02 January, 2023

Revising Home Advantage in Sport – Home Advantage Mediation (HAM) Model -

Home Advantage (HA) is a robust phenomenon in which sport teams or individuals are more successful when they play in front of their fans. There are a number of causes of HA, but most theories assume that the crowd support spurs home players to better performance and biases referees, and that these two factors in turn influence the result. The interest in HA has grown during the Covid-19 pandemic as most competitions were taking place behind closed doors, a perfect control condition for disentangling the causal effects behind HA. Despite the presence of useful conceptual frameworks, most previous research has focused on investigating isolated individual factors. Here we review our newly developed Home Advantage Mediated (HAM) model, which considers all individual factors and their interrelations simultaneously. HAM assumes that the crowd effects are mediated through other relevant factors, such as referee bias and team performance. Most importantly, HAM can be formally expressed as a mediation model, a technique widely employed in social sciences for investigating causal pathways. We demonstrate how researchers can use HAM to model the HA in European football and how moderating variables, such as Covid-19 and absence of fans, can be incorporated in the model to disentangle the processes behind the HA phenomenon. Besides throwing new (modeling) light on one of the most robust phenomena in sport, we also provide information about practical implementation of mediation and moderated mediation models in the Bayesian framework. Similar implementations can be adapted for use in other sport science domains.

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A Citizens’ Hearing: Examining Canada’s Covid Response -

An increasing number of Canadians are concerned about how the COVID-19 crisis was handled by our governments and institutions. We are alarmed by the serious consequences of their decisions and, at times, their apparent indifference to the costs. Those consequences include tragic impacts on the personal lives of many, violations of constitutionally guaranteed rights and freedoms in the name of health security, and economic impacts of lockdown measures, which subjected millions of Canadians to business closures, loss of income, and unemployment. Canadians are asking many questions: Were the measures taken by governments in Canada appropriate to the perceived threat? Were they based on sufficient clinical and statistical evidence? Were they suitably focused? How effective were they? Were there any conflicts of interest at play? Was there enough emphasis on prevention and early treatment? On informed consent? Was sufficient debate permitted? In attempting to prevent COVID-19, what other maladies were we ignoring or fostering? Did the public health interventions, such as mandatory vaccinations, cause more harm than good? These concerns have given rise to a growing demand for an Independent National Inquiry into the management of the COVID-19 crisis in Canada. To encourage and inform such an inquiry, from June 22nd – 24th 2022, the Canadian Covid Care Alliance, in partnership with the Canadian Adverse Event Reporting System (CAERS), Fearless Canada, United Healthcare Workers of Ontario and the Frontier Centre For Public Policy among others, sponsored a cross-country live streamed event moderated by a diverse panel of experts to: Hear testimony illustrating the harms that have resulted from government policies implemented to cope with the COVID-19 outbreak; Receive scientific, medical, and legal testimony as to alternative approaches that were ignored - or even condemned - which might have been pursued; Generate recommendations to ensure that Canadians never again experience the degree of loss, trauma and disruption caused by the official response to COVID-19. A Citizens’ Hearing consists of testimonies challenging the official responses of Canada’s federal and regional governments and recommendations for better handling the next public health crisis, should one of such a scale occur again. Canada’s response to COVID-19 has been far from perfect. We can and should learn from our mistakes. The landscape of this enormous challenge has been and is constantly changing. A Citizens’ Hearing aims to contribute to a national conversation of truth and understanding that might lead us to a new resilience and emergency preparedness. To face the next health crisis, we must change the narrative from one of fear and reaction to one of confidence in a properly managed, proactive and nuanced emergency management process that reacts to real world data, and keeps dialogue and consultation with a cross-section of stakeholders open and transparent.

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Safety and Effectiveness of SA58 Nasal Spray against COVID-19 Infection in Medical Personnel：An Open-label, Blank-controlled Study -

Approved COVID-19 vaccines to date have limited effectiveness in protecting infection and blocking transmission. A nasal spray of broad-spectrum antibody against COVID-19 (SA58 Nasal Spray) has recently been developed by Sinovac Life Sciences Co., Ltd.. From October 31 to November 30, 2022, an open-label, blank controlled study on the SA58 Nasal Spray against COVID-19 infection was conducted with the medical personnel working in the designated COVID-19 hospitals and Fangcang shelter hospitals (alternate care sites) of COVID-19 cases in Hohhot city, the Inner Mongolia Autonomous Region. A total of 6662 medical personnel were involved in this study: 3368 used SA58 Nasal Spray from the drug group, and 3294 not used from blank control group. The medication was self-administered intranasally 1~2 times per day with an interval of 6 hours for 30 days.. The safety results indicated that the SA58 Nasal Spray was well tolerant. The incidence of adverse events (AEs) was 28.6% (497/1736), and the majority of the AEs were mild and from administrative site. 135 COVID-19 cases were identified for SARS-CoV-2 by RT-PCR during the 30-day observation. The cumulative incidence of COVID-19 in the drug group and the control group were 0.026% and 0.116%, respectively. The effectiveness of the SA58 Nasal Spray for preventing COVID-19 infection among medical personnel was evaluated as 77.7% (95% CI: 52.2% - 89.6%). In conclusion, the SA58 Nasal Spray is well-tolerant and highly effective against COVID-19 infection.

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SARS-CoV-2 Protein Nsp2 Stimulates Translation Under Normal and Hypoxic Conditions -

When viruses like SARS-CoV-2 infect cells, they reprogram the repertoire of cellular and viral transcripts that are being translated to optimize their strategy of replication, often targeting host translation initiation factors, particularly eIF4F complex consisting of eIF4E, eIF4G and eIF4A. A proteomic analysis of SARS-CoV-2/human proteins interaction revealed viral Nsp2 and initiation factor eIF4E2, but a role of Nsp2 in regulating translation is unknown. HEK293T cells stably expressing Nsp2 were tested for protein synthesis rates of synthetic and endogenous mRNAs known to be translated via cap- or IRES-dependent mechanism under normal and hypoxic conditions. Both cap- and IRES-dependent translation were increased in Nsp2-expressing cells under normal and hypoxic conditions, especially mRNAs that require high levels of eIF4F. This could be exploited by the virus to maintain high translation rates of both viral and cellular proteins, particularly in hypoxic conditions as may arise in SARS-CoV-2 patients with poor lung functioning.

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Estimates of COVID-19 deaths in Mainland China after abandoning zero COVID policy -

Background: China witnessed a surge of Omicron infections after abandoning zero COVID strategies on December 7, 2022. The authorities report very sparse deaths based on very restricted criteria, but massive deaths are speculated. Methods: We aimed to estimate the COVID-19 fatalities in Mainland China until summer 2023 using the experiences of Hong Kong and of South Korea in 2022 as prototypes. Both these locations experienced massive Omicron waves after having had very few SARS-CoV-2 infections during 2020-2021. We estimated age-stratified infection fatality rates (IFRs) in Hong Kong and South Korea during 2022 and extrapolated to the population age structure of Mainland China. We also accounted separately for deaths of residents in long-term care facilities, which were prominent in Hong Kong. Results: IFR estimates in non-elderly strata were modestly higher in Hong Kong than South Korea and projected 987,455 and 811,571 maximal COVID-19 deaths, respectively, if the entire China population was infected. Expected COVID-19 deaths in Mainland China until summer 2023 ranged from 64,573 to 691,219 assuming 25-70% of the non-elderly population being infected and variable protection of elderly (from none to three-quarter reduction in fatalities). The main analysis (45% of non-elderly population infected and fatality impact among elderly reduced by half) estimated 199,223-249,094 COVID-19 deaths until summer 2023. Large uncertainties exist regarding potential changes in dominant variant, health system strain, and impact on non-COVID-19 deaths. Conclusions: The most critical factor that can affect total COVID-19 fatalities in China is the extent to which the elderly can be protected.

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On temporal changes in the role of different age groups in propagating the Omicron epidemic waves in England -

Background: There is limited information on the role of individuals in different age groups in the spread of infection during the Omicron epidemics, especially ones beyond the winter epidemic wave in 2021-2022. In England, booster vaccination against SARS-CoV-2 is currently restricted to persons aged over 50y and individuals in clinical risk groups. Methods: We used a previously developed methodology to evaluate the role of individuals in different age groups in propagating the Spring, Summer, and Autumn waves of the Omicron epidemic in England. This methodology utilizes the relative risk (RR) statistic that measures the change in the proportion of cases in each age group among all COVID-19 cases in the population before the peak of an epidemic wave vs. after the peak of an epidemic wave. Higher values for the RR statistic represent age groups that experienced a disproportionate depletion of susceptible individuals during the ascent of the epidemic (due to increased contact rates and/or susceptibility to infection). Results: For the 2022 Spring wave, the highest RR estimate belonged to children aged 5 to 9y (RR=2.05 (95%CI (2.02,2.08)), followed by children aged 10 to 14y (RR=1.68 (1.66,1.7)) and children aged 0 to 4y (RR=1.38 (1.36,1.41)). For the Summer wave, the highest RR estimates belonged to persons aged 20 to 34y: (RR=1.09 (1.07,1.12) in aged 20 to 24y, RR=1.09 (1.07,1.11) in aged 25 to 29y, RR=1.09(1.07,1.11) in aged 30 to 34y). For the Autumn wave, the highest RR estimate in adults belonged to those aged 70 to 74y (RR=1.10 (1.07,1.14)), followed by adults aged 35 to 39y (RR=1.09 (1.06,1.12)), adults aged 40 to 44y (RR=1.09 (1.06,1.12)), and adults aged 65 to 69y (RR=1.08 (1.05,1.11)) (with children excluded from the analyses due to limited/irregular detection of COVID-19 cases in children during the Autumn wave). Conclusions: As time progressed, ages of individuals who played the leading roles in propagating the Omicron epidemic waves in England shifted upward, with the leading roles in propagating COVID-19 epidemics in England currently belonging to adults of different ages. Extending booster vaccination to adults aged under 50y, and possibly to children should help limit the spread of Omicron infections in the community.

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Effectiveness of Sotrovimab in Preventing COVID-19-related Hospitalizations or Deaths Among U.S. Veterans -

Background: Data on effectiveness of sotrovimab preventing COVID-19-related hospitalization or mortality, particularly after the emergence of the Omicron variant, are limited. Method: Determine the real-world clinical effectiveness of sotrovimab for prevention of 30-day COVID-19 related hospitalization or mortality using a retrospective cohort within the U.S. Department of Veterans Affairs (VA) healthcare system. Veterans aged ≥18 years, diagnosed with COVID-19 between December 1, 2021, and April 4, 2022, were included. Sotrovimab recipients (n=2,816) were exactly matched to untreated controls (n=11,250) on date of diagnosis, vaccination status, and region. The primary outcome was COVID-19-related hospitalization or all-cause mortality within 30 days from diagnosis. Cox proportional hazards modeling estimated the hazard ratios (HR) and 95% Confidence Interval (CI) for the association between receipt of sotrovimab and outcomes. Results: During BA.1 dominance, compared to matched controls, sotrovimab-treated patients had a 70% lower risk hospitalization within 30 days or mortality (HR 0.30; 95%CI, 0.23-0.40), a 66% lower risk of 30-day hospitalization (HR 0.34; 95%CI, 0.25-0.46), and a 77% lower risk of 30-day all-cause mortality (HR 0.23; 95%CI, 0.14-0.38). During BA.2 dominance sotrovimab-treated patients had a 71% (HR .29; 95%CI, 0.08-0.98) lower risk of 30-day COVID-19-related- hospitalization, emergency, or urgent care. Limitations include confounding by indication. Conclusions: Using national real-world data from high risk and predominantly vaccinated Veterans, administration of sotrovimab, compared with no treatment, was associated with reduced risk of 30-day COVID-19-related hospitalization or all-cause mortality during the Omicron BA.1 period and reduced risk of progression to severe COVID-19 during the BA.2 dominant period.

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Surveillance for SARS-CoV-2 in Ohio’s wildlife, companion, and agricultural animals -

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in humans in late 2019 and spread rapidly to become a global pandemic. A zoonotic spillover event from animal to human was identified as the presumed origin. Subsequently, reports began emerging regarding spillback events resulting in SARS-CoV-2 infections in multiple animal species. These events highlighted critical links between animal and human health while also raising concerns about the development of new reservoir hosts and potential viral mutations that could alter virulence and transmission or evade immune responses. Characterizing susceptibility, prevalence, and transmission between animal species became a priority to help protect animal and human health. In this study, we coalesced a large team of investigators and community partners to surveil for SARS-CoV-2 in domestic and free-ranging animals around Ohio between May 2020 and August 2021. We focused on species with known or predicted susceptibility to SARS-CoV-2 infection, highly congregated or medically compromised animals (e.g. shelters, barns, veterinary hospitals), and animals that had frequent contact with humans (e.g. pets, agricultural animals, zoo animals, or animals in wildlife hospitals). This included free-ranging deer (n=76), mink (n=57), multiple species of bats (n=65), and other wildlife in addition to domestic cats (n=275) and pigs (n= 184). In total, we tested 800 animals (34 species) via rRT-PCR for SARS-CoV-2 RNA. SARS-CoV-2 viral RNA was not detected in any of the tested animals despite a major peak in human SARS-CoV-2 cases that occurred in Ohio subsequent to the peak of animal samplings. Importantly, due to lack of validated tests for animals, we did not test for SARS-CoV-2 antibodies in this study, which limited our ability to assess exposure. While the results of this study were negative, the surveillance effort was critical and remains key to understanding, predicting, and preventing re-emergence of SARS-CoV-2 in humans or animals.

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Study of an age-based Covid-19 outbreak model and the effect of demo-graphic structure of a state on infectious disease dynamics -

In this paper, our objective was to investigate whether the Covid-19 pandemic disease is more likely to break out in some specific age group or not. We also intended to know whether some specific demographic parameters like birth rate, death rate controls the spreading of the disease. Our investigation showed that the post reproductive population group is more prone to the disease for the countries having population pyramid of stationary or con-tracting type where as for the countries with expanding population pyramid, the pre reproductive population is more likely to be attacked by the disease. We also found the domains of values of the demographic parameters that result different dynamic phenomena. Further we tried to know whether a countrys9 population pyramid has an effect in spreading the disease. Our experiment showed that for countries having expanding population pyramid, the total number of cases is expected to be comparatively low whereas for countries having contracting population pyramid, the total number of cases is expected to be comparatively high.

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Bridging the gap_Estimation of 2022/2023 SARS-CoV-2 healthcare burden in Germany based on multidimensional data from a rapid epidemic panel -

Throughout the SARS-CoV-2 pandemic, Germany lacked an adaptive population panel for epidemic diseases and a modelling platform to rapidly incorporate panel estimates. We evaluated how a cross-sectional analysis of 9922 participants of the MuSPAD study in June/July 2022 combined with a newly developed modelling platform could bridge the gap and analyzed antibody levels, neutralizing serum activity and interferon-gamma release response of serum samples. We categorized the population into four groups with differing protection against severe course of disease (validated by neutralizing serum activity), and found that 30% were in the group with highest protection, and 85% in either the highest categories or second highest group regarding protection level. Estimated hospitalizations due to SARS-CoV-2 were predicted to be between 30 to 300% of the peak in 02/2021 dependent on assumed variant characteristics. We showed the feasibility of a rapid epidemic panel able to evaluate complex endpoints for SARS-CoV-2 and inform scenario modelling.

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Automated assessment of chest CT severity scores in patients suspected of COVID-19 infection -

Background: The COVID-19 pandemic has claimed numerous lives in the last three years. With new variants emerging every now and then, the world is still battling with the management of COVID-19. Purpose: To utilize a deep learning model for the automatic detection of severity scores from chest CT scans of COVID-19 patients and compare its diagnostic performance with experienced human readers. Methods: A deep learning model capable of identifying consolidations and ground-glass opacities from the chest CT images of COVID-19 patients was used to provide CT severity scores on a 25-point scale for definitive pathogen diagnosis. The model was tested on a dataset of 469 confirmed COVID-19 cases from a tertiary care hospital. The quantitative diagnostic performance of the model was compared with three experienced human readers. Results: The test dataset consisted of 469 CT scans from 292 male (average age: 52.30) and 177 female (average age: 53.47) patients. The standalone model had an MAE of 3.192, which was lower than the average radiologists9 MAE of 3.471. The model achieved a precision of 0.69 [0.65, 0.74] and an F1 score of 0.67 [0.62, 0.71], which was significantly superior to the average reader precision of 0.68 [0.65, 0.71] and F1 score of 0.65 [0.63, 0.67]. The model demonstrated a sensitivity of 0.69 [95% CI: 0.65, 0.73] and specificity of 0.83 [95% CI: 0.81, 0.85], which was comparable to the performance of the three human readers, who had an average sensitivity of 0.71 [95% CI: 0.69, 0.73] and specificity of 0.84 [95% CI: 0.83, 0.85]. Conclusion: The AI model provided explainable results and performed at par with human readers in calculating CT severity scores from the chest CT scans of patients affected with COVID-19. The model had a lower MAE than that of the radiologists, indicating that the CTSS calculated by the AI was very close in absolute value to the CTSS determined by the reference standard.

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Estimated of expected COVID-19 deaths in Mainland China after abandoning zero COVID policy -

🖺 Full Text HTML: Estimated of expected COVID-19 deaths in Mainland China after abandoning zero COVID policy

Outcomes After Percutaneous Tracheostomy in Patients with COVID-19: A Single-Center Series of 377 Cases -

Introduction: The COVID 19 pandemic was highlighted by a rise in hospital admissions secondary to respiratory decompensation. This was accompanied by an increase in ICU admissions, endotracheal intubation and mechanical ventilation. As a consequence, tracheostomies became essential in preventing complications of prolonged intubation and to facilitate weaning from sedation and mechanical ventilation. With the lack of international consensus on tracheostomy technique and optimal timing, we present our experience with 377 percutaneous tracheostomies performed on critically ill COVID 19 patients. Objective: To report the outcomes of critically ill patients with COVID 19 who underwent percutaneous tracheostomy during a period of 24 months. Methods: A retrospective single-center electronic chart review was performed on all ICU patients who underwent percutaneous tracheostomy after respiratory failure secondary to COVID 19 between March 2020 to March 2022. Results: A total of 377 percutaneous tracheostomies were performed. The mean duration between intubation and percutaneous tracheostomy was 17.4 days (3 to 61). The study included 222 males (59%) and 155 females (41%). The mean age of patients was 56.2 years (17-94), with a mean BMI was 31.3 (14 to 68). The commonest comorbidities among patients were diabetes mellitus (50%) and hypertension (48%). Complications were encountered in 85 cases (23%), with the commonest overall complication being minor bleeding. 203 patients (54%) were weaned from sedation. The mean duration between tracheostomy and weaning from sedation was 7.5 days (1 to 47 days). 156 patients (41%) were weaned from MV. The mean duration between tracheostomy and weaning from MV was 12.9 days (1 to 58 days). There was a total of 236 (63%) deaths reported during the period of this study. No deaths were attributable to the surgical procedure. Conclusion: Percutaneous tracheostomy can be safely performed in patients with COVID 19. With lack of conclusive objective data regarding the optimal timing for tracheostomy, we recommend that tracheostomy be performed as soon as possible after the 7th day endotracheal intubation. Key Words: Percutaneous tracheostomy, COVID 19, Critically ill, ICU

🖺 Full Text HTML: Outcomes After Percutaneous Tracheostomy in Patients with COVID-19: A Single-Center Series of 377 Cases

SARS-CoV-2 seroprevalence and longitudinal antibody response following natural infection in pregnancy -

Importance: Antenatal care provides unique opportunities to assess SARS-CoV-2 seroprevalence and antibody response duration after natural infection detected during pregnancy; transplacental antibody transfer may inform peripartum and neonatal protection. Objective: Estimate seroprevalence and durability of antibodies from natural infection (anti-nucleocapsid (anti-N) IgG) among pregnant people, and evaluate transplacental transfer efficiency. Design: Seroprevalence study: cross-sectional SARS-CoV-2 antibody screening among pregnant people December 9, 2020-June 19, 2021. Cohort study: Pregnant people screened anti-N IgG+ by Abbott Architect chemiluminescent immunoassay in seroprevalence study or identified through medical records with RT-PCR+ or antigen positive results enrolled in a prospective cohort December 9, 2020-June 30, 2022 to longitudinally measure anti-N IgG responses. We collected cord blood and assessed transplacental transfer of maternally-derived anti-N antibodies. Setting: Three hospitals and 14 affiliated clinics providing antenatal and delivery care, Seattle, Washington metropolitan area. Participants: Seroprevalence study: pregnant people were screened for SAR-CoV-2 anti-N IgG during routine care. Cohort study: Pregnant people with evidence of prior SARS-CoV-2 infection (screened anti-N IgG+ from seroprevalence study or identified with a RT-PCR+ or antigen positive result from medical records) were enrolled in a cohort study to longitudinally measure anti-N IgG responses. Exposure(s) (for observational studies): COVID-19 diagnosis, symptoms, and disease severity. Main Outcome(s) and Measure(s): Presence and durability of SARS-CoV-2 anti-N IgG, transplacental transfer of maternally-derived anti-N IgG. Results: Of 1289 pregnant people screened in the seroprevalence study, 5% (65) tested SARS-CoV-2 anti-N IgG+, including 39 (60%) without prior RT-PCR+ or antigen positive results and 53 (82%) without symptoms. Among 89 participants enrolled in the cohort study, 73 (82%) had anti-N IgG+ results during pregnancy. Among 49 participants with delivery samples 33 (67%) were anti-N IgG negative by delivery. Of 24 remaining anti-N IgG+ at delivery with paired cord blood samples, 12 (50%) had efficient transplacental anti-N IgG antibody transfer. Median time from first anti-N IgG to below positive antibody threshold was 17 weeks and did not differ by prior RT-PCR+ or antigen positive status. Conclusions and Relevance: Maternally-derived SARS-CoV-2 antibodies to natural infection may wane before delivery. Vaccines are recommended for pregnant persons to reduce severe illness and confer protection to infants.

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The kinetics of humoral and cellular responses after the booster dose of COVID-19 vaccine in inflammatory arthritis patients -

Introduction: Impaired immunogenicity of COVID-19 vaccinations in inflammatory arthritis (IA) patients results in diminished immunity. However, optimal booster vaccination regimens are still unknown, due to not unstudied kinetics of the immune response after booster vaccinations. Therefore, this study aimed to assess the kinetics of humoral and cellular responses in IA patients after the COVID-19 booster. Patients and Methods: In 29 IA patients and 16 healthy controls (HC) humoral responses (level of IgG antibodies) and cellular responses (IFN-γ production) were assessed before (T0), after 4 weeks (T1), and after more than 6 months (T2) from the booster vaccination with BNT162b2. Results: IA patients, but not HC, showed lower anti-S-IgG concentration and IGRA fold change at T2 compared to T1 (p=0.026 and p=0.031). Furthermore, in IA patients the level of cellular response at T2 returned to the pre-booster level (T0). All immunomodulatory drugs, except IL-6 and IL-17 inhibitors for the humoral and IL-17 inhibitors for the cellular response, impaired the immunogenicity of the booster dose at T2. However, none of the immunomodulatory drugs affected the kinetics of both humoral and cellular responses (measured as the difference between response rates at T1 and T2). Conclusion: Our study showed impaired kinetics of both humoral and cellular responses after the booster dose of the COVID-19 vaccine in IA patients, which, in the case of cellular response, did not allow the vaccination effect to be maintained for more than 6 months. Repetitive vaccination with subsequent booster doses seems to be necessary for IA patients.

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