COVID, Volume 2, Issue 7 (July 2022) – 14 articles

COVID-19-associated pulmonary aspergillosis (CAPA) refers to co-infection with Aspergillus spp. in patients with COVID-19. It has a higher mortality rate when compared with patients only infected with COVID-19, but we still know little about the epidemiology, diagnosis, and best treatment options for patients with CAPA. We report our findings from a year-long retrospective case series of patients with CAPA in two tertiary hospitals in the United Kingdom. We included all patients admitted to critical care with CAPA between March 2020–2021. We used the European Confederation for Medical Mycology and the International Society for Human and Animal Mycology consensus criteria to categorise CAPA. Demographic data, patients’ co-morbidities, time to and method of diagnosis, COVID-19 and aspergillosis treatment, and outcomes were analysed. Thirteen patients were diagnosed with probable CAPA between October/2020–March/2021, and 54.8% also had hypertension. Diagnosis was established after a median of 18 days post-COVID-19 infection, and a median of 7 days post-intubation. All patients had received corticosteroids, as well as tocilizumab (7; 53.8%) and remdesivir (3; 23%). Eleven patients received antifungal treatment. Nine (69%) patients died by 30 days post-ICU admission, one patient died on day 32, and three (23%) patients survived. CAPA has a very high mortality rate. We also identified three areas that merit further investigation: lack of positive tests between March–October 2020; COVID-19 treatments and possible relationship with increased CAPA rates; and the rationale behind antifungal treatment in our hospitals compared to recommended treatment in the literature. Full article

Children with Autism Spectrum Disorder (ASD) were particularly vulnerable to disruptions caused by the COVID-19 pandemic. In this study we conducted an anonymous caregiver survey to assess the impact of the COVID-19 pandemic on the psychosocial and behavioral health of children with ASD. Data from 700 responses identified several significant factors predicting greater difficulties for the child including pre-existing behavioral challenges (OR = 5.179; 95% CI: 2.696, 9.951), disrupted sleep (OR = 2.618; 95% CI 1.341, 5.112), and a diagnosis of depression (OR = 3.425; 95% CI: 1.1621, 4.116). Greater difficulties for caregivers in managing their child’s behaviors were associated with sleep disturbances (OR = 1.926; 95% CI: 1.170, 3.170), self-injurious behavior (OR = 3.587; 95% CI: 1.767, 7.281), and managing the child’s school activities (OR = 3.107; 95% CI: 1.732, 5.257) and free time (OR = 3.758; 95% CI: 2.217, 6.369). However, being under the care of a neuropsychiatrist was associated with less difficulty in managing the child’s behaviors (OR = 2.516; 95% CI: −1.046, −5.382). Finally, the presence of comorbidities (OR = 2.599; 95% CI: 1.053, 4.067) and a greater difficulty in managing the child’s school activities (OR = 2.531; 95% CI: 1.655, 3.868) and free time (OR = 1.651; 95% CI: 1.101, 2.478) were associated with an increased likelihood of caregiver desire for their child to return to in-person school in the fall. The COVID-19 pandemic had a wide-ranging impact on the behaviors of children with ASD and challenges for their caregivers. Full article

Due to the crisis generated by COVID-19 at a global level, many professionals are working under harsh conditions, and the Basque Country is no exception. On 14 March 2020, the head of the government decreed a state of alarm at the state level, which forced us all to be confined to our homes. This situation directly affected the profession of social educator. In fact, these professionals work with the most vulnerable groups, so working on the front line is mandated, even if this results in a significant risk. The situation of the groups in residential resources cannot be easy due to the stress produced by living together and being locked up, and this directly affects the educators who necessarily work in it. However, the over-exertion that all of this requires, which is a risk, has not been detected nor recognized at the social level. For this reason, the objective of this investigation is to measure the stress of social educators of advanced age who work in residential resources in different zones of the Basque Country (northern Spain). Sixty-seven social educators participated in the case study. Qualitative and quantitative methods were combined for data collection. This questionnaire was conducted through the Google Forms platform. The quantitative data collected through the questionnaire were analyzed by descriptive analysis and frequency contrasts were performed through the SPSS V25 program. We can conclude that it is necessary to take into account the difficulties of this sector and the professionals both at the governmental and social levels. Future research should include responses from both groups and workers in order to guarantee adequate inclusion. Full article

Bioaerosols are present everywhere around us, either on surfaces or in the air. Depending on their nature, these bioaerosols have positive or negative impacts on our bodies. Our immune system always creates a balance in our health system in response to these bioaerosols. If our body’s immune system is compromised for a while, it could have many severe health complications. A good example is in patients who recovered from COVID-19 during the COVID-19 pandemic. During treatment, many drugs like dexamethasone, tocilizumob, itolizumab, and steroids were extensively used that suppressed the immune system, resulting in many fungal infections. In this review, we summarise the various studies carried out throughout the globe regarding fungal infection, including Mucormycetes (black fungus), Candida spp., Aspergillus fumigatus, and pneumocystis jirovecii. The patient disease history and treatment details were also examined so as to develop the risk of mortality. Populations with other pre-existing diseases such as diabetes and asthma are more vulnerable to infection. These infections spread at a very high rate and have a high risk of mortality in patients who have recovered from COVID-19. Earnest attention is needed regarding the treatment procedure of COVID-19 patients and for the follow-up of recovered patients. Here, we suggest some treatment methods that will help prevent infection in patients who have recovered from COVID-19 or in immunosuppressed bodies. Full article

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can spread to the environment through several routes and persist for a more extended period. Therefore, we reviewed pertinent literature to understand the transmission dynamics of SARS-CoV-2 and genomic epidemiology of emerging variants of concern (VOCs) in the environment, their inactivation strategies, and the impact of COVID-19 on the ecosystem. The fallouts of the reviewed studies indicate that SARS-CoV-2 transmits through air and fomite, contaminated surfaces, biomedical wastes, and stool, which contaminates the environment through wastewater. As a result, multiple VOCs of SARS-CoV-2 were circulating in the environment. Genomic epidemiology revealed that the most prevalent VOC was Delta (B.1.617.2; 44.24%), followed by Omicron (B.1.1.529; 43.33%), in the environment. Phylogenetic analysis showed that environmental strains are clustered with a likeness of the human strains of the same or nearby countries, emphasizing the significance of continued environmental surveillance to track the emergence of the new variant. Thus, we should reduce viral dispersion in the environment through rapid and appropriate disinfection strategies. Moreover, the increased production and use of macro and microfiber plastic products should be brought under strict legislation with integrated waste management to control the unrelenting propagation of viral RNA. Finally, a comprehensive understanding of the environmental transmission pathways of SARS-CoV-2 is crucial for forecasting outbreak severity in the community, allowing us to prepare with the correct tools to control any impending pandemic. We recommend wastewater-based SARS-CoV-2 surveillance and air particulates to track the emerging VOCs of SARS-CoV-2 spread in the environment. Full article

The SARS-CoV-2 pandemic led to an unprecedented demand for PPE and generated a small-scale industry making personalised face coverings. Concerns had been raised about the use of natural rubber latex (NRL) as an elastomeric material, with its health risks. We have investigated the levels of four NRL allergens and total protein in elastomeric ear-straps in manufactured face coverings and the material sold for their production, and a number of imported N95/KN95 PPE masks. None of the samples identified whether NRL was involved or not. NRL allergens levels in manufactured masks were low or not detectable; 3/10 of the N95/KN95 masks showed levels above the limit of detection, probably reflecting low-level cross-contamination during manufacture. Three batches of material sold for “the manufacture of ear straps for face coverings” had significant but variable levels of allergen (250–2526 ng/g of material). Historically, extractable protein measurements have been used as an indicator of possible NRL proteins. This study showed significant levels of apparent protein in sample extracts without measurable NRL allergens or confirmation by electrophoresis. Therefore, the immunochemical measurement of NRL allergens remains key to rule out elastomeric material with the potential to cause latex-related health problems. Full article

Zimbabwe reported its first case of coronavirus disease 2019 (COVID-19) on 20 March 2020 and the country’s response has largely adhered to international protocols. From the outset of the pandemic, most control measures were premised upon knowledge of breaking infectious diseases’ chains of transmission gained from previous experiences with comparable pathogens. As relatively little was known about the novel virus, and the prospects of effective vaccines were not on the horizon, these tough control measures were deemed appropriate. Two years into the pandemic, a massive evolution of knowledge has transpired, and safe and effective vaccines against the virus are now available, are administered to billions of people, and can significantly reduce new infections, severe disease, hospitalisation, and death from the disease. Based on the understanding of the pandemic and the need to restore socio-economic activities, in this review we propose a paradigm shift in addressing the challenges of the COVID-19 pandemic. The COVID-19 response should take into consideration the local context and tailor-make a response that addresses local challenges. Full article

COVID-19, or coronavirus disease, has caused an ongoing global pandemic causing un-precedented damage in all scopes of life. An infected person with underlaying medical conditions is at greater risk than the rest of the population. Obstructive sleep apnea (OSA) is an illness associated with disturbances during sleep or an unconscious state with blockage of the airway passage. The comobordities of OSA with high blood pressure, diabetes, obesity, and age can place the life of an already infected COVID-19 patient into danger. In this paper, a prediction model for the mortality of a COVID-infected patient suffering from OSA is developed using machine learning algorithms. After an extensive methodical search, we designed an artificial neural network that can predict the mortality with an overall accuracy of 99% and a precision of 100% for forecasting the fatality chances of COVID-infected patients. We believe our model can accurately predict the mortality of the patients and can therefore assist medical health workers in predicting and making emergency clinical decisions, especially in a limited resource scenario, based on the medical history of the patients and their future potential risk of death. In this way, patients with a greater risk of mortality can receive timely treatment and benefit from proper ICU resources. Such artificial intelligent application can significantly reduce the overall mortality rate of vulnerable patients with existing medical disorders. Full article

Background: COVID-19, caused by the novel coronavirus SARS-CoV-2, was declared by WHO in early 2020 as a worldwide pandemic. Several known risk markers are associated with COVID-19 morbidity and mortality, including age, gender, and diseases, such as hypertension, diabetes, and chronic cardiovascular diseases. Recent studies have shown an association between COVID-19 infection and the ABO blood groups. Objective: To assess the prevalence of SARS-CoV-2 among suspected COVID-19 patients as well as the risk markers for COVID-19 associated with ABO blood group, Rhesus factor, and patient’s address during the past year. Methods: 69,019 nasopharyngeal swab samples were collected and analyzed by reverse transcription polymerase chain reaction technique for the detection of SARS-CoV-2 in patients attending a tertiary health care center in South Lebanon during the period between August 2020 and July 2021. Results: Among all tested subjects, the prevalence of SARS-CoV-2 infection was 19.2% (95% CI: 18.9% to 19.5%). Among those with known blood group (N = 17,462), odds of SARS-CoV-2 were higher in group A (Odds Ratio = 1.12, 95% CI: 1.02 to 1.23) and group AB (OR = 1.19, 95% CI: 1.00 to 1.41) relative to the reference group O (OR = 1). Odds of SARS-CoV-2 in the Rh-negative group (OR = 1.02, 95% CI: 0.89 to 1.16) were not significantly different from the Rh-positive group. Among those with known address (N = 30,060), odds of SARS-CoV-2 were lower in residents of remote areas (OR = 0.89, 95% CI: 0.80 to 0.99) relative to central cities. Conclusion: There is a modestly higher risk of SARS-CoV-2 infection associated with blood groups A and AB, and a lower risk associated with living in remote, less crowded regions. Full article

The accurate detection of SARS-CoV-2 through respiratory sampling is critical for the prevention of further transmission and timely initiation of treatment. There is a diverse range of SARS-CoV-2 detection rates in reported studies, with uncertainty regarding the optimal sampling method for COVID-19 diagnosis and monitoring. Oropharyngeal sampling (OPS) is one of the most commonly used methods of respiratory sampling in Ghana and other parts of the world for the detection of SARS-CoV-2 viral RNA. However, this sampling technique has a number of drawbacks, which include difficulty in obtaining high-quality swab samples, increased risk of infection to healthcare workers, and increased cost from a regular supply of swabs, transport media, and personal protective equipment (PPE). This study, therefore, sought to evaluate the diagnostic performance of sputum specimens in the diagnosis of COVID-19. This was a cross-sectional analytical study conducted in two health facilities in Kumasi, Ghana, between April and September 2021. Paired samples (an oropharyngeal swab and sputum) were taken from each recruited patient and run concurrently for the detection of SARS-CoV-2 genes (the N and ORF1ab genes) using RT-qPCR. Of the 317 patients recruited, 50.8% were males, and 60.4% were young adults aged 20–39 years. A significant proportion (65.9%) of the patients did not have any co-morbidity, and the majority were with symptoms; predominantly cough (36.3%), headache (31.5%), general weakness (24.0%), fever (20.2%), and sore throat (16.1%). Being symptomatic (p = 0.003), having comorbidity (p = 0.001), and the reporting facility (p = 0.010) were significantly associated with the COVID-19 status. The sputum samples yielded more COVID-positive, 120/317 (37.9%), as compared to OPS, 83/317 (26.2%). The sputum samples were 85.5% (95% CI, 76.4–91.5) sensitive, 79.1% (95% CI, 73.4–83.7) specific, and with positive and negative predictive values of 59.2% and 93.9%, respectively, when compared with OPS. The overall median of the SARS-CoV-2 viral loads for sputum (3.70 × 10³ copies/mL) were significantly higher than in OPS (1.18 × 10² copies/mL) (p = 0.003). Findings from the study suggest self-collected sputum as a useful alternative to OPS for the diagnosis of COVID-19, providing a comparable diagnostic performance and, thereby, easing the uncomfortable process and mitigating risk of aerosol transmission to healthcare workers. Full article

The antenatal and postnatal effects of maternal SARS-CoV-2 on the fetus outcomes, especially in the case of maternal pre-vaccination against this infection, are still under investigation. Such effects may be due to placental insufficiency caused by maternal hypoxia and inflammatory response associated with SARS-CoV-2, and/or be a direct cytopathic effect of the virus. In this work, we studied the profile of small non-coding RNAs (sncRNAs) in the blood plasma of a newborn from a mother who had SARS-CoV-2 at the 22nd week of gestation after immunization with Gam-COVID-Vac (Sputnik V). The fetus had ultrasound signs of hypertrophy of the right heart and hydropericardium 4 weeks after infection of the mother with SARS-CoV-2, as well as cysts of the cerebral vascular plexuses by the time of birth. Taking this into account, we compared the sncRNA profile of this newborn on the first postpartum day with that of neonates born to COVID-19-negative women with different perinatal outcomes: severe cardiovascular and/or neurological disorders, or absence of any perinatal complications. According to next-generation sequencing data, we found that the fetus born to a COVID-19-affected mother pre-immunized with Gam-COVID-Vac (Sputnik V) vaccine differs from newborns with severe cardiovascular and/or nervous system abnormalities either in multidirectional changes in circulating sncRNAs or in less pronounced unidirectional changes in the level of sncRNAs relative to control samples. Considering this, it can be concluded that maternal vaccination against SARS-CoV-2 before pregnancy has a protective effect in preventing antenatal development of pathological processes in the cardiovascular and nervous systems of the neonate associated with COVID-19. Full article

In early February 2022, the Japanese government sent COVID-19 vaccine vouchers to children ages 5–11. Using keywords obtained from the voucher, the frequently asked questions section, and experts, we descriptively analyzed the advantages and disadvantages of vaccination for children and their parents through a web-based literature survey of media articles and government homepage statements in Japan. For children, vaccination helps prevent severe symptoms and may be particularly beneficial for children in low-income families by lowering the rate of suicide and at-home child abuse. For parents, not vaccinating their child allows them to fulfill a more traditional role as a parent (mothers in particular), reduces the gender gap for mothers, and provides greater peace of mind about their child’s future fertility. We also examined the governmental vaccination campaigns targeting children from public health perspectives. We argue that the letter accompanying the vaccine voucher should clearly emphasize that further transmission will be prevented, reducing domestic infection. In addition to the biological dimensions of COVID-19 in Japan, we emphasize cultural issues and hope that these can be useful for other countries as they create their own vaccination strategies. Public health in Japan could be promoted if all citizens, regardless of age, acquired fundamental knowledge and skills, the motivation to learn, and the ability to utilize knowledge and skills and think, judge, and express personal ideas. Full article