Effects of income inequality on COVID-19 infections and deaths during the first wave of the pandemic: Evidence from European countries

Evidence from research on infectious diseases suggests that income inequality is related to higher rates of infection and death in disadvantaged population groups. Our objective is to examine whether there was an association between income inequality and the numbers of cases and deaths during the first wave of the COVID- 19 pandemic in European countries. We determined the duration of the first wave by first smoothing the number of daily cases, and then using a LOESS regression to fit the smoothed trend. Next, we estimated quasi-Poisson regressions. Results from the bivariate models suggest there was a moderate positive association between the Gini index values and the cumulated number of infections and deaths during the first wave, although the statistical significance of this association disappeared when controls were included. Results from multivariate models suggest that higher numbers of infections and deaths from COVID-19 were associated with countries having more essential workers, larger elderly populations and lower health care capacities.

Kinetics of SARS-CoV-2 antibody responses pre-COVID-19 and post-COVID-19 convalescent plasma transfusion in patients with severe respiratory failure: an observational case–control study

AimsWhile the SARS-CoV-2 pandemic may be contained through vaccination, transfusion of convalescent plasma (CCP) from individuals who recovered from COVID-19 (CCP) is considered an alternative treatment. We investigate if CCP transfusion in patients with severe respiratory failure increases plasma titres of SARS-CoV-2 antibodies and improves clinical outcomes.MethodsPatients with COVID-19 (n=34) were consented for CCP transfusion and serial blood draws pretransfusion and post-transfusion. Plasma SARS-CoV-2 antireceptor binding domain (RBD) IgG and IgM titres were measured by ELISA serially, and compared with serial plasma titre levels from control patients (n=68). The primary outcome was survival at 30 days, and secondary outcomes were length of ventilator and/or extracorporeal membrane oxygenation (ECMO) support, length of stay (LOS) in the hospital and in the intensive care unit (ICU). Outcomes were compared with matched control patients (n=34). Kinetics of antibodies and clinical outcomes were compared using LOess regression and ORs, respectively.ResultsPrior to CCP transfusion, 74% of patients were anti-RBD seropositive for IgG (median 1:3200), and 81% were anti-RBD IgM seropositive (median 1:320), while 16% were seronegative. The kinetics of antibody titres in CCP recipients were similar to controls. CCP recipients presented with similar survival, duration on ventilatory and/or ECMO support, as well as ICU and hospital LOS compared with controls.ConclusionsCCP transfusion did not increase the kinetics of SARS-CoV2 antibodies and did not result in improved clinical outcomes in patients with COVID-19 with severe respiratory failure, suggesting that CCP may not be indicated in this category of patients.

Carbapenem resistant bacteria in Intensive Care Unit during COVID-19 pandemic: multicenter before-after cross sectional study

Objectives: To assess the incidence of colonization and infection with carbapenemase producing Enterobacteriaceae (CPE) and carbapenem resistant Acinetobacter baumannii (CR-Ab) in the ICUs of our city hospitals before and during COVID-19 pandemic. Methods: Multicentre before-after cross sectional study to compare the rates of colonization and infection with CPE and/or CR-Ab in two study periods, period 1 (Jan-Apr 2019) and period 2 (Jan-Apr 2020). Incidence rate ratios (IRR) and 95% CI of weekly colonization and infection rates for each period were compared for the two study periods with Poisson regression. Weekly trends in the incidence of colonization or infection for each study period were summarized using local weighted (Loess) regression. Results: There was no significant change in either IRR and weekly trend in CPE colonization and infection during the two study periods. A shift from KPC to other CPE mechanisms (OXA-48 and VIM) was observed during period 2. Compared to period 1, during period 2 the IRR of colonization and infection with CR-Ab increased of 7.5 and 5.5-fold, respectively. Genome sequencing showed that all CR-Ab strains belonged to the CC92/IC2 clonal lineage. Clinical strains clustered closely into a single monophyletic group in one of the three centres, whereas segregated in two different clusters in the other two centres, strongly appoints for the occurrence of horizontal transmission. Conclusion: Our findings remark the need of pursuing infection control activities targeted against the spread of antimicrobial resistance intra and inter hospitals during COVID-19 pandemic, and if necessary re-modulating them according to the new organizational structures imposed by the pandemic.

615 The Effects of the COVID-19 Pandemic on Implementation of a Psychological Distress Screening Program after Burn Injury

Introduction The relationship between psychiatric conditions and burn injury is complex, as disorders in thought or mood can both predispose to as well as result from thermal injury. We sought to describe our center’s experience with implementation of a psychological distress screening program in the run-up to and during the COVID-19 pandemic. Methods We undertook an analysis of de-identified data as part of a quality improvement review focusing on the results of psychological screening of our outpatient burn population. In the spring of 2019, our verified burn center implemented an outpatient screening program consisting of a registered nurse administering three validated test to screen for Post-Traumatic Stress Disorder screen, depression and anxiety, and problematic alcohol consumption to all patients at the time of physically checking in for their first burn clinic appointment. All outpatients triggering a positive screen are subsequently referred to the burn unit PsyD while a negative screen results in monthly repeat screenings until discharge from the burn clinic or a positive screen, whichever comes first. We analyzed data from the last twelve months of normal outpatient workflow. Loess regression was used to analyze the monthly proportions of patients screening positive. Results During the peak of COVID-19 in our region, clinic staff were reduced, and screening procedures suspended for the months of March and April 2020. Therefore, the study period consisted of 01 July 2019 to 31 August 2020. A median of 36.5 screens were conducted per month [interquartile range 27.75, 44.75]. Of these screens, 26.5% were positive, with 94.2% successfully referred to the burn unit’s postdoctoral fellow. The Loess regression showed the proportion of patients screening positive for psychological stressors from July 2019 until a peak in November 2019. A downtrend was then noted in the proportion screening positive from December 2019 to date (Figure). Conclusions Psychological stressors are prevalent in burn outpatients. We attribute the decrease in positive responses beginning in December 2019 to a combination of a decrease in the frequency of repeat administrations of the screening test in patients after screening positive, and a reluctance of anxious patients to present to the burn clinic for fear of COVID exposure while at the facility.

How well does societal mobility restriction help control the COVID-19 pandemic? Evidence from real-time evaluation

ABSTRACTObjectivesTo determine the impact of restrictions on mobility on reducing transmission of COVID-19.DesignDaily incidence rates lagged by 14 days were regressed on mobility changes using LOESS regression and logit regression between the day of the 100th case in each country to August 31, 2020.Setting34 OECD countries plus Singapore and Taiwan.ParticipantsGoogle mobility data were obtained from people who turned on mobile device-based global positioning system (GPS) and agreed to share their anonymized position information with Google.InterventionsWe examined the association of COVID-19 incidence rates with mobility changes, defined as changes in categories of domestic location, against a pre-pandemic baseline, using country-specific daily incidence data on newly confirmed COVID-19 cases and mobility data.ResultsIn two thirds of examined countries, reductions of up to 40% in commuting mobility (to workplaces, transit stations, retailers, and recreation) were associated with decreased COVID-19 incidence, more so early in the pandemic. However, these decreases plateaued as mobility remained low or decreased further. We found smaller or negligible associations between mobility restriction and incidence rates in the late phase in most countries.ConclusionMild to moderate degrees of mobility restriction in most countries were associated with reduced incidence rates of COVID-19 that appear to attenuate over time, while some countries exhibited no effect of such restrictions. More detailed research is needed to precisely understand the benefits and limitations of mobility restrictions as part of the public health response to the COVID-19 pandemic.WHAT IS ALREADY KNOWN ON THIS TOPICSince SARS-CoV-2 became a pandemic, restrictions on mobility such as limitations on travel and closure of offices, restaurants, and shops have been imposed in an unprecedented way in both scale and scope to prevent the spread of COVID-19 in the absence of effective treatment options or a vaccine. Although mobility restriction has also brought about tremendous costs such as negative economic growth and other collateral impacts on health such as increased morbidity and mortality from lack of access to other essential health services, little evidence exists on the effectiveness of mobility restriction for the prevention of disease transmission. A search of PUBMED and Google Scholar for publications on this topic through Sep 20, 2020 revealed that most of the evidence on the effectiveness of physical distancing comes from mathematical modeling studies using a variety of assumptions. One study investigated only the combined effect of several interventions, including physical distancing, among SARS-CoV-2 infected patients.WHAT THIS STUDY ADDSThis is the first study to investigate the association between change in mobility and incidence of COVID-19 globally using real-time measures of mobility at the population level. For this, we used Google Global Mobility data and the daily incidence of COVID-19 for 36 countries from the day of 100th case detection through August 31, 2020. Our findings from LOESS regression show that in two-thirds of countries, reductions of up to 40% in commuting mobility were associated with decreased COVID-19 incidence, more so early in the pandemic. This decrease, however, plateaued as mobility decreased further. We found that associations between mobility restriction and incidence became smaller or negligible in the late phase of the pandemic in most countries. The reduced incidence rate of COVID-19 cases with a mild to moderate degree of mobility restriction in most countries suggests some value to limited mobility restriction in early phases of epidemic mitigation. The lack of impact in some others, however, suggests further research is needed to confirm these findings and determine the distinguishing factors for when mobility restrictions are helpful in decreasing viral transmission. Governments should carefully consider the level and period of mobility restriction necessary to achieve the desired benefits and minimize harm.

multiHiCcompare: joint normalization and comparative analysis of complex Hi-C experiments

Motivation With the development of chromatin conformation capture technology and its high-throughput derivative Hi-C sequencing, studies of the three-dimensional interactome of the genome that involve multiple Hi-C datasets are becoming available. To account for the technology-driven biases unique to each dataset, there is a distinct need for methods to jointly normalize multiple Hi-C datasets. Previous attempts at removing biases from Hi-C data have made use of techniques which normalize individual Hi-C datasets, or, at best, jointly normalize two datasets. Results Here, we present multiHiCcompare, a cyclic loess regression-based joint normalization technique for removing biases across multiple Hi-C datasets. In contrast to other normalization techniques, it properly handles the Hi-C-specific decay of chromatin interaction frequencies with the increasing distance between interacting regions. multiHiCcompare uses the general linear model framework for comparative analysis of multiple Hi-C datasets, adapted for the Hi-C-specific decay of chromatin interaction frequencies. multiHiCcompare outperforms other methods when detecting a priori known chromatin interaction differences from jointly normalized datasets. Applied to the analysis of auxin-treated versus untreated experiments, and CTCF depletion experiments, multiHiCcompare was able to recover the expected epigenetic and gene expression signatures of loss of chromatin interactions and reveal novel insights. Availability and implementation multiHiCcompare is freely available on GitHub and as a Bioconductor R package https://bioconductor.org/packages/multiHiCcompare. Supplementary information Supplementary data are available at Bioinformatics online.

Ethnicity Specific Cutoffs for Neutropenia Are Predictive of Overall Survival in a Large Elderly Cohort: An Analysis of 26,652 Individuals

Background: A neutrophil count of 1500 cells per microliter has been traditionally used as the cutoff for neutropenia and has been considered a marker of increased susceptibility to infections and adverse prognosis. Despite conventional use of this definition, there are no large studies that have examined the direct relationship of low neutrophil counts with overall survival, especially in relation to different ethnicities. Thus, the aim of this study was to examine the prevalence of neutropenia and its prognostic impact among the various ethnicities. Methods: The study cohort was selected from an inner city, multiethnic outpatient population and included 26,652 subjects that were 65 years of age or above. Cox Proportional Hazard Models were built to compare the survival experience of neutropenic and non-neutropenic subjects within three separate ethnic strata. LOESS curves were used to graphically assess the relationship of mortality risk with absolute neutrophil counts in the different ethnicities. Results: Using a cutoff of 1500 neutrophils per microliter, neutropenia was observed in approximately 0.6% of non-Hispanic Caucasians, 2.9% of non-Hispanic Blacks (African Americans) and 1.4% of Hispanics (p<0.001, ChiSquare test). The presence of neutropenia was associated with significantly shorter overall survival among non-Hispanic Caucasians (HR 2.14; 95% CI 1.40 - 3.30; p<0.01), whereas it conferred a lower, albeit not statistically significant, risk for African Americans (HR 0.80; 95% CI 0.60 - 1.06; p=0.12). There was a 26% increased risk of death for Hispanic neutropenic individuals compared to those with normal neutrophil counts, but this was also not statistically significant (HR 1.26; 95% CI 0.90 - 1.77; p=0.18). After adjustment for age, gender, Charlson comorbidity index (CCI) and other hematologic parameters (total white blood cell count, hemoglobin and platelet count), neutropenia remained an independent predictor of mortality for the non-Hispanic Caucasians (HR 1.78; 95% CI 1.11 - 2.71; p=0.015) and maintained its non-significant association with shorter overall survival in the non-Hispanic Black and Hispanic groups (HR 1.03; 95% CI 0.76 -1.39; p=0.86 and HR 1.28; 0.90 - 1.82; p=0.17, respectively). Next, to determine the neutrophil cutoff with optimal prognostic value among African Americans, we used LOESS regression curves and Cox Proportional Hazard modeling to show that mortality risk became significant at neutrophil counts below 1100 cells per microliter (Figure 1). Using this new cutoff, prevalence of neutropenia within the African American subcohort was 0.6% and it was significantly associated with a two-fold increase in the risk of death adjusted for all the above covariates (HR: 2.01; 95% CI 1.22 - 3.32; p<0.01). Conclusions: Using a large inner city cohort, we demonstrated that neutropenia is an independent prognostic variable in the elderly. Our study suggests that the prognostic value of the currently used definition of neutropenia on overall survival varies among different ethnicities. A cutoff of 1100 neutrophils per microliter may be a more prognostically relevant marker of neutropenia in African Americans and can be used as a novel potential threshold of intervention in this population. Figure 1. LOESS regression model showing the association between absolute neutrophil count (horizontal axis) and the log relative hazard of all-cause mortality (vertical axis) for non-Hispanic Caucasians and non-Hispanic Blacks after adjusting for age, gender, Charlson comorbidity index, white blood cell count, hemoglobin level and platelet count. The shaded areas around each curve demarcate the 95% confidence intervals. Figure 1. LOESS regression model showing the association between absolute neutrophil count (horizontal axis) and the log relative hazard of all-cause mortality (vertical axis) for non-Hispanic Caucasians and non-Hispanic Blacks after adjusting for age, gender, Charlson comorbidity index, white blood cell count, hemoglobin level and platelet count. The shaded areas around each curve demarcate the 95% confidence intervals. Disclosures No relevant conflicts of interest to declare.