0.01). The first wave of the COVID-19 in Edo State witnessed a consistent and progressive decline in test positivity rate till it deepened at 0.6 % by the end of November, 2020. Conclusion: Increasing sample testing has significant positive correlation with COVID-19 case detection in Edo State. Positivity rate was a good indicator to monitor COVID-19 outbreak response in Edo State. Targeted surveillance and sample collection for testing can significantly help improve the quality and case yield during epidemic outbreak response. Bridging the gap in sample collection for testing can greatly influence how quickly an epidemic outbreak response and control is achieved.