The COVID-19 Hospitalization Metric in the Pre- and Post-vaccination Eras as a Measure of Pandemic Severity: A Retrospective, Nationwide Cohort Study

Background: COVID-19 hospitalization definitions do not include a disease severity assessment. Thus, we sought to identify a simple and objective mechanism for identifying hospitalized severe cases and to measure the impact of vaccination on trends. Methods: All admissions to a Veterans Affairs (VA) hospital, where routine screening is recommended, between 3/1/2020-11/22/2021 with SARS-CoV-2 were included. Moderate-to-severe COVID-19 was defined as any oxygen supplementation or any SpO2 <94% between one day before and two weeks after the positive SARS-CoV-2 test. Admissions with moderate-to-severe disease were divided by the total number of admissions, and the proportion of admissions with moderate-to-severe COVID-19 was modelled using a penalized spline in a Poisson regression and stratified by vaccination status. Dexamethasone receipt and its correlation with moderate-to-severe cases was also assessed. Results: Among 67,025 admissions with SARS-CoV-2, the proportion with hypoxemia or supplemental oxygen fell from 64% prior to vaccine availability to 56% by November 2021, driven in part by lower rates in vaccinated patients (vaccinated, 52% versus unvaccinated, 58%). The proportion of cases of moderate-to-severe disease identified using SpO2 levels and oxygen supplementation was highly correlated with dexamethasone receipt (correlation coefficient, 0.95), and increased after 7/1/2021, concurrent with delta variant predominance. Conclusions: A simple and objective definition of COVID-19 hospitalizations using SpO2 levels and oxygen supplementation can be used to track pandemic severity. This metric could be used to identify risk factors for severe breakthrough infections, to guide clinical treatment algorithms, and to detect trends in changes in vaccine effectiveness over time and against new variants.

The COVID-19 Hospitalization Metric in the Pre- and Post-vaccination Eras as a Measure of Pandemic Severity: A Retrospective, Nationwide Cohort Study

Background: COVID-19 hospitalization definitions do not include a disease severity assessment. Thus, we sought to identify a simple and objective mechanism for identifying hospitalized severe cases and to measure the impact of vaccination on trends.Methods: All admissions to a Veterans Affairs (VA) hospital, where routine screening is recommended, between 3/1/2020-11/22/2021 with SARS-CoV-2 were included. Moderate-to-severe COVID-19 was defined as any oxygen supplementation or any SpO2 <94% between one day before and two weeks after the positive SARS-CoV-2 test. Admissions with moderate-to-severe disease were divided by the total number of admissions, and the proportion of admissions with moderate-to-severe COVID-19 was modelled using a penalized spline in a Poisson regression and stratified by vaccination status. Dexamethasone receipt and its correlation with moderate-to-severe cases was also assessed. Results: Among 67,025 admissions with SARS-CoV-2, the proportion with hypoxemia or supplemental oxygen fell from 64% prior to vaccine availability to 56% by November 2021, driven in part by lower rates in vaccinated patients (vaccinated, 52% versus unvaccinated, 58%). The proportion of cases of moderate-to-severe disease identified using SpO2 levels and oxygen supplementation was highly correlated with dexamethasone receipt (correlation coefficient, 0.95), and increased after 7/1/2021, concurrent with delta variant predominance.Conclusions: A simple and objective definition of COVID-19 hospitalizations using SpO2 levels and oxygen supplementation can be used to track pandemic severity. This metric could be used to identify risk factors for severe breakthrough infections, to guide clinical treatment algorithms, and to detect trends in changes in vaccine effectiveness over time and against new variants.

Daily Lactobacillus Probiotic versus Placebo in COVID-19-Exposed Household Contacts (PROTECT-EHC): A Randomized Clinical Trial

Background: The COVID-19 pandemic continues to pose unprecedented challenges to worldwide health. While vaccines are effective, supplemental strategies to mitigate the spread and severity of COVID-19 are urgently needed. Emerging evidence suggests susceptibility to infections, including respiratory tract infections, may be reduced by probiotic interventions. Therefore, probiotics may be a low-risk, widely implementable modality to mitigate risk of COVID-19 disease, particularly in areas with low vaccine availability and/or uptake. Methods: We conducted a randomized, double-blind, placebo-controlled trial across the United States testing the probiotic Lactobacillus rhamnosus GG (LGG) as post-COVID-19-exposure prophylaxis. We enrolled individuals > 1 year of age with a household contact with a recent (≤ 7 days) diagnosis of COVID-19. Participants were randomized to receive daily LGG or placebo for 28 days. Stool was collected to evaluate the microbiome. The primary outcome was development of symptoms of illness compatible with COVID-19 within 28 days. Findings: We enrolled 182 COVID-19-exposed participants. Intention-to-treat analysis showed that participants randomized to LGG were less likely to develop symptoms versus those randomized to placebo (26.4% vs. 42.9%, p=0.02). Further, LGG was associated with a statistically significant reduction in COVID-19 diagnosis (log rank p=0.049) via time-to-event analysis. Overall incidence of COVID-19 diagnosis was not significantly different between LGG (8.8%) and placebo (15.4%) (p=0.17). LGG was well-tolerated with no increased side effects versus placebo. Interpretation: These findings suggest that LGG probiotic may protect against the development of COVID-19 infection and symptoms when used as post-exposure prophylaxis within 7 days after exposure. Funding: This work was supported by a grant from the Duke Microbiome Center to A.D.S. and P.E.W. and private philanthropic donations to A.D.S. DSM/iHealth donated the LGG and placebo for the trial but had no role in its design, conduct, analysis, or writing. Trial registration: NCT04399252

Knowledge, Attitude and Acceptance of a COVID-19 Vaccine in Indian Population : a Cross Sectional Study

INTRODUCTION: The COVID-19 pandemic keeping on to devastate the world. A vaccine provides the best hope to control the pandemic. Understanding vaccine acceptance is important, because there is relatively high vaccine hesitancy for existing vaccines and relatively low vaccination coverage. MATERIALS AND METHODS: Participants included are adults between the age group of 18-29 years (n=100). This is a cross-sectional, web based observational study conducted over a period of 1 month. An online survey is carried out through distribution of questionnaire via social network with snow ball effect. RESULTS: A total 100 participants were included in the study. Almost more than half (55%) of the young adults aged between 18 and 29 years were oblivious about the COVID-19 vaccine availability, followed by 22% person aged between 30-39 years and 22% of the persons aged between 40- 59 years and around 1% of more than 60 years were oblivious about the vaccine availability. Among the study participants, nearly 40% were willing to take COVID-19 vaccine when it is available for use and only 30% did not want the vaccination. CONCLUSION: The most dominant factor for vaccine hesitancy is because of adverse effects following immunization. Vaccine acceptability may be increased once additional information about vaccine safety and efficacy is available in the public domain, preferably from a trusted, centralized source of information.

Impact of electronic vaccine intelligence network application used in immunization sessions in Pune city

Background: Millions of deaths due to various diseases have been reduced globally as well as in India since inception of vaccination programme. In order to avoid the instances of cold chain failure and ensure constant monitoring of temperature of cold chain equipment’s Electronic vaccine intelligence network (eVIN) technology was adopted by Government of India.Methods: A mixed methodology design with both qualitative as well as quantitative components were studied. This study was conducted in 16 immunization centres spread across the metropolitan Pune city in western Maharashtra.Results: Vaccine beneficiaries increased for polio 814 (3.25%), DPT1643 (21.79%), MR 9615 (23.02%) and IPV 2297 (23.58) vaccine after execution of eVIN app. Vaccine availability of BCG (6.04%), Polio (20.02%), MR (64.24%), IPV (11.38%) and hep B had increased as compared to the other vaccines. The vaccine wastage decreased for penta (8.64%), IPV (123.98%), TT (32.63%) and hep B (47%) vaccines post eVIN application compared to the pre eVIN. The qualitative study included in depth interviews, key informants’ interview and focus group discussions. Various themes and subthemes emerged like the user-friendliness of app, difficulties faced by health care workers, their suggestions for improvements in the app.Conclusions: The eVIN system is playing a pivotal role in effective and efficient management of vaccine supply, maintaining stock availability and monitoring. To reduce vaccine wastage usage of small dose vials in immunization sessions would be helpful.

The COVID States Project #71: Childhood COVID-19 vaccine uptake and intentions

In early November 2021, children ages 5-11 were authorized by the Centers for Disease Control and Prevention (CDC) to receive the Pfizer-BioNTech COVID-19 vaccine, making an additional 28 million children eligible for the shot. Given this significant advancement in COVID-19 vaccine availability - particularly in light of recent concerns over the Omicron variant - in this report we examine parent-reported COVID-19 vaccination intentions and uptake for children.Below, we examine reported childhood vaccination rates by childhood age and across different parent demographic subgroups. Additionally, we report parents’ expressed likelihood of vaccinating their children against COVID-19 across five survey waves from February, April, June, September, and November 2021.

Modeling COVID-19 Aerosol Transmission in Primary Schools

Schools must balance public health, education, and social risks associated with returning to in-person learning. These risks are compounded by the ongoing uncertainty about vaccine availability and uptake for children under 12 years of age. In this paper, we show how the risk of infections that result directly from in-class aerosol transmission within an elementary school population can be estimated in order to compare the effects of different countermeasures. We compare the effectiveness of these countermeasures in reducing transmission including required masking at three levels of mask effectiveness, improving room airflow exchange rates, weekly testing of the students, and lunch partitioning. Our results show that multiple layers of interventions are necessary to keep in-class infections relatively low. These results can inform school administrators about how these interventions can help manage COVID-19 spread within their own elementary school populations.

Vaccine access shrinks disparities between long-term care and community rates of COVID-19 mortality

This longitudinal secondary data analysis examines differences in COVID-19 incidence and mortality among long-term care facility (LTCF) residents with those living in the community in South Carolina (SC) throughout the pandemic, including the time of vaccine availability. Data came from the SC Department of Health and Environmental Control (SCDHEC). Descriptive statistics and trends for cases of infections and deaths were calculated. Cox proportional hazards were used to compare COVID-19 mortality in LTC residents to community dwelling older adults, controlling for age, gender, race, and pre-existing chronic health conditions. Until early January of 2021, significantly greater incidence rates of infection (116.2 per 10,000 per month) and hazard of death after infection (HR=1.83, 95% CI: 1.70-1.98) were experienced among LTC residents as compared to older adults in the community even after statewide mask mandates and visitation guidance. Since vaccine availability, COVID incidence rates among LTC residents fell by half (59.5 per 10,000 per month after vaccines), and the relative hazard of death compared to older adults in the community was diminished (HR=1.44, 95% CI:1.29-1.61). Reducing the gap between LTCF and community-wide infection and mortality rates suggests that vaccination against COVID-19 is correlated with reduced disease spread in the greater community and in LTCF. Results indicate that policies and regulations addressing LTC resident and staff vaccination may effectively protect the most vulnerable older adults and the workforce providing their care while mask mandates and visitation guidance do not.