COVID, Volume 3, Issue 5 (May 2023) – 12 articles

The novel Coronavirus disease 2019 (COVID-19) presents a major threat to public health but can be prevented by safe and effective COVID-19 vaccines. Vaccine acceptance among healthcare workers (HCWs) is essential to promote uptake. This study, aimed to determine the COVID-19 vaccination uptake and hesitancy and its associated factors among HCWs in Tanzania. We employed a convergent-parallel mixed-methods design among 1368 HCWs across health facilities in seven geographical zones in Tanzania in 2021. We collected quantitative data by using an interviewer-administered questionnaire and qualitative data, using in-depth interviews and focus group discussions. Participants in the quantitative aspect were conveniently selected whereas those in the qualitative aspect were purposively selected based on their role in patient care, management, and vaccine provision. Stata software version 16.1 was used in the analysis of quantitative data and thematic analysis for the qualitative data. Multiple logistic regression was used to assess the determinants of COVID-19 vaccine uptake. The median age of 1368 HCWs was 33, and the interquartile range was 28–43 years; 65.6% were aged 30+ years, and 60.1% were females. Over half (53.4%) of all HCWs received the COVID-19 vaccine, 33.6% completely refused, and 13% chose to wait. HCWs aged 40+ years, from lower-level facilities (district hospitals and health centers), who worked 6+ years, and with perceived high/very high risk of COVID-19 infection had significantly higher odds of vaccine uptake. The qualitative data revealed misinformation and inadequate knowledge about COVID-19 vaccine safety and efficacy as the key barriers to uptake. Nearly half of all HCWs in Tanzania are still unvaccinated against COVID-19. The predominance of contextual influence on COVID-19 vaccine uptake calls for interventions to focus on addressing contextual determinants, focusing on younger HCWs’ population, short working duration, those working at different facility levels, and providing adequate vaccine knowledge. Full article

Background: Stress and depression are common mental health concerns among college students. Factors related to weight status and stigma are associated with poor mental health outcomes. We sought to describe the prevalence of weight dissatisfaction in relation to stress and depression among college students (n = 551). Methods: A cross-sectional study was conducted via a convenient sample between December 2020 and February 2021. Mean differences in the Perceived Stress Scale-10 scores and Center for Epidemiologic Studies Depression Scale scores were examined using a one-way analysis of variance. Associations between stress, depression, and weight dissatisfaction were measured by logistic regression. Results: Weight dissatisfied (75.1%) students had significantly higher mean depression scores compared to weight satisfied. The weight dissatisfied students were 1.05 times more likely to be depressed compared to those who were weight satisfied. Significant mean differences in stress and/or depression were found for weight dissatisfied students by gender, race, parental status, marital status, residence, and U.S. citizenship. Weight dissatisfaction was higher than that reported in the literature, possibly due to the influence of social isolation during the COVID-19 pandemic. Conclusions: Strategies to reduce the prevalence of weight dissatisfaction for improved mental health should be explored, particularly efforts to reduce weight stigmatization and expand access to mental health care. Full article

The occurrence of breakthrough infections with SARS-CoV-2 in vaccinated individuals argues against abandoning mitigation efforts such as social distancing. Some public health messages, however, promote vaccination by increasing psychological distress, which interferes with social distancing. Prosocial messages present an alternative approach that may avoid this problem. Accordingly, the present study examined the relation of pandemic mitigation with scores on prosocial personality traits (i.e., altruism, sympathy, and trust) and vaccination intentions. Regression analyses indicated that while vaccination intentions increased significantly with an increase in trust, distancing increased significantly with increases in altruism and sympathy. Because older adults are much more vulnerable to COVID-19 than younger adults, these findings reveal an altruistic paradox, in which older adults, perhaps the most altruistic portion of the population, may be dependent on the altruistic behavior of younger adults, who may be the least altruistic portion. The challenge for public health messaging will be to motivate younger adults to take the consequences of their mitigation decisions for others into account. Full article

1. Background: Some reports have suggested that as many as one-half of all hospital inpatients identified as COVID-19-positive during the Omicron BA.1 variant-driven wave were incidental cases admitted primarily for reasons other than their viral infections. To date, however, there are no prospective longitudinal studies of a representative panel of hospitals based on pre-established criteria for determining whether a patient was, in fact, admitted as a result of the disease. 2. Materials and Methods: To fill this gap, we developed a formula to estimate the fraction of incidental COVID-19 hospitalizations that relies on measurable, population-based parameters. We applied our approach to a longitudinal panel of 164 counties throughout the United States, covering a 4-week interval ending in the first week of January 2022. 3. Results: Within this panel, we estimated that COVID-19 incidence was rising exponentially at a rate of 9.34% per day (95% CI, 8.93–9.87). Assuming that only one-quarter of all Omicron BA.1 infections had been reported by public authorities, we further estimated the aggregate prevalence of active SARS-CoV-2 infection during the first week of January to be 3.45%. During the same week, among 250 high-COVID-volume hospitals within our 164-county panel, an estimated one in four inpatients was COVID-positive. Based upon these estimates, we computed that 10.6% of such COVID-19-positive hospitalized patients were incidental infections. Across individual counties, the median fraction of incidental COVID-19 hospitalizations was 9.5%, with an interquartile range of 6.7 to 12.7%. 4. Conclusion: Incidental COVID-19 infections appear to have been a nontrivial fraction of all COVID-19-positive hospitalized patients during the Omicron BA.1 wave. In the aggregate, however, the burden of patients admitted for complications of their viral infections was far greater. Full article

In the context of new therapeutic protocols and vaccines developed in the past 3 years, coronavirus 2019 (COVID-19) continues to exert an important impact on the healthcare systems worldwide. Age and a history of cardiovascular or respiratory diseases remain relevant in terms of prognosis for all COVID-19 patients, independent of the viral strain, by conveying a worse outcome and increased rates of in-hospital mortality. Previous studies reported heterogenous cardiovascular manifestations in COVID-19 patients from acute myocarditis or myopericarditis, acute coronary syndromes, stress cardiomyopathy, de novo arrhythmias to pulmonary embolism, or in some rare cases, endocarditis. In this review, we assessed the potential acute, in-hospital and long-term cardiac complications in patients diagnosed with COVID-19. Full article

Introduction: The Coronavirus disease of 2019 (COVID-19) is a catastrophic emerging global health threat caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has a wide range of complications and sequelae. It is devastating in developing countries, causing serious health and socioeconomic crises as a result of the increasingly overburdened healthcare system. This study was conducted to determine the prevalence of SARS-CoV-2 infection in Ethiopia. Methods: Electronic databases, such as PubMed, Google Scholar, Web of Science, Research Gate, Embase, and Scopus were thoroughly searched from March to April 2022 to identify relevant studies. The quality of the included studies was evaluated using the Newcastle-Ottawa Quality scale for cross-sectional studies. STATA-12 was used for analysis. A random-effects model was used to compute the pooled prevalence of SARS-CoV-2 infection. The heterogeneity was quantified by using the I² value. Subgroup analysis was done for sex, age of study subjects, population type, diagnostic methods, and publication year. Publication bias was assessed using a funnel plot and Egger’s test. A sensitivity analysis was also done. Result: 11 studies consisting of 35,376 study participants (15,759 male and 19,838 female) were included in this systematic review and meta-analysis. The pooled prevalence of SARS-CoV-2 was 8.83%. There was substantial heterogeneity, with an I² value of 99.3%. The pooled prevalence of SARS-CoV-2 was higher in males (9.27%) than in females (8.8%). According to the publication year, a higher prevalence was obtained in 2021 (12.69%). Similarly, it was higher in the population of specific groups (16.65%) than in the general population (5.75%). Conclusion: the national pooled prevalence of SARS-CoV-2 infection in the Ethiopian population was 8.83%. This indicates that the burden of COVID-19 is still high, which urges routine screening and appropriate treatment. Full article

Vaccines have been identified as a crucial strategy to control the spread of COVID-19 and reduce its impact. However, there are concerns about the acceptance of vaccines within African, Caribbean, and Black (ACB) communities. Based on a community sample of ACB people in Ottawa, Ontario (n = 375), the current study aimed to use logistic regression analysis and identify factors associated with COVID-19 vaccine willingness. A multivariate analysis shows that ACB people who believed that the ACB population is at a higher risk for COVID-19 were more likely to be willing to receive the vaccine compared to those who did not (OR = 1.79, p < 0.05). ACB people who had received at least one dose of the COVID-19 vaccine were more likely to be willing to receive it in the future (OR = 2.75, p < 0.05), and trust in government COVID-19 information was also positively associated with vaccine willingness (OR = 3.73, p < 0.01). In addition, English-speaking respondents were more willing to receive the vaccine compared to French-speaking respondents (OR = 3.21, p < 0.01). In terms of socioeconomic status, ACB people with a post-graduate degree (OR = 2.21, p < 0.05) were more likely to report vaccine willingness compared to those without a bachelor’s degree. Based on these findings, we discuss implications for policymakers and directions for future research. Full article

(1) Background: Data on COVID-19 outcomes and disease course as a function of different medications used to treat cardiovascular disease and chronic kidney disease (CKD), as well as the presence of different comorbidities in primarily Black cohorts, are lacking. (2) Methods: We conducted a retrospective medical chart review on 327 patients (62.6% Black race) who were admitted to the Detroit Medical Center, Detroit, MI. Group differences (CKD vs. non-CKD) were compared using the Pearson χ² test. We conducted univariate and multivariate regression analyses for factors contributing to death during hospitalization due to COVID-19 (primary outcome) and ICU admission (secondary outcome), adjusting for age, sex, different medications, and comorbidities. A sub-analysis was also completed for CKD patients. (3) Results: In the fully adjusted model, a protective effect of ACEi alone, but not in combination with ARB or CCB, for ICU admission was found (OR = 0.400, 95% CI [0.183–0.874]). Heart failure was significantly associated with the primary outcome (OR = 4.088, 95% CI [1.1661–14.387]), as was COPD (OR = 3.747, 95% CI [1.591–8.828]). (4) Conclusions: Therapeutic strategies for cardiovascular disease and CKD in the milieu of different comorbidities may need to be tailored more prudently for individuals with COVID-19, especially Black individuals. Full article

Accurate prediction of SARS-CoV-2 infection based on symptoms can be a cost-efficient tool for remote screening in healthcare settings with limited SARS-CoV-2 testing capacity. We used a machine learning approach to determine self-reported symptoms that best predict a positive SARS-CoV-2 test result in physician trainees from a large healthcare system in New York. We used survey data on symptoms history and SARS-CoV-2 testing results collected retrospectively from 328 physician trainees in the Mount Sinai Health System, over the period 1 February 2020 to 31 July 2020. Prospective data on symptoms reported prior to SARS-CoV-2 test results were available from the employee health service COVID-19 registry for 186 trainees and analyzed to confirm absence of recall bias. We estimated the associations between symptoms and IgG antibody and/or reverse transcriptase polymerase chain reaction test results using Bayesian generalized linear mixed effect regression models adjusted for confounders. We identified symptoms predicting a positive SARS-CoV-2 test result using extreme gradient boosting (XGBoost). Cough, chills, fever, fatigue, myalgia, headache, shortness of breath, diarrhea, nausea/vomiting, loss of smell, loss of taste, malaise and runny nose were associated with a positive SARS-CoV-2 test result. Loss of taste, myalgia, loss of smell, cough and fever were identified as key predictors for a positive SARS-CoV-2 test result in the XGBoost model. Inclusion of sociodemographic and occupational risk factors in the model improved prediction only slightly (from AUC = 0.822 to AUC = 0.838). Loss of taste, myalgia, loss of smell, cough and fever are key predictors for symptom-based screening of SARS-CoV-2 infection in healthcare settings with remote screening and/or limited testing capacity. Full article

Evusheld is a combination injection of tixagevimab and cilgavimab and is indicated for the pre-exposure prophylaxis of COVID-19 in adults and adolescents aged 12 years and older. Its use has been advocated for immunosuppressed individuals, such as blood cancer patients, although uptake varies significantly between countries. Despite extensive use internationally, there has been limited analysis of potential psychological benefits that vulnerable patients might gain from receiving this prophylactic medication. In this study we have quantified four key psychological health parameters in blood cancer patients who received Evusheld (EQ5D-3L quality of life score, DSM5 Agoraphobia score, Duke’s Social Support Index and the hospital anxiety and depression score) and compared their responses with a control group of patients who did not receive Evusheld. We show that patients who opted for treatment had higher baseline markers of psychological stress and ill-health compared with non-treated individuals but that treatment with Evusheld significantly improved the psychological health of recipients and increased the level of physical social/work interactions over that of control patients. Although there are limitations with this small study, the findings strongly suggest that Evusheld prophylaxis can provide significant psychological benefits for vulnerable blood cancer patients who have significant anxiety about COVID-19 infection. Full article

COVID-19 is an infectious disease caused by SARS-CoV-2. This virus presents high levels of mutation and transmissibility, which contributed to the emergence of the pandemic. Our study aimed to analyze, in silico, the genomic diversity of SARS-CoV-2 strains in Bahia State by comparing patterns in variability of strains circulating in Brazil with the first isolated strain NC_045512 (reference sequence). Genomes were collected using GISAID, and subsequently aligned and compared using structural and functional genomic annotation. A total of 744 genomes were selected, and 20,773 mutations were found, most of which were of the SNP type. Most of the samples presented low mutational impact, and of the samples, the P.1 (360) lineage possessed the highest prevalence. The most prevalent epitopes were associated with the ORF1ab protein, and in addition to P.1, twenty-one other lineages were also detected during the study period, notably B.1.1.33 (78). The phylogenetic tree revealed that SARS-CoV-2 variants isolated from Bahia were clustered closely together. It is expected that the data collected will help provide a better epidemiological understanding of the COVID-19 pandemic (especially in Bahia), as well as helping to develop more effective vaccines that allow less immunogenic escape. Full article