07 February, 2021

Muscle strength is associated with COVID-19 hospitalization in adults 50 years of age and older -

Background. Muscle strength has been associated with a wide range of health outcomes. Yet, whether individuals with weaker strength are more at risk for severe COVID-19 is still unclear. The objective of this study was to investigate the independent association between muscle strength and COVID-19 hospitalization. Methods. Data from 3600 adults 50 years of age and older were analyzed using logistic models adjusted for several chronic conditions, body mass index, age, and sex. Hand grip strength was repeatedly measured between 2004 and 2017 using a handheld dynamometer. COVID-19 hospitalization during the lockdown was self-reported in summer 2020 and was used an indicator of COVID-19 severity. Results. Results showed that higher grip strength was associated with a lower risk of COVID-19 hospitalization (adjusted odds ratio [OR] per increase of 1 SD in grip strength = .64, 95% confidence interval [95% CI] = .45-.87, p = .015). Results also showed that age (OR for a 10-year period = 1.70, 95% CI = 1.32-2.20, p < .001) and obesity (OR = 2.01, 95% CI = 1.00-3.69, p = .025) was associated with higher risk of COVID-19 hospitalization. Sensitivity analyses using different measures of grip strength and robustness analyses based on rare-events logistic regression and COVID-19 patients were consistent with the main results. Conclusions. Muscle strength is an independent risk factor for COVID-19 severity in adults 50 years of age and older.

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High efficacy of face masks explained by characteristic regimes of airborne SARS-CoV-2 virus abundance -

Airborne transmission by droplets and aerosols is important for the spread of viruses and face masks are a well-established preventive measure, but their effectiveness for mitigating COVID-19 is still under debate. We show that variations in mask efficacy can be explained by different regimes of virus abundance. For SARS-CoV-2, the virus load of infectious individuals can vary by orders of magnitude, but we find that most environments and contacts are in a virus-limited regime where simple surgical masks are highly effective on individual and population-average levels, whereas more advanced masks and other protective equipment are required in potentially virus-rich indoor environments such as medical centers and hospitals. Due to synergistic effects, masks are particularly effective in combination with other preventive measures like ventilation and distancing.

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Vaccination strategies for minimizing loss of life in Covid-19 in a Europe lacking vaccines -

Aim and Background: We aimed at identifying vaccination strategies that minimize loss of life in the Covid-19 pandemic. Covid-19 mainly kills the elderly, but the pandemic is driven by social contacts that are more frequent in the young. Vaccines elicit stronger immune responses per dose in younger persons. As vaccine production is a bottleneck, many countries have adopted a strategy of first vaccinating the elderly and vulnerable, while postponing vaccination of the young. Methods: Based on published age-stratified immunogenicity data of the Moderna mRNA-1273 vaccine, we compared the established ′one dose fits all′ approach with tailored strategies: The known differential immunogenicity of vaccine doses in different age groups is exploited to vaccinate the elderly at full dose, while the young receive a reduced dose, amplifying the number of individuals receiving the vaccine early. A modeling approach at European Union scale with population structure, Covid-19 case and death rates similar to Europe in late January 2021 is used. Results: When the elderly were vaccinated preferentially, the pandemic initially continued essentially unchecked, as it was dominantly driven by social contacts in other age groups. Tailored strategies, including regular dosing in the elderly but reduced dose vaccination in the young, multiplied early vaccination counts, and even with some loss in protection degree for the individual person, the protective effect towards stopping the pandemic and protecting lives was enhanced, even for the elderly. In the European Union, pandemic duration (threshold >100′000 cases/day) was shortened from 53 to 18-24 days; cumulative death count over 100 days was reduced by >30′000. Conclusion: Protecting the vulnerable, minimizing overall deaths and stopping the pandemic is best achieved by an adaptive vaccination strategy using an age-tailored vaccine dose.

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

Background: 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 (Methylprednisolone or Dexamethasone) and Tocilizumab (TCZ), an interleukin-6 receptor antagonist, are approved for the treatment of CRS in India. The aim of this study was to evaluate the efficacy and safety of combination therapy of TCZ and steroids in COVID-19 associated CRS. Methods: This retrospective cohort study was conducted at a tertiary level private hospital in Pune, India between 2nd April and 2nd November 2020. All patients administered TCZ and steroids for treatment of CRS were included. The primary endpoint was the incidence of all-cause mortality. Secondary outcomes studied were the need for mechanical ventilation and incidence of infectious complications. Baseline and time-dependent risk factors significantly associated with death were identified by Relative risk estimation. Results: Out of 2831 admitted patients, 515 (24.3% females) were administered TCZ and steroids. Median age of the cohort was 57 (IQR: 46.5, 66) years. Almost 72 % patients had preexisting co-morbidities. Median time to TCZ administration since onset of symptoms was 9 days (IQR: 7, 11). 63% patients needed intensive care unit (ICU) admission. Mechanical ventilation was required in 242 (47%) patients. Of these, 44.2% (107/242) recovered and were weaned off the ventilator. There were 135 deaths (26.2%), while 380 patients (73.8%) had clinical improvement. Infectious complications like hospital acquired pneumonia, bloodstream bacterial and fungal infections were observed in 2.13 %, 2.13 % and 0.06 % patients respectively. Age ≥ 60 years (p=0.014), presence of co-morbidities like hypertension (p = 0.011), IL-6 ≥ 100 pg/ml (p = 0.002), D-dimer ≥ 1000 ng/ml (p < 0.0001), CT severity index ≥ 18 (p < 0.0001) and systemic complications like lung fibrosis (p = 0.019), cardiac arrhythmia (p < 0.0001), hypotension (p < 0.0001) and encephalopathy (p < 0.0001) were associated with increased risk of death. Conclusions: Combination therapy of TCZ and Steroids is likely to be safe and effective in the management of COVID-19 associated cytokine release syndrome. Efficacy of this anti-inflammatory combination therapy needs to be validated in randomized controlled clinical trials.

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A cautionary note on recall vaccination in ex-COVID-19 subjects -

Currently approved COVID-19 vaccines based on mRNA or adenovirus require a first jab followed by recall immunization. There is no indication as to whether individuals who have recovered from COVID-19 should be vaccinated, and if so, if they should receive one or two vaccine doses. Here, we tested the antibody response developed after the first dose of the mRNA based vaccine encoding the SARS-CoV-2 full-length spike protein (BNT162b2) in 124 healthcare professionals of which 57 had a previous history of COVID-19 (ExCOVID). Post-vaccine antibodies in ExCOVID individuals increase exponentially within 7-15 days after the first dose compared to naive subjects (p<0.0001). We developed a multivariate Linear Regression (LR) model with l2 regularization to predict the IgG response for SARS-COV-2 vaccine. We found that the antibody response of ExCOVID patients depends on the IgG pre-vaccine titer and on the symptoms that they developed during the disorder, with anosmia/dysgeusia and gastrointestinal disorders being the most significantly positively correlated in the LR. Thus, one vaccine dose is sufficient to induce a good antibody response in ExCOVID subjects. This poses caution for ExCOVID subjects to receive a second jab both because they may have a overreaction of the inflammatory response and also in light of the current vaccine shortage.

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Immuno-fibrotic drivers of impaired lung function in post-COVID-19 syndrome -

Introduction: Subjects recovering from COVID-19 frequently experience persistent respiratory ailments; however, little is known about the underlying biological factors that may direct lung recovery and the extent to which these are affected by COVID-19 severity. Methods: We performed a prospective cohort study of subjects with persistent symptoms after recovering from acute COVID-19 illness, collecting clinical data, pulmonary function tests, and blood. Plasma samples were used for multiplex profiling of circulating factors associated with inflammation, metabolism, angiogenesis, and fibrosis. Results: Sixty-one subjects were enrolled across two academic medical centers at a median of 9 weeks (interquartile range 6-10) after COVID-19 illness: n=13 subjects (21%) mild/non-hospitalized, n=30 (49%) hospitalized/non-critical, and n=18 subjects (30%) hospitalized/intensive care (ICU). Fifty-three subjects (85%) had lingering symptoms, most commonly dyspnea (69%) and cough (58%). Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and diffusing capacity for carbon monoxide (DLCO) declined as COVID-19 severity increased (P<0.05), but did not correlate with respiratory symptoms. Partial least-squares discriminant analysis of plasma biomarker profiles clustered subjects by past COVID-19 severity. Lipocalin 2 (LCN2), matrix metalloproteinase-7 (MMP-7), and hepatocyte growth factor (HGF) identified by the model were significantly higher in the ICU group (P<0.05) and inversely correlated with FVC and DLCO (P<0.05). Conclusions: Subjective respiratory symptoms are common after acute COVID-19 illness but do not correlate with COVID-19 severity or pulmonary function. Host response profiles reflecting neutrophil activation (LCN2), fibrosis signaling (MMP-7), and alveolar repair (HGF) track with lung impairment and may be novel therapeutic or prognostic targets.

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Relationships Between Changes in Self-Reported Physical Activity and Sedentary Behaviours and Health During the Coronavirus (COVID-19) Pandemic in France and Switzerland -

The coronavirus disease 2019 (COVID-19) pandemic may have detrimental effects on physical and mental health, but physical activity can help people to cope with stress, thereby mitigating its potential negative health consequences. In our study, we investigated whether changes in physical activity and sedentary behaviours are associated with changes in mental and physical health during the COVID-19 lockdown.

🖺 Full Text HTML: Relationships Between Changes in Self-Reported Physical Activity and Sedentary Behaviours and Health During the Coronavirus (COVID-19) Pandemic in France and Switzerland

COVID-19 Provides a Rare Opportunity to Create a Stronger, More Equitable Society -

COVID-19—and the ensuing economic fallout—exposed society’s vast inequalities. Current stimulus plans and ongoing debates revolve around restoring society to its pre-COVID-19 state, a singular focus driven by a prevalent status quo bias. We propose that policymakers should adopt a more ambitious goal: to take advantage of the change momentum of COVID-19 to reduce social inequalities in order to build society’s resilience for the next time disaster strikes. We suggest that this redesign will require a focus on the multidimensional nature of social and economic inequalities, and a shift toward strengthening communities rather than a sole focus on individual households and businesses. This crisis should be seen as a unique window for restructuring society by creating new norms and ideals rather than returning to the pre-COVID-19 status quo.

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The Influence of Public Health England’s Change4Life Disney Branded 10-minute Shake Ups on Children’s Post Activity Affective Response. -

Physical activity (PA) is considered essential to overall health yet it is consistently reported that children are failing to meet the recommended levels. Due to the bidirectional relationship between affective states and PA, affective responses are a potential predictor to long term engagement. Since late March 2020 the UK government enforced ‘lockdown’ measures to help control the spread of Coronavirus (COVID-19); however, this has impacted children’s PA. Using online resources at home to support PA is now common. The primary aim of this research was to investigate the use of the Change4Life 10-minute Shake Ups to support PA by examining the effects of Disney branding upon children’s (n=32) post activity affective responses and perceived exertion. The secondary was to investigate the effect of the lockdown on PA habits. Children had similar positive affective responses and perceived effort to activities; however, branding was considered to be a key contributing factor based upon qualitative feedback from parents. Children’s PA levels dropped slightly since ‘lockdown’ was imposed; though online resources have been utilised to support PA. The use of immersive elements such as characters and narrative in PA sessions, as well as utilising online resources during ‘lockdown’ appear potentially promising for future research.

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The Masked Majority: Underprediction Of Widespread Support For Covid-19 Safety Policies. -

The unprecedented COVID-19 pandemic in the US required organizations to make their own decisions regarding prevention policies, such as whether to require and enforce mask wearing, in the absence of regulations and norms. In five pre-registered studies, we investigate whether people support strict COVID-19 prevention policies and whether that support is underestimated, across business types, types of policy cues (stated and viral videos), and types of policies (required mask-wearing and vaccination). We consistently find that people strongly favor organizations with strict policies, such that the risks of both losing customers and of negative consumer perceptions are higher for lax policies (e.g., recommended mask-wearing) than for strict policies (requiring and enforcing mask-wearing). Nevertheless, customers and managers alike underestimate public support for strict policies, with negative consequences for word-of-mouth behavior. The underappreciation of support for public health measures that we document can impede the establishment of norms and the adoption of strict policies, undermining efforts to combat public health crises such as COVID-19.

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Encouraging the resumption of economic activity after COVID-19: Evidence from a large scale field experiment in China -

As the COVID-19 pandemic comes to an end, governments find themselves facing a new challenge: motivating citizens to resume economic activity. What is an effective way to do so? We investigate this question using a field experiment in the city of Zhengzhou, China immediately following the end of the city’s COVID-19 lockdown. Using self-reports and GPS trajectory data from participants’ phones, we assessed the effect of providing information about the proportion of participants’ neighbors who have resumed economic activity. We find that informing individuals about their neighbors’ plans to visit restaurants increases the fraction of participants visiting restaurants by 12 percentage points (37%), amongst those participants who underestimated the proportion of neighbors who resumed economic activity. Those who overestimated did not respond by reducing restaurant attendance, so the intervention yielded no `boomerang’ effect. We explore moderators, risk perceptions, and a placebo intervention for parks. All of these analyses suggest our intervention worked by reducing the perceived risk of going to restaurants.

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Longitudinal change in adolescent depression and anxiety symptoms from before to during the COVID-19 pandemic: An international collaborative of 12 samples -

The study aimed to examine changes in depression and anxiety symptoms from before to during the first six months of the COVID-19 pandemic in a large, diverse, international sample of 1,339 adolescents (9-18 years, 59% female). We also examined if age, race/ethnicity, disease burden, or strictness of government restrictions moderated change in symptoms. Data from 12 longitudinal studies (10 U.S., 1 Netherlands, 1 Peru) were combined. Linear mixed effect models showed that depression symptoms increased significantly (median increase=28%), whereas anxiety symptoms remained stable overall. The most negative mental health impacts were reported by multiracial adolescents and those under ‘lockdown’ restrictions. Policy makers need to consider these impacts by investing in ways to support adolescents’ mental health during the pandemic.

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Assessing Self-Other Distinctions Through Decision-making Under Risk in The Era of Covid-19 -

The current Covid-19 pandemic has demanded a degree of sacrifice from individuals for the sake of the greater good. Individuals have taken costly actions, both volitional and imposed, to reduce harm to strangers. The pandemic oers a unique opportunity to examine a fundamental question: where does the distinction between self and other lie? This question can be framed as a moral dilemma between competing motives of self-serving and pro-social behavior. Given the multifaceted uncer- tainty surrounding the Covid-19 pandemic, we propose to assess self-other distinction using models of decision-making under risk. We administered two surveys, where participants selected between sure and risky treatments for fictitious diseases, for themselves, a loved one and a stranger. Choice of treatment option showed risk-seeking tendencies that decreased with expected disease severity, across all targets, suggesting risk preferences for the other parallel those for the self. However, distinctions across targets emerged when decisions were conditioned on treatment cost, with sure treatments cho- sen more often for self and a close other; and sure treatment assigned a higher price for diseases with low expected severity, for self and other. These findings inform on what constitutes a measure of self-other distinction; and the limits of what can be asked of an individual in service to a stranger.

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Where All the Roads Meet? A Cross Over Perspective on Host Factors Regulating SARS-CoV-2 Replication -

In the recent issue of Cell, four studies utilized genome wide CRISPR/Cas screens to identify host factors critical for the SARS-CoV-2 replication. We performed a comparative analysis of significant host factors (p<0.05) that were identified in these studies and found that fifteen candidates were common in at least three studies. Apart from ACE2 other common host factors included COG3, COG8, GDI2, ARPP19, SLC35B2, LIMA1, TLR9, VPS26A, CSNK2B, LRRN2, DDX51, ALG6, C1QTNF7 and BCOR. Interestingly, some of these host factors have been shown to be critical for other viruses including HIV-1, Dengue, Influenza, Zika etc., suggesting their crucial role in viral biology. Additionally, viral interactome of these host factors revealed that they were associated with several SARS-CoV-2 proteins as well. Hence, we present here, a comparative analysis of four genome wide screens against SARS-CoV-2, revealing common host factors that could be modulated to regulate SARS-CoV-2 and other viruses as well.

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SARS-CoV-2 Worldwide Replication Drives Rapid Rise and Selection of Mutations across the Viral Genome: A Time-Course Study Potential Challenge for Vaccines and Therapies -

Scientists and public were alarmed at first viral variant of SARS-CoV2 reported in December 2020. We have followed time course of emerging viral mutants and variants during the SARS-CoV-2 pandemic in ten countries. We examined complete SARS-CoV-2 nucleotide sequences in GISAID with sampling extending until January 20, 2021. These sequences originated from ten different countries: United Kingdom, South Africa, Brazil, USA, India, Russia, France, Spain, Germany, and China. Among the novel mutations, some previously reported mutations waned and some of them increased over time. VUI2012/01 (B.1.1.7) and 501Y.V2 (B.1.351), the UK and South Africa variants, respectively, and two variants from Brazil, 484K.V2, P.1 and P.2, increased in prevalence. Despite lockdowns, worldwide active replication in genetically and socio-economically diverse populations facilitated selection of new mutations. The data on mutant and variant SARS-CoV-2 strains provided here comprise a global resource for easy access to the myriad mutations and variants detected to date globally. Rapidly evolving new variant and mutant strains might give rise to escape variants, capable of limiting the efficacy of vaccines, therapies, and diagnostic tests.

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