Vaccine effectiveness against severe acute respiratory infections (SARI) COVID-19 hospitalisations estimated from real-world surveillance data,Slovenia, October 2021

We estimated vaccine effectiveness (VE) against severe COVID-19 during October 2021, using Slovenian surveillance data. For people fully vaccinated with any vaccine in age groups 18–49, 50–64, ≥ 65 years, VE was 86% (95% CI: 79–90), 89% (85–91), and 77% (74–81). Among ≥ 65 year-olds fully vaccinated with mRNA vaccines, VE decreased from 93% (95% CI: 88–96) in those vaccinated ≤ 3 months ago to 43% (95% CI: 30–54) in those vaccinated ≥ 6 months ago, suggesting the need for early boosters.     

Effectiveness of mRNA COVID-19 vaccines in preventing SARS-CoV-2 infections and COVID-19 hospitalisations and deaths in elderly long-term care facility residents,Spain, weeks 53 2020 to 13 2021

Residents in long-term care facilities (LTCF) experienced a large morbidity and mortality during the COVID-19 pandemic in Spain and were prioritised for early COVID-19 vaccination. We used the screening method and population-based data sources to obtain estimates of mRNA COVID-19 vaccine effectiveness for elderly LTCF residents. The estimates were 71% (95% CI: 56–82%), 88% (95% CI: 75–95%), and 97% (95% CI: 92-99%), against SARS-CoV-2 infections (symptomatic and asymptomatic), and COVID-19 hospitalisations and deaths, respectively.     

Tracheostomy for COVID-19 respiratory failure: timing,ventilatory characteristics,and outcomes

BackgroundWhereas data from the pre-pandemic era have demonstrated that tracheostomy can accelerate liberation from the ventilator, reduce need for sedation, and facilitate rehabilitation, concerns for healthcare worker safety have led to disagreement on tracheostomy placement in COVID-19 patients. Data on COVID-19 patients undergoing tracheostomy may inform best practices. Thus, we report a retrospective institutional cohort experience with tracheostomy in ventilated patients with COVID-19, examining associations between time to tracheostomy and duration of mechanical ventilation in relation to patient characteristics, clinical course, and survival.MethodsClinical data were extracted for all COVID-19 tracheostomies performed at a quaternary referral center from April-July 2020. Outcomes studied included mortality, adverse events, duration of mechanical ventilation, and time to decannulation.ResultsAmong 64 COVID-19 tracheostomies (13% of COVID-19 hospitalizations), patients were 64% male and 42% African American, with a median age of 54 (range, 20–89). Median time to tracheostomy was 22 (range, 7–60) days and median duration of mechanical ventilation was 39.4 (range, 20–113) days. Earlier tracheostomy was associated with shortened mechanical ventilation (R²=0.4, P<0.01). Median decannulation time was 35.3 (range, 7–79) days. There was 19% mortality and adverse events in 45%, mostly from bleeding in therapeutically anticoagulated patients.ConclusionsTracheostomy was associated with swifter liberation from the ventilator and acceptable safety for physicians in this series of critically ill COVID-19 patients. Patient mortality was not increased relative to historical data on acute respiratory distress syndrome (ARDS). Future studies are required to establish conclusions of causality regarding tracheostomy timing with mechanical ventilation, complications, or mortality in COVID-19 patients.     

Decline of influenza and respiratory syncytial virus detection in facility-based surveillance during the COVID-19 pandemic,South Africa,January to October 2020

BackgroundIn South Africa, COVID-19 control measures to prevent SARS-CoV-2 spread were initiated on 16 March 2020. Such measures may also impact the spread of other pathogens, including influenza virus and respiratory syncytial virus (RSV) with implications for future annual epidemics and expectations for the subsequent northern hemisphere winter.MethodsWe assessed the detection of influenza and RSV through facility-based syndromic surveillance of adults and children with mild or severe respiratory illness in South Africa from January to October 2020, and compared this with surveillance data from 2013 to 2019.ResultsFacility-based surveillance revealed a decline in influenza virus detection during the regular season compared with previous years. This was observed throughout the implementation of COVID-19 control measures. RSV detection decreased soon after the most stringent COVID-19 control measures commenced; however, an increase in RSV detection was observed after the typical season, following the re-opening of schools and the easing of measures.ConclusionCOVID-19 non-pharmaceutical interventions led to reduced circulation of influenza and RSV in South Africa. This has limited the country’s ability to provide influenza virus strains for the selection of the annual influenza vaccine. Delayed increases in RSV case numbers may reflect the easing of COVID-19 control measures. An increase in influenza virus detection was not observed, suggesting that the measures may have impacted the two pathogens differently. The impact that lowered and/or delayed influenza and RSV circulation in 2020 will have on the intensity and severity of subsequent annual epidemics is unknown and warrants close monitoring.     

A simple model for control of COVID-19 infections on an urban campus

A customized susceptible, exposed, infected, and recovered compartmental model is presented for describing the control of asymptomatic spread of COVID-19 infections on a residential, urban college campus embedded in a large urban community by using public health protocols, founded on surveillance testing, contact tracing, isolation, and quarantine. Analysis in the limit of low infection rates—a necessary condition for successful operation of the campus—yields expressions for controlling the infection and understanding the dynamics of infection spread. The number of expected cases on campus is proportional to the exogenous infection rate in the community and is decreased by more frequent testing and effective contact tracing. Simple expressions are presented for the dynamics of superspreader events and the impact of partial vaccination. The model results compare well with residential data from Boston University’s undergraduate population for fall 2020.

The COVID-19 pandemic has challenged residential colleges and universities to design and implement layers of public health protocols to repopulate residential campuses and restore in-person learning. Developing these protocols is especially challenging for urban campuses where students, faculty, and staff are in constant contact with a larger community. Students living on and off campus are constantly interacting with city residents and students from other institutions. Control of viral spread in this environment requires limiting the number of on-campus cases to prevent rapid spread of the disease among student populations living in congregate housing.The challenge is made much more complex with COVID-19 because, as documented by others (1, 2), a significant fraction of the infected people may be asymptomatic during all or a portion of the time when they can infect others. The analysis presented here is based on the hypothesis that control of COVID-19 infection rates on a college campus requires frequent surveillance testing of students, staff, and faculty, coupled with isolation of positive cases and contact tracing and quarantining of close contacts.A simple mathematical framework is developed for describing the dynamics of infection in a university community with a surveillance testing system. The model assumes that the university is embedded in a larger urban area so that there is exogenous transmission of the disease to members of the university community from people who are not in it. A customized version of the standard SEIR (susceptible, exposed, infected, and recovered) model (3) for infection spread is presented for this purpose. In the analysis, the exposed population corresponds to the asymptomatic carriers described above. The model demonstrates the usual range of dynamic response for a SEIR model, with high infection rates leading to herd immunity. The focus of our analysis is on control of the infection rate in the presence of exogeneous input from the surrounding community. It is demonstrated that this is possible in the linear response or asymptotic limit of low infection rate. In this limit, the spread of exogenously introduced infections decays exponentially in time, resulting in a bounded number of cases per day in proportion to the exogenous input. Over time, the total number of cases grows linearly if the daily exogenous input is constant. This linear regime has been observed in simulations by others (4), but its importance in the context described here has not been identified.An asymptotic analysis valid in this limit is described that results in closed-form expressions for the control of the virus as a function of key parameters in the model, including the testing frequency and the test’s sensitivity. The results complement numerical simulations using compartment (5) and network or agent-based models (4, 6) and have the advantage of simplicity. Finally, the predictions are discussed in the context of results from the residential undergraduate program at Boston University, where such a surveillance system using qRT-PCR and contacting tracing was implemented during fall 2020 (7).     

Precautions against COVID-19 reduce respiratory virus infections among children in Southwest China

Acute respiratory tract infections pose a serious threat to the health of children worldwide, with viral infections representing a major etiology of this type of disease. Protective measures such as mask-wearing, social distancing, and hand hygiene can be effective in curbing the spread of severe acute respiratory syndrome coronavirus 2. These precautions may also have an impact on the spread of other respiratory viruses. In this study, we retrospectively compared the respiratory virus infections of children in Southwest China before and after the outbreak of COVID-19. Nasopharyngeal swabs were collected from 1578 patients under 14 years old with acute respiratory tract infection symptoms before and after COVID-19 pandemic. Nine common respiratory viruses including human bocavirus, human rhinoviruses, human coronaviruses, human adenoviruses, human metapneumovirus, respiratory syncytial virus, influenza A virus, influenza B virus, and parainfluenza virus were measured by advanced fragment analysis. The respiratory virus infection rates among children of all ages and genders in Southwest China under the precautions against COVID-19 pandemic were significantly lower than that of the same period before the pandemic. Our findings indicate that public health measures implemented during the COVID-19 pandemic, including strict mask-wearing, social distancing, and hand hygiene, may be effective in preventing the transmission of other respiratory viruses in children, thereby controlling the spread of infections.     

重症胰腺炎合并ARDS的诊断治疗

目的探讨重症胰腺炎（SAP）并发成人呼吸窘迫综合症（ARDS）的诊断和治疗。方法对我院近10年收治的72例重症胰腺炎（SAP）其中并发成人呼吸窘迫综合症38例进行回顾性临床总结,分析其血气PaO2／FiO2、Qs／Qt等与诊断和治疗的关系。结果重症胰腺炎（SAP）并发ARDS的发生率52．77％（38／72）．在及时合理治疗原发病的基础上,均给予机械通气,平均6．5天,机械通气24h后血气分析显示PaO2为（94．85±12．25）mmHg,PaO2为（34．4±7．05）mmHg,Qs／Qt值为5．25％±6．85％,全组死亡10例,放弃治疗3例,死亡率26．31％。结论重症胰腺炎（SAP）在及时处理原发病的基础上,对并发的ARDS进行早期诊断和治疗,正确使用呼吸机,防治并及时处理其它并发症,是降低病死率的有效措施。     

糖皮质激素在SARS、MERS治疗中的应用进展及对COVID-19治疗的启示

COVID-19是一种新发的急性呼吸道传染性疾病,其病原与严重急性呼吸综合征（severe acute respiratory syndrome, SARS）和中东呼吸综合征（Middle East respiratory syndrome, MERS）的病原同为冠状病毒,目前针对COVID-19的治疗尚缺乏有效的抗病毒药物。糖皮质激素广泛应用于危重症患者的救治,但其使用有可能带来各种不良反应,甚至危及患者生命,如何适时适量应用糖皮质激素一直是针对这类疾病治疗的争论焦点之一。本文对既往SARS、MERS等病毒性肺炎治疗中糖皮质激素使用情况进行综述,以期为COVID-19治疗提供借鉴。     

Predictors of high flow oxygen therapy failure in COVID-19-related severe hypoxemic respiratory failure

BackgroundDuring COVID-19 pandemic, people who developed pneumonia and needed supplemental oxygen, where treated with low-flow oxygen therapy systems and non-invasive methods, including oxygen therapy using high flow nasal cannula (HFNC) and the application of bi-level or continuous positive airway pressure (BiPAP or CPAP). We aimed to investigate the outcomes of critical COVID-19 patients treated with HFNC and unveil predictors of HFNC failure.MethodsWe retrospectively enrolled patients admitted to COVID-19 wards and treated with HFNC for COVID-19-related severe hypoxemic respiratory failure. The primary outcome of this study was treatment failure, such as the composite of intubation or death during hospital stay. The association between treatment failure and clinical features was evaluated using logistic regression models.ResultsOne hundred thirty-two patients with a median (IQR) PaO₂/FiO₂ ratio 96 (63–173) mmHg at HFNC initiation were studied. Overall, 45.4% of the patients were intubated. Hospital mortality was 31.8%. Treatment failure (intubation or death) occurred in 50.75% and after adjustment for age, gender, Charlson Comorbidity index (CCI) score and National Early Warning Score 2 (NEWS2) score on admission and PaO₂/FiO₂ ratio and acute respiratory distress syndrome (ARDS) severity at the time of HFNO initiation, it was significantly associated with the presence of dyspnea [adjusted OR 2.48 (95% CI: 1.01–6.12)], and higher Urea serum levels [adjusted OR 1.25 (95% CI: 1.03–1.51) mg/dL].ConclusionsHFNC treatment was successful in almost half of the patients with severe COVID-19-related acute hypoxemic respiratory failure (AHRF). The presence of dyspnea and high serum Urea levels on admission are closely related to HFNC failure.     

Risk reduction of severe outcomes in vaccinated COVID-19 cases: an analysis of surveillance data from Estonia,Ireland, Luxembourg and Slovakia,January to November 2021

Despite high COVID-19 vaccine coverage in the EU/EEA, there are increasing reports of SARS-CoV-2 infections and hospitalisations in vaccinated individuals. Using surveillance data from Estonia, Ireland, Luxembourg and Slovakia (January–November 2021), we estimated risk reduction of severe outcomes in vaccinated cases. Increasing age remains the most important driver of severity, and vaccination significantly reduces risk in all ages for hospitalisation (adjusted relative risk (aRR): 0.32; 95% confidence interval (CI): 0.26–0.39) and death (aRR: 0.20; 95% CI: 0.13–0.29).     

Adverse events following first and second dose COVID-19 vaccination in England,October 2020 to September 2021: a national vaccine surveillance platform self-controlled case series study

BackgroundPost-authorisation vaccine safety surveillance is well established for reporting common adverse events of interest (AEIs) following influenza vaccines, but not for COVID-19 vaccines.AimTo estimate the incidence of AEIs presenting to primary care following COVID-19 vaccination in England, and report safety profile differences between vaccine brands.MethodsWe used a self-controlled case series design to estimate relative incidence (RI) of AEIs reported to the national sentinel network, the Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub. We compared AEIs (overall and by clinical category) 7 days pre- and post-vaccination to background levels between 1 October 2020 and 12 September 2021.ResultsWithin 7,952,861 records, 781,200 individuals (9.82%) presented to general practice with 1,482,273 AEIs, 4.85% within 7 days post-vaccination. Overall, medically attended AEIs decreased post-vaccination against background levels. There was a 3–7% decrease in incidence within 7 days after both doses of Comirnaty (RI: 0.93; 95% CI: 0.91–0.94 and RI: 0.96; 95% CI: 0.94–0.98, respectively) and Vaxzevria (RI: 0.97; 95% CI: 0.95–0.98). A 20% increase was observed after one dose of Spikevax (RI: 1.20; 95% CI: 1.00–1.44). Fewer AEIs were reported as age increased. Types of AEIs, e.g. increased neurological and psychiatric conditions, varied between brands following two doses of Comirnaty (RI: 1.41; 95% CI: 1.28–1.56) and Vaxzevria (RI: 1.07; 95% CI: 0.97–1.78).ConclusionCOVID-19 vaccines are associated with a small decrease in medically attended AEI incidence. Sentinel networks could routinely report common AEI rates, contributing to reporting vaccine safety.     

Case series of four secondary mucormycosis infections in COVID-19 patients,the Netherlands,December 2020 to May 2021

We describe four secondary fungal infections caused by Mucorales species in COVID-19 patients. Three COVID-19 associated mucormycosis (CAM) occurred in ICU, one outside ICU. All were men aged > 50 years, three died. Clinical presentations included pulmonary, rhino-orbital cerebral and disseminated infection. Infections occurred in patients with and without diabetes mellitus. CAM is an emerging disease and our observations underscore the need to be aware of invasive mucormycosis, including in COVID-19 patients without (poorly controlled) diabetes mellitus and outside ICU.     

Re-emergence of enterovirus D68 in Europe after easing the COVID-19 lockdown,September 2021

We report a rapid increase in enterovirus D68 (EV-D68) infections, with 139 cases reported from eight European countries between 31 July and 14 October 2021. This upsurge is in line with the seasonality of EV-D68 and was presumably stimulated by the widespread reopening after COVID-19 lockdown. Most cases were identified in September, but more are to be expected in the coming months. Reinforcement of clinical awareness, diagnostic capacities and surveillance of EV-D68 is urgently needed in Europe.     

Coronavirus Disease-19 (COVID-19) associated with severe acute pancreatitis: Case report on three family members

Background/ObjectivesAbdominal pain is one of the known symptoms associated with coronavirus disease 2019. Little is known about the development of acute pancreatitis as a complication of severe acute respiratory syndrome coronavirus 2 infection. This case report describes the presentation of acute pancreatitis in two of three family members with severe COVID-19 infection.MethodsData were collected from three family members admitted with COVID-19 to the intensive care unit in March 2020. This study was reviewed and approved by the local data and ethics committee (31-1521-253).ResultsTwo of the three family members were diagnosed with acute pancreatitis associated with SARS-CoV-2. Other causes of acute pancreatitis were excluded for both patients (including alcohol, biliary obstruction/gall stones, drugs, trauma, hypertriglyceridemia, hypercalcemia, and hypotension).ConclusionsThese cases highlight acute pancreatitis as a complication associated with COVID-19 and underlines the importance of measuring pancreas-specific plasma amylase in patients with COVID-19 and abdominal pain.     

Hospital outcomes of community-acquired COVID-19 versus influenza: Insights from the Swiss hospital-based surveillance of influenza and COVID-19

BackgroundSince the onset of the COVID-19 pandemic, the disease has frequently been compared with seasonal influenza, but this comparison is based on little empirical data.AimThis study compares in-hospital outcomes for patients with community-acquired COVID-19 and patients with community-acquired influenza in Switzerland.MethodsThis retrospective multi-centre cohort study includes patients > 18 years admitted for COVID-19 or influenza A/B infection determined by RT-PCR. Primary and secondary outcomes were in-hospital mortality and intensive care unit (ICU) admission for patients with COVID-19 or influenza. We used Cox regression (cause-specific and Fine-Gray subdistribution hazard models) to account for time-dependency and competing events with inverse probability weighting to adjust for confounders.ResultsIn 2020, 2,843 patients with COVID-19 from 14 centres were included. Between 2018 and 2020, 1,381 patients with influenza from seven centres were included; 1,722 (61%) of the patients with COVID-19 and 666 (48%) of the patients with influenza were male (p < 0.001). The patients with COVID-19 were younger (median 67 years; interquartile range (IQR): 54–78) than the patients with influenza (median 74 years; IQR: 61–84) (p < 0.001). A larger percentage of patients with COVID-19 (12.8%) than patients with influenza (4.4%) died in hospital (p < 0.001). The final adjusted subdistribution hazard ratio for mortality was 3.01 (95% CI: 2.22–4.09; p < 0.001) for COVID-19 compared with influenza and 2.44 (95% CI: 2.00–3.00, p < 0.001) for ICU admission.ConclusionCommunity-acquired COVID-19 was associated with worse outcomes compared with community-acquired influenza, as the hazards of ICU admission and in-hospital death were about two-fold to three-fold higher.