Search

Background: While many patients seem to recover from SARS-CoV-2 infections, many patients report experiencing SARS-CoV-2 symptoms for weeks or months after their acute COVID-19 ends, even developing new symptoms weeks after infection. These long-term effects are called post-acute sequelae of SARS-CoV-2 (PASC) or, more commonly, Long COVID. The overall prevalence of Long COVID is currently unknown, and tools are needed to help identify patients at risk for developing long COVID., Methods: A working group of the Rapid Acceleration of Diagnostics-radical (RADx-rad) program, comprised of individuals from various NIH institutes and centers, in collaboration with REsearching COVID to Enhance Recovery (RECOVER) developed and organized the Long COVID Computational Challenge (L3C), a community challenge aimed at incentivizing the broader scientific community to develop interpretable and accurate methods for identifying patients at risk of developing Long COVID. From August 2022 to December 2022, participants developed Long COVID risk prediction algorithms using the National COVID Cohort Collaborative (N3C) data enclave, a harmonized data repository from over 75 healthcare institutions from across the United States (U.S.)., Findings: Over the course of the challenge, 74 teams designed and built 35 Long COVID prediction models using the N3C data enclave. The top 10 teams all scored above a 0.80 Area Under the Receiver Operator Curve (AUROC) with the highest scoring model achieving a mean AUROC of 0.895. Included in the top submission was a visualization dashboard that built timelines for each patient, updating the risk of a patient developing Long COVID in response to clinical events., Interpretation: As a result of L3C, federal reviewers identified multiple machine learning models that can be used to identify patients at risk for developing Long COVID. Many of the teams used approaches in their submissions which can be applied to future clinical prediction questions., Funding: Research reported in this RADx® Rad publication was supported by the National Institutes of Health. Timothy Bergquist, Johanna Loomba, and Emily Pfaff were supported by Axle Subcontract: NCATS-STSS-P00438., Competing Interests: Declaration of interests Danielle Mowery serves as an unpaid member of the Epic Cosmos Governing Council. Romain Pirracchio received funding from the FDA CERSI grant U01FD005978 and the PCORI grant P0562155 and received a consulting honorarium from Phillips. Martin van der Laan received funding from the NIAID grant 5R01AI074345. Johanna Loomba received contract funding from the NIH RECOVER program. Emily Pfaff received funding from the NIH and PCORI. The views expressed in this manuscript are solely those of the authors and do not necessarily represent those of the National Institutes of Health, the U.S. Department of Health and Human Services or the U.S. government. Qi Long was supported by grants from the NIH., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Postacute sequelae after the coronavirus disease (COVID) of 2019 (PASC) is increasingly recognized, although data on solid organ transplant (SOT) recipients (SOTRs) are limited. Using the National COVID Cohort Collaborative, we performed 1:1 propensity score matching (PSM) of all adult SOTR and nonimmunosuppressed/immunocompromised (ISC) patients with acute COVID infection (August 1, 2021 to January 13, 2023) for a subsequent PASC diagnosis using International Classification of Diseases, 10th Revision, Clinical Modification codes. Multivariable logistic regression was used to examine not only the association of SOT status with PASC, but also other patient factors after stratifying by SOT status. Prior to PSM, there were 8769 SOT and 1 576 769 non-ISC patients with acute COVID infection. After PSM, 8756 SOTR and 8756 non-ISC patients were included; 2.2% of SOTR (n = 192) and 1.4% (n = 122) of non-ISC patients developed PASC (P value < .001). In the overall matched cohort, SOT was independently associated with PASC (adjusted odds ratio [aOR], 1.48; 95% confidence interval [CI], 1.09-2.01). Among SOTR, COVID infection severity (aOR, 11.6; 95% CI, 3.93-30.0 for severe vs mild disease), older age (aOR, 1.02; 95% CI, 1.01-1.03 per year), and mycophenolate mofetil use (aOR, 2.04; 95% CI, 1.38-3.05) were each independently associated with PASC. In non-ISC patients, only depression (aOR, 1.96; 95% CI, 1.24-3.07) and COVID infection severity were. In conclusion, PASC occurs more commonly in SOTR than in non-ISC patients, with differences in risk profiles based on SOT status., Competing Interests: Declaration of competing interest The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation., (Copyright © 2024 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.)

The COVID-19 pandemic has led to challenges in high-impact extra-curricular educational practice. Using cross-national, large-scale survey data, this study discusses the current state of participation of high-impact educational practices (HIPs) among Chinese and American undergraduates, changes in this participation over time, and the differences between undergraduates in the two countries in this regard, from 2018 to 2021. We find that participation in social practices was significantly greater than research-related and extended learning activities in both China and the U.S. The involvement of first-year undergraduates in the three typical HIP activities was lower than that of seniors, especially in doing research with faculty. American seniors participated more in service learning and study abroad than Chinese seniors. The proportion of senior students who had studied abroad was lower than the proportion of first-year students who planned to study overseas, particularly in China. COVID-19 led to a significant drop in participation in service learning and study abroad in China, and it also amplified the impact of institutional support on the participation of undergraduates in HIPs.

BACKGROUND: The emergence of COVID-19 resulted in a substantial loss of education because of global school closures. Face masks are a potential measure to restrain the COVID-19 spread; therefore, this paper evaluated the effectiveness of face masks in reducing COVID-19 incidence in school settings. METHODS: A systematic review was conducted by searching the literature in the Cochrane COVID-19 Study Register and the World Health Organization COVID-19 global literature. Data were summarized in tabular forms, and the findings were presented as narrative synthesis. RESULTS: A total of 15,709 records were retrieved. The screening and selection led to the inclusion of 12 observational and 2 quasi-experimental studies. Nine studies were conducted in different states, counties, or districts of the United States, and the remaining 5 were reported from Germany, Finland, Spain, and the United Kingdom. The results of 10 out of 14 studies favored mask use in reducing school COVID-19 incidence. Three studies found no link between mask use and COVID-19 incidences, whereas 1 quasi-experimental study noted a higher COVID-19 incidence with mask use in students aged 6-11 years than no use of mask among preschool children aged 3-5 years. CONCLUSION: Mask mandates may lessen the incidence of respiratory infectious diseases in school settings during a pandemic; more well-designed studies are warranted to clarify further the evidence regarding mask use in school settings.

The COVID-19 pandemic has impacted academic labour, with women being disproportionately negatively affected. This scoping review provides an exploratory snapshot into the corpus of literature investigating the impact of the pandemic on academic labour. We used a set of criteria to first identify the 86 titles from which we selected 45 as the data set. We analyzed the data on characteristics of location, investigative methods, publication information, and discipline. The findings showed that most of the data were global in context; used primarily qualitative methodologies; published in a wide variety of journals; and spanned diverse disciplines, including science and health, education, business, sociology, and political sciences. We then analyzed the data thematically. The themes we identified were gender inequity, identities and intersectionality, performing work-home binaries, and invisible labour. We added a fifth theme, lived experiences, consisting of women academics' firsthand accounts. We consider this theme unique, despite its overlap with the other themes, because it is evidence of women academics telling their personal stories. We discuss how our findings show that pandemic conditions worsened existing inequities. The solutions most often cited in the data place emphasis and responsibility on the individual, but we argue that institutions should instead be responsible to redress inequities through improving workplace labour processes. Our research can aid future research on how policy theory can inform socially just policies and practices in the post-pandemic university.

Following the authorization the use of COVID-19 vaccines in babies age six months through children four years old in the United States, some individuals (parents, pediatricians, and communicators) framed COVID-19 vaccination as an issue of access, while many others expressed hesitancy and some resisted recommendations from the US Centers for Disease Control and Prevention. In this context, this study aimed to explore: 1) divergent reactions to the authorization of COVID-19 vaccine use in children aged six months to four years; and 2) opposing logics underlying attitudes towards pro-vaccination, anti-vaccination, and vaccine hesitancy regarding COVID-19 vaccines. To achieve this, a digital ethnography was conducted, involving monitoring of 5,700 reactions to a series of eight infographics published on social media by the John Hopkins Bloomberg School of Public Health, and participant observation in an online focus group over a one-year period, from December 2021 to December 2022, consisting of 18 mothers. The findings suggest that healthcare professionals should consider different notions of "risk" when interacting with patients, especially those who are hesitant to vaccinate.

Background: Politicization and misinformation or disinformation of unproven COVID-19 therapies have resulted in communication challenges in presenting science to the public, especially in times of heightened public trepidation and uncertainty., Objective: This study aims to examine how scientific evidence and uncertainty were portrayed in US news on 3 unproven COVID-19 therapeutics, prior to the development of proven therapeutics and vaccines., Methods: We conducted a media analysis of unproven COVID-19 therapeutics in early 2020. A total of 479 discussions of unproven COVID-19 therapeutics (hydroxychloroquine, remdesivir, and convalescent plasma) in traditional and online US news reports from January 1, 2020, to July 30, 2020, were systematically analyzed for theme, scientific evidence, evidence details and limitations, safety, efficacy, and sources of authority., Results: The majority of discussions included scientific evidence (n=322, 67%) although only 24% (n=116) of them mentioned publications. "Government" was the most frequently named source of authority for safety and efficacy claims on remdesivir (n=43, 35%) while "expert" claims were mostly mentioned for convalescent plasma (n=22, 38%). Most claims on hydroxychloroquine (n=236, 79%) were offered by a "prominent person," of which 97% (n=230) were from former US President Trump. Despite the inclusion of scientific evidence, many claims of the safety and efficacy were made by nonexperts. Few news reports expressed scientific uncertainty in discussions of unproven COVID-19 therapeutics as limitations of evidence were infrequently included in the body of news reports (n=125, 26%) and rarely found in headlines (n=2, 2%) or lead paragraphs (n=9, 9%; P<.001)., Conclusions: These results highlight that while scientific evidence is discussed relatively frequently in news reports, scientific uncertainty is infrequently reported and rarely found in prominent headlines and lead paragraphs., (©Sara Watson, Tyler J Benning, Alessandro R Marcon, Xuan Zhu, Timothy Caulfield, Richard R Sharp, Zubin Master. Originally published in JMIR Infodemiology (https://infodemiology.jmir.org), 29.08.2024.)

Background and Objectives: Long COVID, characterized by persistent symptoms beyond the acute infection phase, remains poorly characterized in children. Our study aim is to determine if children who exhibit any symptoms/conditions associated with Long COVID after acute COVID-19 infection have higher Emergency Department (ED) utilization compared to those who do not exhibit these symptoms., Methods: Data from the HealthJump ambulatory database from the COVID-19 Research Database Consortium was utilized to identify pediatric COVID-19 cases from March 2020 to May 2023. Long COVID cases were defined based on symptoms/conditions occurring 30-180 days after initial COVID diagnosis. Descriptive statistics and multivariable logistic regression models were used to model the relationship between Long COVID and child ED utilization., Results: Out of 130,010 children diagnosed with COVID-19, 43,645 (33.6%) exhibited at least one Long COVID symptom/condition. Children with Long COVID symptoms/conditions had 152% higher odds (OR: 2.52, CI: 2.32-2.73) of ED visits, while those with specific symptoms including "chest pain" had 255% higher odds (AOR: 3.55, CI: 2.73-4.54) and "fluid and electrolyte disturbances" had 229% higher odds (AOR: 3.29, CI: 2.23-4.73) compared to those without those symptoms/conditions., Conclusion: This study reveals that children with Long COVID symptoms had notably higher odds of ED visits, with chest pain, fluid imbalances, and generalized pain being most closely linked to such visits. This study highlights the burden of Long COVID on ED providers and underscores the importance of improved guidance for managing Long COVID symptoms in children., (© 2024. The Author(s).)

People with long COVID are those who still have symptoms, signs, and conditions after the initial phase of infection of SARS-CoV-2. The incidence of long COVID varies among regions-31% in North America, 44% in Europe, and 51% in Asia, which is challenging the healthcare system, but there is limited guidelines for its treatment. With more and more nationwide projects funded by the government such as the RECOVER initiative in the United States and National Institute for Health Research funding in the United Kingdom, an increasing number of ongoing clinical trials are investigating the efficacy of diverse therapies on reversing long COVID. After searching the World Health Organization International Clinical Trial Registry Platform, 587 clinical studies are identified as long COVID studies. Among these, 312 studies (53.2%) are testing potential therapies. Most of the long COVID trials were conducted in the United States (58 trials [18.6%]), followed by India (55 trials [17.6%]), and Spain (20 trials [6.4%]). Interventions in these clinical trials include physical exercise, rehabilitation therapy, behavioral therapy, and pharmacological therapies including herbs, paxlovid, and fluvoxamine. These trials are aiming to deal with these long COVID symptoms and signs including fatigue, decreased pulmonary function, reduced cognitive function, and others. To date, only 11 of these 312 studies have published their results that were not confirmative, unfortunately. Future studies should be designed to address sleep disorders which were seldomly included in registered clinical studies. Moreover, interventions aimed at treating the underlying pathophysiology of long COVID are also necessary but currently lacking., Competing Interests: Declarations of competing interest The authors have no competing interests to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Pediatricians and primary care providers serve an important role in building trust with families and communities. To support the critical role of front-line providers, this perspective seeks to reflect on the work of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices to support COVID-19 pandemic response efforts. Although Advisory Committee on Immunization Practice (ACIP) recommends vaccines for all age groups, this perspective focuses on the pediatric lens and is tailored to Academic Pediatrics. ACIP adapted from in-person meetings 3 times yearly to virtual meetings on an emergency basis to ensure a thorough review and presentation of all the components of the evidence to recommendation framework, including explicit consideration of equity in the decision-making process. The need for diverse enrollment in clinical trials was highlighted as critical for supporting recommendations and enhancing trust. Near real-time vaccine safety surveillance was implemented at scale and emphasized the importance of collaboration between federal partners engaged in vaccine safety in the United States and extended to other countries with similar safety surveillance systems to enable early recognition and response to safety concerns. A key equity opportunity for future pandemics is to shorten the time between vaccines being available for adults and young children., Competing Interests: Declaration of Competing Interest Drs Lee and Poehling both served as voting members of the Advisory Committee on Immunization Practices throughout the COVID-19 pandemic; this perspective reflects their opinions and experience and not that of the government or the official committee. Dr Poehling has no conflicts of interest to declare. She reports that the institution receives grant funding from Optum Social Responsibility for an intimate partner violence collaborative pilot and from the Kate B. Reynolds Charitable Trust for a community-led initiative to address disparities in maternal and infant health outcomes. She also receives Foundation funding to support newborn safe sleep. Dr Lee has no conflicts of interest to declare., (Copyright © 2024 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objective: The epidemiology of COVID-19 has substantially changed since its emergence given the availability of effective vaccines, circulation of different viral variants, and re-infections. We aimed to develop models to predict 30-day COVID-19 hospitalization and death in the Omicron era for contemporary clinical and research applications., Methods: We used comprehensive electronic health records from a national cohort of patients in the Veterans Health Administration (VHA) who tested positive for SARS-CoV-2 between March 1, 2022, and March 31, 2023. Full models incorporated 84 predictors, including demographics, comorbidities, and receipt of COVID-19 vaccinations and anti-SARS-CoV-2 treatments. Parsimonious models included 19 predictors. We created models for 30-day hospitalization or death, 30-day hospitalization, and 30-day all-cause mortality. We used the Super Learner ensemble machine learning algorithm to fit prediction models. Model performance was assessed with the area under the receiver operating characteristic curve (AUC), Brier scores, and calibration intercepts and slopes in a 20% holdout dataset., Results: Models were trained and tested on 198,174 patients, of whom 8% were hospitalized or died within 30 days of testing positive. AUCs for the full models ranged from 0.80 (hospitalization) to 0.91 (death). Brier scores were close to 0, with the lowest error in the mortality model (Brier score: 0.01). All three models were well calibrated with calibration intercepts <0.23 and slopes <1.05. Parsimonious models performed comparably to full models., Conclusions: We developed prediction models that accurately estimate COVID-19 hospitalization and mortality risk following emergence of the Omicron variant and in the setting of COVID-19 vaccinations and antiviral treatments. These models may be used for risk stratification to inform COVID-19 treatment and to identify high-risk patients for inclusion in clinical trials., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Importance: Identifying and tracking new infections during an emerging pandemic is crucial to design and deploy interventions to protect populations and mitigate the pandemic's effects, yet it remains a challenging task., Objective: To characterize the ability of nonprobability online surveys to longitudinally estimate the number of COVID-19 infections in the population both in the presence and absence of institutionalized testing., Design, Setting, and Participants: Internet-based online nonprobability surveys were conducted among residents aged 18 years or older across 50 US states and the District of Columbia, using the PureSpectrum survey vendor, approximately every 6 weeks between June 1, 2020, and January 31, 2023, for a multiuniversity consortium-the COVID States Project. Surveys collected information on COVID-19 infections with representative state-level quotas applied to balance age, sex, race and ethnicity, and geographic distribution., Main Outcomes and Measures: The main outcomes were (1) survey-weighted estimates of new monthly confirmed COVID-19 cases in the US from January 2020 to January 2023 and (2) estimates of uncounted test-confirmed cases from February 1, 2022, to January 1, 2023. These estimates were compared with institutionally reported COVID-19 infections collected by Johns Hopkins University and wastewater viral concentrations for SARS-CoV-2 from Biobot Analytics., Results: The survey spanned 17 waves deployed from June 1, 2020, to January 31, 2023, with a total of 408 515 responses from 306 799 respondents (mean [SD] age, 42.8 [13.0] years; 202 416 women [66.0%]). Overall, 64 946 respondents (15.9%) self-reported a test-confirmed COVID-19 infection. National survey-weighted test-confirmed COVID-19 estimates were strongly correlated with institutionally reported COVID-19 infections (Pearson correlation, r = 0.96; P < .001) from April 2020 to January 2022 (50-state correlation mean [SD] value, r = 0.88 [0.07]). This was before the government-led mass distribution of at-home rapid tests. After January 2022, correlation was diminished and no longer statistically significant (r = 0.55; P = .08; 50-state correlation mean [SD] value, r = 0.48 [0.23]). In contrast, survey COVID-19 estimates correlated highly with SARS-CoV-2 viral concentrations in wastewater both before (r = 0.92; P < .001) and after (r = 0.89; P < .001) January 2022. Institutionally reported COVID-19 cases correlated (r = 0.79; P < .001) with wastewater viral concentrations before January 2022, but poorly (r = 0.31; P = .35) after, suggesting that both survey and wastewater estimates may have better captured test-confirmed COVID-19 infections after January 2022. Consistent correlation patterns were observed at the state level. Based on national-level survey estimates, approximately 54 million COVID-19 cases were likely unaccounted for in official records between January 2022 and January 2023., Conclusions and Relevance: This study suggests that nonprobability survey data can be used to estimate the temporal evolution of test-confirmed infections during an emerging disease outbreak. Self-reporting tools may enable government and health care officials to implement accessible and affordable at-home testing for efficient infection monitoring in the future.

Background: Post-coronavirus disease 2019 (COVID-19) syndrome, or long COVID, has a variety of symptoms, but little is known about the condition. This study evaluated the association between individual factors, social determinants of health, and the likelihood of long COVID by assessing internet usage as an indicator of viable access to telehealth., Methods: Data from the 2022 National Health Interview Survey identified adults who (1) reported a previous COVID-19-positive test and/or diagnosis and (2) experienced long COVID. A 2-stage selection model predicted COVID-19 infection in the first stage and long COVID in the second stage. To test the potential use of telehealth, binary dependent variable regression evaluated internet usage among respondents with long COVID., Results: About 40% (N=10,318) of respondents had tested positive/been diagnosed with COVID-19, but less than 20% of them (N=1797) had long COVID. Although older respondents were less likely to have COVID (odds ratio [OR]=0.48; 95% confidence interval [CI]=0.44, 0.53), they were more likely to experience long COVID (OR=1.63; CI=1.37, 1.93). Relative to White individuals, Black individuals were less likely to have COVID (OR=0.78; CI=0.69, 0.89) but significantly more likely (OR=1.21; CI=1.09, 1.64) to experience long COVID. Long COVID was also more likely among low-income earners (first income-to-poverty ratio quartile OR=1.40, CI=1.14, 1.72; second income-to-poverty ratio OR=1.37, CI=1.14, 1.64) and those without a college degree (OR=1.42; CI=1.01, 1.66). There were no statistically significant differences in internet access between racial, geographic, or income groups., Conclusion: Long COVID is significantly more likely among Black individuals and low-income households than among their counterparts, but with few recourses available, telehealth service delivery could be a feasible intervention mechanism.

Objective: We studied whether the use of hydroxychloroquine (HCQ) for COVID-19 resulted in supply shortages for patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE)., Methods: We used US claims data (IQVIA PHARMETRICS® Plus for Academics [PHARMETRICS]) and hospital electronic records from Spain (Institut Municipal d'Assistència Sanitària Information System [IMASIS]) to estimate monthly rates of HCQ use between January 2019 and March 2022, in the general population and in patients with RA and SLE. Methotrexate (MTX) use was estimated as a control., Results: More than 13.5 million individuals (13,311,811 PHARMETRICS, 207,646 IMASIS) were included in the general population cohort. RA and SLE cohorts enrolled 135,259 and 39,295 patients, respectively, in PHARMETRICS. Incidence of MTX and HCQ were stable before March 2020. On March 2020, the incidence of HCQ increased by 9- and 67-fold in PHARMETRICS and IMASIS, respectively, and decreased in May 2020. Usage rates of HCQ went back to prepandemic trends in Spain but remained high in the United States, mimicking waves of COVID-19. No significant changes in HCQ use were noted among patients with RA and SLE. MTX use rates decreased during HCQ approval period for COVID-19 treatment., Conclusion: Use of HCQ increased dramatically in the general population in both Spain and the United States during March and April 2020. Whereas Spain returned to prepandemic rates after the first wave, use of HCQ remained high and followed waves of COVID-19 in the United States. However, we found no evidence of general shortages in the use of HCQ for both RA and SLE in the United States., (© 2024 The Authors. Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

To effectively respond to an emerging infectious disease outbreak, policymakers need timely and accurate measures of disease prevalence in the general population. This paper presents a new methodology to estimate real-time population infection rates from non-random testing data. The approach compares how the observed positivity rate varies with the size of the tested population and applies this gradient to infer total population infections. Applying this methodology to daily testing data across U.S. states during the first wave of the COVID-19 pandemic, we estimated widespread undiagnosed COVID-19 infections. Nationwide, we found that for every identified case, there were 12 population infections. Our prevalence estimates align with results from seroprevalence surveys, alternate approaches to measuring COVID-19 infections, and total excess mortality during the first wave of the pandemic., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Benatia et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Track PCC includes five geographic surveillance sites to conduct standardized population-based surveillance to estimate and track Post-COVID Conditions (PCC) by age, sex, race/ethnicity, geographic area, severity of initial infection, and risk factors among persons with evidence of SARS-CoV-2 infection (based on the Council of State and Territorial Epidemiologist [CSTE] case definitions for confirmed cases or laboratory-confirmed evidence of infection)., Methods: The study will estimate the incidence, prevalence, including temporal trends, and duration and severity of PCC symptoms, among children, adolescents, and adults. PCCs include a broad range of symptoms and conditions that continue or develop after acute SARS-CoV-2 infection or COVID-19 illness. Surveillance includes both passive and active components for diverse populations in Arizona, Indiana, and Utah as well as the Bronx Borough, NY, and part of Philadelphia County, PA. Passive surveillance will utilize electronic health records and health information exchanges within each site catchment area to longitudinally follow persons with COVID-19 to estimate PCC occurring at least 30 days after acute COVID-19 illness. Active surveillance will utilize self-report of PCCs from detailed surveys of persons ages 7 years and older with evidence of SARS-CoV-2 infection in the past 3 months. Respondents will complete follow-up surveys at 6-, 12- and 18-months post-infection., Discussion: These data can help identify which groups are most affected by PCC, and what health differences among demographic groups exist, as well as indicate potential barriers to care. These additional levels of granularity can inform public health action and help direct needed clinical care for patients., (© 2024. The Author(s).)

Adults aged ≥65 years experience the highest risk for COVID-19-related hospitalization and death, with risk increasing with increasing age; outpatient antiviral treatment reduces the risk for these severe outcomes. Despite the proven benefit of COVID-19 antiviral treatment, information on differences in use among older adults with COVID-19 by age group is limited. Nonhospitalized patients aged ≥65 years with COVID-19 during April 2022-September 2023 were identified from the National Patient-Centered Clinical Research Network. Differences in use of antiviral treatment among patients aged 65-74, 75-89, and ≥90 years were assessed. Multivariable logistic regression was used to estimate the association between age and nonreceipt of antiviral treatment. Among 393,390 persons aged ≥65 years, 45.9% received outpatient COVID-19 antivirals, including 48.4%, 43.5%, and 35.2% among those aged 65-75, 76-89, and ≥90 years, respectively. Patients aged 75-89 and ≥90 years had 1.17 (95% CI = 1.15-1.19) and 1.54 (95% CI = 1.49-1.61) times the adjusted odds of being untreated, respectively, compared with those aged 65-74 years. Among 12,543 patients with severe outcomes, 2,648 (21.1%) had received an outpatient COVID-19 antiviral medication, compared with 177,874 (46.7%) of 380,847 patients without severe outcomes. Antiviral use is underutilized among adults ≥65 years; the oldest adults are least likely to receive treatment. To prevent COVID-19-associated morbidity and mortality, increased use of COVID-19 antiviral medications among older adults is needed., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Faraz S. Ahmad reports receipt of consulting fees and editorial support from Pfizer. Thomas W. Carton reports receipt of grant support from the Task Force for Global Health. No other potential conflicts of interest were disclosed.

Debilitating symptoms, affecting multiple organ systems, can last years., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: Disclosures: Disclosure forms are available with the article online.

The latest variant of coronavirus is omicron. The World Health Organization (WHO) designated variation 'B.1.1.529' named omicron as a variant of concern (VOC) on 26 November 2021. By September 2020, it will have infected over 16 million patients and killed over 600,000 people over the world. This very infectious viral illness still poses a danger to world health; it has also become the greatest problem the world is facing and become the main area of research. The development of vaccines is insufficient to stop their spread and serious effects. Despite several reputable pharmaceutical firms claiming to have developed a cure for COVID-19. For that purpose, the field-based 3D-QSAR model has been used to analyze a series of anti-diabetic drugs to repurpose them against COVID-19. The LOO verified partial least square (PLS) model generates satisfactory q 2 (0.4) and r 2 were discovered to be the lead drugs. Density functional theory at the B3LYP/6-311G* technique was used to examine structural geometries, electronic characteristics, and molecular electrostatic potential (MEP). This work will greatly assist in the detection and development of leads for early drug development to control COVID-19.Communicated by Ramaswamy H. Sarma.L8 , and L23 were discovered to be the lead drugs. Density functional theory at the B3LYP/6-311G* technique was used to examine structural geometries, electronic characteristics, and molecular electrostatic potential (MEP). This work will greatly assist in the detection and development of leads for early drug development to control COVID-19.Communicated by Ramaswamy H. Sarma.

Competing Interests: Disclosures: Disclosure forms are available with the article online. All financial and intellectual disclosures of interest were declared, and potential conflicts were discussed and managed. Drs. Akl, Kansagara, Mackey, and Wilt were recused from authorship and voting due to moderate-level conflicts of interest (recently authored relevant publications). A record of disclosures of interest and management of conflicts is kept for each PHMSC meeting and conference call and can be viewed at www.acponline.org/about-acp/who-we-are/leadership/boards-committees-councils/population-health-and-medical-science-committee/doi-and-coi-management-summary-for-population-health-and-medical-science-committee.

Children with sickle cell disease (SCD) are at risk of complications from viral infections, including SARS-CoV-2. We present the clinical characteristics and outcomes of pediatric patients with SCD from the Pediatric COVID-19 United States Registry who developed acute COVID-19 due to SARS-CoV-2 infection (n = 259) or multisystem inflammatory syndrome in children (MIS-C; n = 4). Nearly half of hospitalized children with SCD and SARS-CoV-2 infection required supplemental oxygen, though children with SCD had fewer intensive care (ICU) admissions compared to the general pediatric and immunocompromised populations. All registry patients with both SCD and MIS-C required ICU admission. Children with SCD are at risk of severe disease with SARS-CoV-2 infection, highlighting the importance of vaccination in this vulnerable population., (© 2024 Wiley Periodicals LLC.)

Background: The COVID-19 pandemic devastated many countries worldwide by causing large numbers of fatalities. In our research, we wanted to answer the question: Why was there such a large difference in the mortality rate between South Korea and the United States? This is because many East Asian countries, such as Korea, had a lower mortality rate than many countries, including developed ones, across the world - the mortality rate of South Korea was about five times lower than the United States., Methods: This study comprehensively compares strategies used to address the COVID-19 pandemic in two different countries: South Korea and the United States. The various aspects of these two countries' responses are examined, including initial response, information dissemination and public compliance, mitigation strategies, and vaccine rollout and their impacts., Results: Early and widespread testing, rigorous contact tracing, the clear release of government information, and an organized vaccine rollout powered a proactive approach in South Korea. The United States had a contrasting response consisting of delayed and more decentralized measures, where testing lagged due to varying policies and the political controversies facing vaccine distribution., Conclusions: We signify the gravity of rapid response and testing, clear communication, and efficient vaccine distribution, as we believe this could correlate with a lower mortality rate. In addition, we discuss future directions, including the need for a specific health infrastructure and protocol against highly infectious outbreaks.

Background: Postacute sequelae of COVID-19 (PASC), also known as long COVID, is a broad grouping of a range of long-term symptoms following acute COVID-19. These symptoms can occur across a range of biological systems, leading to challenges in determining risk factors for PASC and the causal etiology of this disorder. An understanding of characteristics that are predictive of future PASC is valuable, as this can inform the identification of high-risk individuals and future preventative efforts. However, current knowledge regarding PASC risk factors is limited., Objective: Using a sample of 55,257 patients (at a ratio of 1 patient with PASC to 4 matched controls) from the National COVID Cohort Collaborative, as part of the National Institutes of Health Long COVID Computational Challenge, we sought to predict individual risk of PASC diagnosis from a curated set of clinically informed covariates. The National COVID Cohort Collaborative includes electronic health records for more than 22 million patients from 84 sites across the United States., Methods: We predicted individual PASC status, given covariate information, using Super Learner (an ensemble machine learning algorithm also known as stacking) to learn the optimal combination of gradient boosting and random forest algorithms to maximize the area under the receiver operator curve. We evaluated variable importance (Shapley values) based on 3 levels: individual features, temporal windows, and clinical domains. We externally validated these findings using a holdout set of randomly selected study sites., Results: We were able to predict individual PASC diagnoses accurately (area under the curve 0.874). The individual features of the length of observation period, number of health care interactions during acute COVID-19, and viral lower respiratory infection were the most predictive of subsequent PASC diagnosis. Temporally, we found that baseline characteristics were the most predictive of future PASC diagnosis, compared with characteristics immediately before, during, or after acute COVID-19. We found that the clinical domains of health care use, demographics or anthropometry, and respiratory factors were the most predictive of PASC diagnosis., Conclusions: The methods outlined here provide an open-source, applied example of using Super Learner to predict PASC status using electronic health record data, which can be replicated across a variety of settings. Across individual predictors and clinical domains, we consistently found that factors related to health care use were the strongest predictors of PASC diagnosis. This indicates that any observational studies using PASC diagnosis as a primary outcome must rigorously account for heterogeneous health care use. Our temporal findings support the hypothesis that clinicians may be able to accurately assess the risk of PASC in patients before acute COVID-19 diagnosis, which could improve early interventions and preventive care. Our findings also highlight the importance of respiratory characteristics in PASC risk assessment., International Registered Report Identifier (irrid): RR2-10.1101/2023.07.27.23293272., (©Zachary Butzin-Dozier, Yunwen Ji, Haodong Li, Jeremy Coyle, Junming Shi, Rachael V Phillips, Andrew N Mertens, Romain Pirracchio, Mark J van der Laan, Rena C Patel, John M Colford, Alan E Hubbard, The National COVID Cohort Collaborative (N3C) Consortium. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 15.08.2024.)

Background: The COVID-19 pandemic, caused by SARS-CoV-2, has had a profound impact worldwide, leading to widespread morbidity and mortality. Vaccination against COVID-19 is a critical tool in controlling the spread of the virus and reducing the severity of the disease. However, the rapid development and deployment of COVID-19 vaccines have raised concerns about potential adverse events following immunization (AEFIs). Understanding the temporal and spatial patterns of these AEFIs is crucial for an effective public health response and vaccine safety monitoring., Objective: This study aimed to analyze the temporal and spatial characteristics of AEFIs associated with COVID-19 vaccines in the United States reported to the Vaccine Adverse Event Reporting System (VAERS), thereby providing insights into the patterns and distributions of the AEFIs, the safety profile of COVID-19 vaccines, and potential risk factors associated with the AEFIs., Methods: We conducted a retrospective analysis of administration data from the Centers for Disease Control and Prevention (n=663,822,575) and reports from the surveillance system VAERS (n=900,522) between 2020 and 2022. To gain a broader understanding of postvaccination AEFIs reported, we categorized them into system organ classes (SOCs) according to the Medical Dictionary for Regulatory Activities. Additionally, we performed temporal analysis to examine the trends of AEFIs in all VAERS reports, those related to Pfizer-BioNTech and Moderna, and the top 10 AEFI trends in serious reports. We also compared the similarity of symptoms across various regions within the United States., Results: Our findings revealed that the most frequently reported symptoms following COVID-19 vaccination were headache (n=141,186, 15.68%), pyrexia (n=122,120, 13.56%), and fatigue (n=121,910, 13.54%). The most common symptom combination was chills and pyrexia (n=56,954, 6.32%). Initially, general disorders and administration site conditions (SOC 22) were the most prevalent class reported. Moderna exhibited a higher reporting rate of AEFIs compared to Pfizer-BioNTech. Over time, we observed a decreasing reporting rate of AEFIs associated with COVID-19 vaccines. In addition, the overall rates of AEFIs between the Pfizer-BioNTech and Moderna vaccines were comparable. In terms of spatial analysis, the middle and north regions of the United States displayed a higher reporting rate of AEFIs associated with COVID-19 vaccines, while the southeast and south-central regions showed notable similarity in symptoms reported., Conclusions: This study provides valuable insights into the temporal and spatial patterns of AEFIs associated with COVID-19 vaccines in the United States. The findings underscore the critical need for increasing vaccination coverage, as well as ongoing surveillance and monitoring of AEFIs. Implementing targeted monitoring programs can facilitate the effective and efficient management of AEFIs, enhancing public confidence in future COVID-19 vaccine campaigns., (©Yiming Li, Jianfu Li, Yifang Dang, Yong Chen, Cui Tao. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 15.07.2024.)

Background: The impact of both COVID-19 infection and vaccination status on patients with head and neck squamous cell carcinoma (HNSCC) remains unknown., Objective: To determine the impact of COVID-19 infection and vaccination status on 60-day mortality, cardiovascular, and respiratory complications in patients with a prior diagnosis of HNSCC., Methods: This was a retrospective cohort study through the Veterans Affairs (VA) Corporate Data Warehouse of Veterans with HNSCC who were tested for COVID-19 during any inpatient VA medical center admission. A cohort of patients was created of Veterans with a diagnosis of HNSCC of the oral cavity,oropharynx, hypopharynx, larynx, and nasopharynx based on International Classification of Disease (ICD) codes. Data collected included clinical/demographic data, vaccination status, and incidence of 60-day mortality, 60-day cardiovascular complication (including myocardial infarction, venous thromboembolism, cerebrovascular accident), and 60-day respiratory complication (including acute respiratory failure, acute respiratory distress syndrome, and pneumonia). The interactions between COVID-19 infection, vaccination status, morbidity and mortality were investigated., Results: Of the 14 262 patients with HNSCC who were tested for COVID-19 during inpatient admission, 4754 tested positive (33.3%), and 9508 (67.7%) tested negative. Patients who tested positive demonstrated increased 60-day mortality (4.7% vs. 2.0%, respectively; p < 0.001), acute respiratory failure (ARF; 15.4% vs. 7.1%, p < 0.001), acute respiratory distress syndrome (ARDS; 0.9% vs. 0.2%, p < 0.001), and pneumonia (PNA; 20.0% vs. 6.4%, p < 0.001) compared to those who never tested positive, respectively. Patients who received COVID-19 vaccination between 2 weeks and 6 months prior to a positive test demonstrated decreased rates of ARF (13.2% vs. 16.0%, p = 0.034) and PNA (16.7% vs. 20.9%, p = 0.003) compared to the unvaccinated group. A logistic regression of patients with COVID-19 infections who died within 60 days was performed, with no significant survival advantage among patients vaccinated between 2 weeks and 6 months prior to the positive test., Conclusion: COVID-19 infection may significantly increase rates of 60-day mortality and respiratory complications in patients with HNSCC. COVID-19 vaccination between 2 weeks and 6 months prior to infection may decrease severity of respiratory complications but did not show significant mortality benefits in this study. These data highlight the need for surveillance of respiratory infection and vaccination in this vulnerable population., (© 2024 Wiley Periodicals LLC.)

Long-COVID (having symptoms lasting 3 months or longer post-infection) is an emerging public health concern, yet research on whether COVID-19 booster vaccines can mitigate this condition is limited. This study examined associations between booster uptake and long-COVID prevalence among U.S. adults. Data were analyzed from 8757 adults aged 18 years or older with a history of COVID-19 infection from the 2022 National Health Interview Survey. Weighted prevalence and logistic regression models examined relationships between self-reported COVID-19 booster vaccination status and long-COVID, adjusting for sociodemographics and health factors. 19.5 % reported experiencing long-COVID. Individuals receiving the COVID-19 booster vaccine had significantly lower adjusted odds of long-COVID (OR 0.75, 95 % CI 0.61-0.93) compared to unvaccinated individuals. Overall, these findings suggest that COVID-19 booster vaccination is associated with a reduced prevalence of long-COVID among the U.S. adult population, underscoring the importance of optimizing booster uptake to mitigate the long-term impacts of COVID-19., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier India Pvt Ltd. Published by Elsevier Ltd.. All rights reserved.)

Multisystem inflammatory syndrome in children (MIS-C), also known as pediatric inflammatory multisystem syndrome (PIMS), is a new postinfectious illness associated with COVID-19, affecting children after SARS-CoV-2 exposure. The hallmarks of this disorder are hyperinflammation and multisystem involvement, with gastrointestinal, cardiac, mucocutaneous, and hematologic disturbances seen most commonly. Cardiovascular involvement includes cardiogenic shock, ventricular dysfunction, coronary artery abnormalities, and myocarditis. Now entering the fourth year of the pandemic, clinicians have gained some familiarity with the clinical presentation, initial diagnosis, cardiac evaluation, and treatment of MIS-C. This has led to an updated definition from the Centers for Disease Control and Prevention in the USA driven by increased experience and clinical expertise. Furthermore, the available evidence established expert consensus treatment recommendations supporting a combination of immunoglobulin and steroids. However, the pathophysiology of the disorder and answers to what causes this remain under investigation. Fortunately, long-term outcomes continue to look promising, although continued follow-up is still needed. Recently, COVID-19 mRNA vaccination is reported to be associated with reduced risk of MIS-C, while further studies are warranted to understand the impact of COVID-19 vaccines on MIS-C. We review the findings and current literature on MIS-C, including pathophysiology, clinical features, evaluation, management, and medium- to long-term follow-up outcomes.

Coronavirus disease 2019 (COVID-19) epidemiology and product landscapes have changed considerably since onset of the pandemic. Safe and effective vaccines and therapeutics are available, but the continual emergence of severe acute respiratory syndrome coronavirus 2 variants introduce limitations in our ability to prevent and treat disease. Project NextGen is a collaboration between the Biomedical Advanced Research and Development Authority, part of the Administration for Strategic Preparedness and Response, and the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, that is leveraging public-private partnerships to address gaps in the nation's COVID-19 vaccine and therapeutic capabilities. Targeted investments will advance promising next-generation candidates through the most difficult phases of clinical development to encourage further private sector interest for later stage development and commercial availability. New commercial vaccines and therapeutics that are more durable and effective across variants will improve our fight against COVID-19 and transform our response to future threats., Competing Interests: Potential conflicts of interest . The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Objective: Vocal fold paresis or paralysis (VFP) may severely affect quality of life due to dysphonia and respiratory distress. As an increasing percentage of the United States population receives the COVID-19 vaccination, the objective of this study is to determine the correlation of COVID-19 postvaccination recurrent laryngeal neuropathy and resulting VFP., Methods: The Vaccine Adverse Event Reporting System database was queried for patients exhibiting symptoms of VFP following COVID-19 vaccination. Patient demographics and clinical information including presenting symptoms, time of symptom onset, time of diagnosis and laterality., Results: Twenty patients were found to have laryngoscopy confirmed VFP following COVID-19 vaccination. Vaccinations for Pfizer-BioNTech, Moderna, and Janssen were reported. Of those reported, 13 patients were female (65.0%) and seven were male (35.0%), with a mean age of 61.8 years. The most common presenting symptom was a hoarse voice (30.0%). A majority of these cases were unilateral in nature (64.0%). Mean time from vaccination to symptom onset was 12.1 days and mean time from vaccination to diagnosis was 37.6 days., Conclusion: For patients presenting with voice or swallowing complaints after receiving the COVID-19 vaccine, prompt evaluation by an otolaryngologist should occur. However, the potential VFP side effect of vaccination is very rarely cited in the literature and largely outweighed by the benefits of vaccination. Further research is needed to delineate the exact pathophysiology of this complication and determine whether a causal relationship exists., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Despite reassuring scientific data, the lay press and social media continue to propagate largely unsubstantiated claims that a significant number of athletes have died from cardiovascular complications related to COVID-19 vaccines. The present study sought to determine the incidence of COVID-19 vaccine cardiovascular complications in Team USA athletes., Hypothesis: It was predicted that there would be a low incidence of cardiovascular complications from COVID-19 vaccination in Team USA athletes., Study Design: Descriptive epidemiology study., Level of Evidence: Level 4., Methods: A retrospective review was conducted on the United States Olympic and Paralympic Committee electronic medical record, inclusive of athletes who represented Team USA in the 2020 Tokyo and 2022 Beijing Olympic and Paralympic Games, for COVID-19 vaccine cardiac complications including sudden cardiac arrest/death, myocarditis, pericarditis, and myopericarditis. Vaccination status (ie, fully vaccinated, yes or no), date of vaccination and eligible boosters, and type of vaccination during the study period were abstracted from the electronic medical record., Results: A total of 1229 athletes represented Team USA during the 2020 Tokyo (Olympic, 697; Paralympic, 237) and 2022 Beijing Games (Olympic, 229; Paralympic, 66). For the 2020 Tokyo Games, 73.8% of Olympians and 80.6% of Paralympians with available vaccination status had completed a primary vaccine series. For the 2022 Beijing Games, 100% of Olympians and Paralympians with available vaccination status were fully vaccinated. No athletes suffered sudden cardiac arrest/death or were diagnosed with myocarditis, pericarditis, or myopericarditis after COVID-19 vaccination., Conclusion: The data demonstrate an overall willingness of elite athletes to receive recommended COVID-19 vaccination coupled with a complete absence of vaccine-related cardiac complications in >1 year of follow-up., Clinical Relevance: Supposedly, this is the first study to investigate the incidence of COVID-19 vaccine cardiovascular complications in elite athletes. These data are an important first step to better inform cardiologists and sports medicine physicians who care for elite athletes., Competing Interests: The following authors declared potential conflicts of interest: A.B.S. has received consulting fees from the USOPC. J.T.F. has received royalties from UpToDate and Demos Publishing. A.L.B. has received grants from the National Institute of Health/National Heart, Lung and Blood Institute, the National Football Players Association, and the American Heart Association, and consulting fees from the USOPC, US Soccer, US Rower, the New England Patriots, the Boston Bruins, the New England Revolution, and Harvard University. W.M.A. has received royalties from Springer Nature, consulting fees from Korey Stringer Institute and Emerja Corp, and has stock or stock options in My Normative and Emerja Corp.

Most studies examining factors associated with pediatric influenza (flu) and coronavirus disease (COVID-19) vaccination uptake focus on parental demographics. We examined whether the childhood cultural health environment (CHE) of parents (measured by self-reported regular attendance at doctor and dentist visits during childhood) was associated with flu and COVID-19 vaccination of their children. Using 2023 survey data from 397 US parents and causal inference methods, we estimated the average causal effect of parental CHE on flu vaccination rates (0.16 [95 % confidence interval: 0.06,0.27]) and COVID-19 (0.14 [95 % confidence interval: 0.04,0.24]), indicating that if all parents had attended regular doctor/dentist visits as children, flu and COVID-19 vaccination rates in children would be 16 % and 14 % higher, respectively, than if none had. Our findings suggest that early life exposure to medical and dental care has significant and lasting effects on the health of individuals and families., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier India Pvt Ltd. Published by Elsevier Ltd.. All rights reserved.)

We consider the problem of targeted mass screening of heterogeneous populations under limited testing capacity. Mass screening is an essential tool that arises in various settings, e.g., ensuring a safe supply of blood, reducing prevalence of sexually transmitted diseases, and mitigating the spread of infectious disease outbreaks. The goal of mass screening is to classify whole population groups as positive or negative for an infectious disease as efficiently and accurately as possible. Under limited testing capacity, it is not possible to screen the entire population and hence administrators must reserve testing and target those among the population that are most in need or most susceptible. This paper addresses this decision problem by taking advantage of accessible population-level risk information to identify the optimal set of sub-populations to target for screening. We conduct a comprehensive analysis that considers the two most commonly adopted schemes: Individual testing and Dorfman group testing. For both schemes, we formulate an optimization model that aims to minimize the number of misclassifications under a testing capacity constraint. By analyzing the formulations, we establish key structural properties which we use to construct efficient and accurate solution techniques. We conduct a case study on COVID-19 in the United States using geographic-based data. Our results reveal that the considered proactive targeted schemes outperform commonly adopted practices by substantially reducing misclassifications. Our case study provides important managerial insights with regards to optimal allocation of tests, testing designs, and protocols that dictate the optimality of schemes. Such insights can inform policy-makers with tailored and implementable data-driven recommendations., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

We investigate risk factors for severe COVID-19 in persons living with HIV (PWH), including among racialized PWH, using the U.S. population-sampled National COVID Cohort Collaborative (N3C) data released from January 1, 2020 to October 10, 2022. We defined severe COVID-19 as hospitalized with invasive mechanical ventilation, extracorporeal membrane oxygenation, discharge to hospice or death. We used machine learning methods to identify highly ranked, uncorrelated factors predicting severe COVID-19, and used multivariable logistic regression models to assess the associations of these variables with severe COVID-19 in several models, including race-stratified models. There were 3 241 627 individuals with incident COVID-19 cases and 81 549 (2.5%) with severe COVID-19, of which 17 445 incident COVID-19 and 1 020 (5.8%) severe cases were among PWH. The top highly ranked factors of severe COVID-19 were age, congestive heart failure (CHF), dementia, renal disease, sodium concentration, smoking status, and sex. Among PWH, age and sodium concentration were important predictors of COVID-19 severity, and the effect of sodium concentration was more pronounced in Hispanics (aOR 4.11 compared to aOR range: 1.47-1.88 for Black, White, and Other non-Hispanics). Dementia, CHF, and renal disease was associated with higher odds of severe COVID-19 among Black, Hispanic, and Other non-Hispanics PWH, respectively. Our findings suggest that the impact of factors, especially clinical comorbidities, predictive of severe COVID-19 among PWH varies by racialized groups, highlighting a need to account for race and comorbidity burden when assessing the risk of PWH developing severe COVID-19., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: We assessed associations between binding antibody (bAb) concentration <5 days from symptom onset and testing positive for COVID-19 among patients in a test-negative study., Methods: From October 2021 to June 2022, study sites in 7 states enrolled patients aged ≥6 months presenting with acute respiratory illness. Respiratory specimens were tested for SARS-CoV-2. In blood specimens, we measured concentrations of anti-SARS-CoV-2 antibodies against the spike protein receptor binding domain (RBD) and nucleocapsid antigens from the ancestral strain in standardized bAb units (BAU). Percentage change in odds of COVID-19 by increasing anti-RBD bAb was estimated via logistic regression as (1 - adjusted odds ratio of COVID-19) × 100, adjusting for COVID-19 mRNA vaccine doses, age, site, and high-risk exposure., Results: Out of 2018 symptomatic patients, 662 (33%) tested positive for acute SARS-CoV-2 infection. Geometric mean RBD bAb levels were lower among COVID-19 cases than SARS-CoV-2 test-negative controls during the Delta-predominant period (112 vs 498 BAU/mL) and Omicron-predominant period (823 vs 1189 BAU/mL). Acute-phase ancestral spike RBD bAb levels associated with 50% lower odds of COVID-19 were 1968 BAU/mL against Delta and 3375 BAU/mL against Omicron; thresholds may differ in other laboratories., Conclusions: During acute illness, antibody concentrations against ancestral spike RBD were associated with protection against COVID-19., Competing Interests: Potential conflicts of interest. R. K. Z. reports grants from the CDC during the conduct of the study and grants from Sanofi Pasteur outside the submitted work. C. G. G. reports other from the CDC, grants from the National Institutes of Health, other from the Food and Drug Administration, grants and other from the Agency for Healthcare Research and Quality, other from Merck, and other from Syneos Health, outside the submitted work. H. K. T. reports grants from the CDC during the conduct of the study. E. A. B. reports grants from the CDC during the conduct of the study. E. T. M. reports grants from the CDC during the conduct of the study and grants from Merck outside the submitted work. M. G. reports grants from the CDC during the conduct of the study and grants from the CDC, CDC-Vanderbilt, and CDC–Abt Associates, outside the submitted work. M. G. is also cochair of the Infectious Diseases and Immunization Committee, Texas Pediatric Society, Texas Chapter of the American Academy of Pediatrics. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest., (Published by Oxford University Press on behalf of Infectious Diseases Society of America 2024.)

In September 2020, the National Institutes of Health acted in response to the COVID-19 pandemic, recognizing the critical need to combat misinformation, particularly in communities disproportionately affected by the crisis. The Community Engagement Alliance (CEAL) emerged as an initiative dedicated to fostering reliable, science-based information, diversity, and inclusion; aiming to implement effective strategies to mitigate the spread of COVID-19 nationwide. One of the teams participating in this initiative is Puerto Rico-CEAL (PR-CEAL). Our whose goal was to raise awareness about the coronavirus disease and advance research, mainly focusing on vulnerable and underserved populations. This concept paper seeks to outline PR-CEAL's infrastructure during its initial two cycles, providing insights into the research and community engagement activities designed to enhance prevention, counter misinformation, and foster awareness and uptake of COVID-19 vaccines. Ultimately, our objective is to reflect on the strengths and challenges encountered thus far as we endeavor to sustain this robust infrastructure, addressing ongoing public health issues with a forward-looking approach., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Pons-Calvo, Pérez, Canales-Birriel, Tamarit-Quevedo, Solís-Torres, López-Cepero, García-Rivera, Larriuz, Acosta-Pérez, Colón, Román, Ortiz, Rivera-Gastón and Colón-López.)

Accurate molecular diagnostic tests are necessary for confirming a diagnosis of coronavirus disease 2019 (COVID-19) and for identifying asymptomatic carriage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The number of available SARS-CoV-2 nucleic acid detection tests continues to increase as does the COVID-19 diagnostic literature. Thus, the Infectious Diseases Society of America (IDSA) developed an evidence-based diagnostic guideline to assist clinicians, clinical laboratorians, patients, and policymakers in decisions related to the optimal use of SARS-CoV-2 nucleic acid amplification tests. In addition, we provide a conceptual framework for understanding molecular diagnostic test performance, discuss nuances of test result interpretation in a variety of practice settings, and highlight important unmet research needs related to COVID-19 diagnostic testing. IDSA convened a multidisciplinary panel of infectious diseases clinicians, clinical microbiologists, and experts in systematic literature review to identify and prioritize clinical questions and outcomes related to the use of SARS-CoV-2 molecular diagnostics. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make testing recommendations. The panel agreed on 12 diagnostic recommendations. Access to accurate SARS-CoV-2 nucleic acid testing is critical for patient care, hospital infection prevention, and the public health response to COVID-19 infection. Information on the clinical performance of available tests continues to grow, but the quality of evidence of the current literature to support this updated molecular diagnostic guideline remains moderate to very low. Recognizing these limitations, the IDSA panel weighed available diagnostic evidence and recommends nucleic acid testing for all symptomatic individuals suspected of having COVID-19. In addition, testing is suggested for asymptomatic individuals with known or suspected contact with a COVID-19 case when the results will impact isolation/quarantine/personal protective equipment (PPE) usage decisions. Evidence in support of rapid testing and testing of upper respiratory specimens other than nasopharyngeal swabs, which offer logistical advantages, is sufficient to warrant conditional recommendations in favor of these approaches., Competing Interests: Potential conflicts of interest. The following list displays what has been reported to the IDSA. To provide thorough transparency, the IDSA requires full disclosure of all relationships, regardless of relevancy to the guideline topic. Evaluation of such relationships as potential conflicts of interest is determined by a review process which includes assessment by the Board of Directors’ liaison to the Standards and Practice Guideline Committee and, if necessary, the Conflicts of Interest (COI) and Ethics Committee. The assessment of disclosed relationships for possible COI is based on the relative weight of the financial relationship (ie, monetary amount) and the relevance of the relationship (ie, the degree to which an association might reasonably be interpreted by an independent observer as related to the topic or recommendation of consideration). The reader of these guidelines should be mindful of this when the list of disclosures is reviewed. M. K. H. receives research funding from the Centers for Disease Control and Prevention (CDC); and served as a member of Clinical Adjudication Panel for an investigational COVID-19 vaccine made by Sanofi Pasteur. K. E. H. served an advisor to Quidel, BioFire, Pfizer, and Takeda; received other numerations from Quidel, Pfizer, and Takeda; served as Editor to the American Society of Microbiology (ASM) and member of the Clinical and Laboratory Standards Institute Antifungal Committee; received research funding from the National Institutes of Health (NIH); and served on the exam committee for the American Board of Internal Medicine and associate editor for Open Forum Infectious Diseases. J. A. E. serves as a consultant for Sanofi Pasteur, Pfizer, and AstraZeneca and reports consulting fees from Moderna and Meissa Vaccines; is an advisor/consultant for Meissa Vaccines; receives research funding from the CDC, Pfizer, Brotman Baty Research Institute, Merck, Novavax, GlaxoSmithKline, and AstraZeneca; served as an advisor to Teva Pharmaceuticals; and served as a member of the Pediatric Infectious Diseases Society (PIDS) Publication Committee and Transplant ID Committee, and reports support for travel to the 2022 European Society for Paediatric Infectious Diseases (ESPID) meeting to present from ESPID/AstraZeneca. M. J. L. serves as an advisor for Sanofi, Seqirus, Medicago, GSK, Janssen, Novavax, Pfizer, and MD Brief; receives research funding from the Canadian Institutes of Health Research, World Health Organization (WHO), and Medical Research Council (United Kingdom); has received an in-kind supply of vaccine from Sanofi; has been paid for expert testimony on institutional and workplace vaccine policy; and has served on the DSMB for CanSino Biologics and an advisor to Merck. R. P. has a patent on a Bordetella pertussis/parapertussis PCR issued, a patent on a device/method for sonication with royalties paid by Samsung to Mayo Clinic, and a patent on an anti-biofilm substance issued; serves as a consultant to PhAST, Torus Biosystems, Day Zero Diagnostics, Mammoth Biosciences, Netflix, Abbott Laboratories, Oxford Nanopore Technologies, CARB-X, Qvella, and HealthTrackRx; receives other numeration (honoraria) from NBME, UpToDate, and the Infectious Disease Board Review Course; received grants from CD Diagnostics, Merck, Hutchison Biofilm Medical Solutions, Accelerate, ContraFect, TenNor Therapeutics Limited, Shionogi, NIH, Biofire, Adaptive Phage Therapeutics, National Science Foundation, and the Department of Defense; has served as a consultant to Curetis, Specific Technologies, NextGen Diagnostics, Pathoquest, Selux Diagnositcs, and 1928 Diagnostics; and reports support for attending meetings and/or travel from ASM Biofilms and ISAC and roles as Chair of ASM Governance Committee and as a member of the ASM Finance Committee. S. S. serves as a Board member for the Evidence Foundation; receives honoraria for evidence reviews, methodological support, and teaching from the Evidence Foundation; serves on guideline panels for the American Gastroenterological Association (AGA); reports unpaid roles as Co-Director for the Evidence Foundation and US Grade Network and former Chair Clinical Guidelines Committee for the AGA; and receives research funding from the Department of Veterans Affairs Evidence Synthesis Program. Y. F.-Y. serves as a Board member for the Evidence Foundation; receives honoraria for evidence reviews, methodological support, and teaching from the Evidence Foundation, the AGA for evidence reviews, and the Institute for Clinical and Economic Review (ICER) for committee meetings; serves as a Director for the Evidence Foundation and for the US GRADE Network; and served on an Independent Appraisal Committee for ICER. R. L. M. serves as a Board member for the Evidence Foundation and receives honoraria for evidence reviews, methodological support, and teaching from the Evidence Foundation. M. H. M. serves as a Board member for the Evidence Foundation; receives honoraria for evidence reviews, methodological support, and teaching from the Evidence Foundation; receives research funding from the Agency for Healthcare Research and Quality (AHRQ), the Endocrine Society, and the Society for Vascular Surgery; has received research funding from the American Society of Hematology and the WHO; and has served as a guideline methodologist for the WHO. A. B. received an honorarium from the ICER (clinical expert at an ICER public meeting [discussion in 2022 re: COVID-19 oral drug costs], honorarium $750). R. A. M. serves as a Board member for the Evidence Foundation; receives honoraria for evidence reviews, methodological support, and teaching from the Evidence Foundation and ICER for committee meetings; receives research funding from the NIH, the WHO, the American College of Rheumatology, the American Society of Hematology, and Bohringer Ingelheim; serves as Chair of the Midwest Comparative Effectiveness Public Advisory Council of the ICER; serves on the Methods Committee for Kidney Disease Improving Global Outcomes Work Group; serves on the Clinical Guidelines Committee for the Canadian Society of Nephrology; and previously served on the Clinical Guidelines Committee for the American College of Physicians (ACP). D. J. M. reports an NIH DP2 award, Shepherd contract, and is Co-Investigator on an Epicenter award from CDC, R01 on C. difficile from the AHRQ, and IIR on Diagnostic Stewardship from VA HSRD; support for conference planning and speaking from SHEA/IDSA; and an unpaid role as co-lead on the task force on diagnostic stewardship. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Seeking and obtaining effective health care for Long COVID remains a challenge in the USA. Women have particularly been impacted, as they are both at higher risk of developing Long COVID and of facing gendered barriers to having symptoms acknowledged. Long COVID clinics, which provide multidisciplinary and coordinated care, have emerged as a potential solution. To date, however, there has been little examination of U.S. patient experiences with Long COVID clinics and how patients may or may not have come to access care at a Long COVID clinic., Methods: We conducted semi-structured interviews with 30 U.S. women aged 18 or older who had experienced Long COVID symptoms for at least 3 months, who had not been hospitalized for acute COVID-19, and who had seen at least one medical provider about their symptoms. Participants were asked about experiences seeking medical care for Long COVID. Long COVID clinic-related responses were analyzed using qualitative framework analysis to identify key themes in experiences with Long COVID clinics., Results: Of the 30 women, 43.3% (n = 13) had been seen at a Long COVID clinic or by a provider affiliated with a Long COVID clinic and 30.0% (n = 9) had explored or attempted to see a Long COVID clinic but had not been seen at time of interview. Participants expressed five key themes concerning their experiences with seeking care from Long COVID clinics: (1) Access to clinics remains an issue, (2) Clinics are not a one stop shop, (3) Not all clinic providers have sufficient Long COVID knowledge, (4) Clinics can offer validation and care, and (5) Treatment options are critical and urgent., Conclusions: While the potential for Long COVID clinics is significant, findings indicate that ongoing barriers to care and challenges related to quality and coordination of care hamper that potential and contribute to distress among women seeking Long COVID care. Since Long COVID clinics are uniquely positioned and framed as being the place to go to manage complex symptoms, it is critical to patient wellbeing that they be properly resourced to provide a level of care that complies with emerging best practices., (© 2024. The Author(s).)

Scenario-based modeling frameworks have been widely used to support policy-making at state and federal levels in the United States during the COVID-19 response. While custom-built models can be used to support one-off studies, sustained updates to projections under changing pandemic conditions requires a robust, integrated, and adaptive framework. In this paper, we describe one such framework, UVA-adaptive, that was built to support the CDC-aligned Scenario Modeling Hub (SMH) across multiple rounds, as well as weekly/biweekly projections to Virginia Department of Health (VDH) and US Department of Defense during the COVID-19 response. Building upon an existing metapopulation framework, PatchSim, UVA-adaptive uses a calibration mechanism relying on adjustable effective transmissibility as a basis for scenario definition while also incorporating real-time datasets on case incidence, seroprevalence, variant characteristics, and vaccine uptake. Through the pandemic, our framework evolved by incorporating available data sources and was extended to capture complexities of multiple strains and heterogeneous immunity of the population. Here we present the version of the model that was used for the recent projections for SMH and VDH, describe the calibration and projection framework, and demonstrate that the calibrated transmissibility correlates with the evolution of the pathogen as well as associated societal dynamics., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

COVID-19 vaccinations protect against severe illness and death, but associations with post-COVID conditions (PCC) are less clear. We aimed to evaluate the association between prior COVID-19 vaccination and new-onset PCC among individuals with SARS-CoV-2 infection across eight large healthcare systems in the United States. This retrospective matched cohort study used electronic health records (EHR) from patients with SARS-CoV-2 positive tests during March 2021-February 2022. Vaccinated and unvaccinated COVID-19 cases were matched on location, test date, severity of acute infection, age, and sex. Vaccination status was ascertained using EHR and integrated data on externally administered vaccines. Adjusted relative risks (RRs) were obtained from Poisson regression. PCC was defined as a new diagnosis in one of 13 PCC categories 30 days to 6 months following a positive SARS-CoV-2 test. The study included 161,531 vaccinated COVID-19 cases and 161,531 matched unvaccinated cases. Compared to unvaccinated cases, vaccinated cases had a similar or lower risk of all PCC categories except mental health disorders (RR: 1.06, 95% CI: 1.02-1.10). Vaccination was associated with ≥10% lower risk of sensory (RR: 0.90, 0.86-0.95), circulatory (RR: 0.88, 0.83-0.94), blood and hematologic (RR: 0.79, 0.71-0.89), skin and subcutaneous (RR: 0.69, 0.66-0.72), and non-specific COVID-19 related disorders (RR: 0.53, 0.51-0.56). In general, associations were stronger at younger ages but mostly persisted regardless of SARS-CoV-2 variant period, receipt of ≥3 vs. 1-2 vaccine doses, or time since vaccination. Pre-infection vaccination was associated with reduced risk of several PCC outcomes and hence may decrease the long-term consequences of COVID-19., (© 2024. The Author(s).)

Objective: The Theory of Planned Behavior has been applied to COVID-19 protective behaviors, but evidence suggests this theory may be less predictive over time and less valid in individualistic societies. The current study applied this theory among American college students as vaccines became available and added perceived risk. Participants: 242 undergraduate students at two universities. Methods: Participants completed an online survey and analyses were conducted using PROCESS. Results: Perceived risk was indirectly related to protective behavior via intentions which were significantly impacted by positive attitudes, descriptive norms, and perceived behavioral control. Conclusions: Even within an individualistic culture and when vaccines were becoming available, the Theory of Planned Behavior predicts protective behaviors. Including risk perception also furthers understanding of this theory by identifying one factor related to norms and perceived behavioral control. These results may inform the design of interventions designed to increase compliance with pandemic-related policies and other positive behaviors.

Background: In the context of immune-mediated inflammatory diseases (IMIDs), COVID-19 outcomes are incompletely understood and vary considerably depending on the patient population studied. We aimed to analyse severe COVID-19 outcomes and to investigate the effects of the pandemic time period and the risks associated with individual IMIDs, classes of immunomodulatory medications (IMMs), chronic comorbidities, and COVID-19 vaccination status., Methods: In this retrospective cohort study, clinical data were derived from the electronic health records of an integrated health-care system serving patients in 51 hospitals and 1085 clinics across seven US states (Providence St Joseph Health). Data were observed for patients (no age restriction) with one or more IMID and for unmatched controls without IMIDs. COVID-19 was identified with a positive nucleic acid amplification test result for SARS-CoV-2. Two timeframes were analysed: March 1, 2020-Dec 25, 2021 (pre-omicron period), and Dec 26, 2021-Aug 30, 2022 (omicron-predominant period). Primary outcomes were hospitalisation, mechanical ventilation, and mortality in patients with COVID-19. Factors, including IMID diagnoses, comorbidities, long-term use of IMMs, and COVID-19 vaccination status, were analysed with multivariable logistic regression (LR) and extreme gradient boosting (XGB)., Findings: Of 2 167 656 patients tested for SARS-CoV-2, 290 855 (13·4%) had confirmed COVID-19: 15 397 (5·3%) patients with IMIDs and 275 458 (94·7%) without IMIDs. In the pre-omicron period, 169 993 (11·2%) of 1 517 295 people who were tested for COVID-19 tested positive, of whom 23 330 (13·7%) were hospitalised, 1072 (0·6%) received mechanical ventilation, and 5294 (3·1%) died. Compared with controls, patients with IMIDs and COVID-19 had higher rates of hospitalisation (1176 [14·6%] vs 22 154 [13·7%]; p=0·024) and mortality (314 [3·9%] vs 4980 [3·1%]; p<0·0001). In the omicron-predominant period, 120 862 (18·6%) of 650 361 patients tested positive for COVID-19, of whom 14 504 (12·0%) were hospitalised, 567 (0·5%) received mechanical ventilation, and 2001 (1·7%) died. Compared with controls, patients with IMIDs and COVID-19 (7327 [17·3%] of 42 249) had higher rates of hospitalisation (13 422 [11·8%] vs 1082 [14·8%]; p<0·0001) and mortality (1814 [1·6%] vs 187 [2·6%]; p<0·0001). Age was a risk factor for worse outcomes (adjusted odds ratio [OR] from 2·1 [95% CI 2·0-2·1]; p<0·0001 to 3·0 [2·9-3·0]; p<0·0001), whereas COVID-19 vaccination (from 0·082 [0·080-0·085]; p<0·0001 to 0·52 [0·50-0·53]; p<0·0001) and booster vaccination (from 2·1 [2·0-2·2]; p<0·0001 to 3·0 [2·9-3·0]; p<0·0001) status were associated with better outcomes. Seven chronic comorbidities were significant risk factors during both time periods for all three outcomes: atrial fibrillation, coronary artery disease, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, chronic liver disease, and cancer. Two IMIDs, asthma (adjusted OR from 0·33 [0·32-0·34]; p<0·0001 to 0·49 [0·48-0·51]; p<0·0001) and psoriasis (from 0·52 [0·48-0·56] to 0·80 [0·74-0·87]; p<0·0001), were associated with a reduced risk of severe outcomes. IMID diagnoses did not appear to be significant risk factors themselves, but results were limited by small sample size, and vasculitis had high feature importance in LR. IMMs did not appear to be significant, but less frequently used IMMs were limited by sample size. XGB outperformed LR, with the area under the receiver operating characteristic curve for models across different time periods and outcomes ranging from 0·77 to 0·92., Interpretation: Our results suggest that age, chronic comorbidities, and not being fully vaccinated might be greater risk factors for severe COVID-19 outcomes in patients with IMIDs than the use of IMMs or the IMIDs themselves. Overall, there is a need to take age and comorbidities into consideration when developing COVID-19 guidelines for patients with IMIDs. Further research is needed for specific IMIDs (including IMID severity at the time of SARS-CoV-2 infection) and IMMs (considering dosage and timing before a patient's first COVID-19 infection)., Funding: Pfizer, Novartis, Janssen, and the National Institutes of Health., Competing Interests: Declaration of interests PJM reports grants or research support from AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, Sun Pharma, and UCB; and speaker bureau fees from AbbVie, Amgen, Eli Lilly, Janssen, and UCB. PJM is also a consultant of AbbVie, Acelyrin, Aclaris, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Inmagene, Moonlake Pharma, Novartis, Sun Pharma, Takeda, UCB, and Ventyx. PJM has a leadership role in the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis. MC reports grants or research support from Novartis, Pfizer, and Janssen; and speaker bureau fees from Abbvie, BMS, Janssen, Medtronic, and Pfizer. MC is also a consultant of AbbVie, BMS, Fresenius-Kabi, Janssen, Lilly, Medtronic, and Takeda; and is on the Data Safety Monitoring Board of Pfizer, AbbVie, BMS, Janssen, and Fresenius-Kabi. JH reports funding for this study (paid to institute); grants from Pfizer and Novartis; and a contract from Janssen. JH has also received contract funding (paid to institute) from Bristol Myers Squibb and Gilead for research unrelated to this study. QW's work was funded in part by Pfizer, Novartis, and Janssen. SM's and BB's work was funded in part by Pfizer and Novartis. WFM's work was funded in part by Pfizer. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Bivalent mRNA coronavirus disease 2019 (COVID-19) vaccines may be simultaneously administered with other recommended vaccines, including seasonal influenza vaccines. However, few studies have evaluated the safety of co-administration of bivalent mRNA COVID-19 and seasonal influenza vaccines., Objective: The aim was to describe reports to the Vaccine Adverse Event Reporting System (VAERS) after co-administration of bivalent mRNA COVID-19 and seasonal influenza vaccines., Methods: We searched the VAERS database for reports of adverse events (AEs) following co-administration of bivalent mRNA COVID-19 and seasonal influenza vaccines during the period of September 1, 2022-March 31, 2023. We assessed the characteristics of these reports and described the most frequently reported AEs. Clinicians reviewed available medical records for reports of serious AEs and adverse events of special interest (AESI)., Results: During the period of 1 September 2022 through 31 March 2023, VAERS received 3689 reports of AEs following co-administration of bivalent mRNA COVID-19 and seasonal influenza vaccines. The median age of vaccinees was 59 years (interquartile range 39, 70 years); 342 reports (9.3%) were classified as serious. The most common AEs among non-serious reports were severe-acute-respiratory-syndrome-related coronavirus (SARS-CoV-2) infection (785, 23.5%), cough (592, 17.7%), and fatigue (568, 17.0%). The most common AEs among serious reports were Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection (88, 25.7%), dyspnea (81, 23.7%), and condition aggravated (55, 16.1%)., Discussion: Reports of AEs following co-administration of bivalent mRNA COVID-19 and seasonal influenza vaccines did not reveal any unusual or unexpected patterns of AEs. Increased reporting of certain events (e.g., COVID-19) was expected due to Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) reporting requirements. CDC and FDA will continue to monitor the safety of co-administration of mRNA COVID-19 and seasonal influenza vaccines., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Infants aged <6 months are at increased risk for severe COVID-19 disease but are not yet eligible for COVID-19 vaccination; these children depend upon transplacental transfer of maternal antibody, either from vaccination or infection, for protection. COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) data were analyzed to estimate COVID-19-associated hospitalization rates and identify demographic and clinical characteristics and maternal vaccination status of infants aged <6 months hospitalized with laboratory-confirmed COVID-19. During October 2022-April 2024, COVID-NET identified 1,470 COVID-19-associated hospitalizations among infants aged <6 months. COVID-19-associated hospitalization rates among young infants were higher than rates among any other age group, except adults aged ≥75 years, and are comparable to rates among adults aged 65-74 years. The percentage of hospitalized infants whose mothers had been vaccinated during pregnancy was 18% during October 2022-September 2023 and decreased to <5% during October 2023-April 2024. Severe outcomes among infants hospitalized with COVID-19 occurred frequently: excluding newborns hospitalized at birth, approximately one in five young infants hospitalized with COVID-19 required admission to an intensive care unit, nearly one in 20 required mechanical ventilation, and nine infants died during their COVID-19-associated hospitalization. To help protect pregnant persons and infants too young to be vaccinated, prevention for these groups should focus on ensuring that pregnant persons receive recommended COVID-19 vaccines., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Andrea George reports grants from the Council of State and Territorial Epidemiologists during the study. Lauren Leegwater reports grants from the Michigan Department of Health and Human Services during the study. No other potential conflicts of interest were disclosed.

Background: We aimed to determine if pre-existing immunocompromising conditions (ICCs) were associated with the presentation or outcome of patients with acute coronavirus disease 2019 (COVID-19) admitted for pediatric intensive care., Methods: Fifty-five hospitals in 30 US states reported cases through the Overcoming COVID-19 public health surveillance registry. Patients <21 years admitted 12 March 2020-30 December 2021 to the pediatric intensive care unit (PICU) or high-acuity unit for acute COVID-19 were included., Results: Of 1274 patients, 105 (8.2%) had an ICC, including 33 (31.4%) hematologic malignancies, 24 (22.9%) primary immunodeficiencies and disorders of hematopoietic cells, 19 (18.1%) nonmalignant organ failure with solid-organ transplantation, 16 (15.2%) solid tumors, and 13 (12.4%) autoimmune disorders. Patients with ICCs were older, had more underlying renal conditions, and had lower white blood cell and platelet counts than those without ICCs, but had similar clinical disease severity upon admission. In-hospital mortality from COVID-19 was higher (11.4% vs 4.6%, P = .005) and hospitalization was longer (P = .01) in patients with ICCs. New major morbidities upon discharge were not different between those with and without ICC (10.5% vs 13.9%, P = .40). In patients with ICCs, bacterial coinfection was more common in those with life-threatening COVID-19., Conclusions: In this national case series of patients <21 years of age with acute COVID-19 admitted for intensive care, existence of a prior ICCs were associated with worse clinical outcomes. Reassuringly, most patients with ICCs hospitalized in the PICU for severe acute COVID-19 survived and were discharged home without new severe morbidities., Competing Interests: Potential conflicts of interest. B. M. C. reports grants from NHLBI, American Lung Association, Doris Duke Foundation/Walder Foundation, and American Thoracic Society; payment for expert testimony from Tripplett Woolf Garretson; and participation on a multidisciplinary team for Sobi. N. B. H. reports grants from Sanofi, Quidel, and Merck. C. V. H. reports royalties, consulting fees, for Reviewer for Up To Date and Dynamed clinical databases; payment for presentations from Biofire; and expert consultation for the AstraZeneca FluMist Board. A. G. R. reports licenses as a Section Editor for Pediatric Critical Care Medicine, UpToDate, Inc; consulting fees from ThermoFisher, Inotrem; honoraria from a Grand Rounds presentation at St. Jude; support for meetings and/or travel from International Sepsis Forum, Institut Merieux, ThermoFisher; participation on an advisory board for the NIH Grace Study, REMAP-CAP, NIH-PREVENT-VILI; a medical advisory board member for Families Fighting Flu; chair member for International Sepsis Forum; and received reagents from Illumina, Inc. M. K. reports support for meetings and/or travel from the National Institute of Health (NIH) and a role on an advisory board for KultureCity. H. D. reports honoraria from Delex Pharma International, Inc. N. Z. C. reports grants from Cincinnati Children's Hospital Medical Center. J. C. F. reports grants from the National Institute of Diabetes and Digestive and Kidney Diseases (K23DK119463 and P50DK114786), and Pennsylvania CURE Grant. M. W. H. reports licenses from Kiadis, sub-board service for the American Board of Pediatrics, participation on a Data and Safety Monitoring Board (DSMB) for Abbvie, and receipt of drugs from Partner Therapeutics and Sobi. J. C. reports receipt of equipment from Illumina. B. L. reports receipt of an Immune Deficiency Foundation Research Grant. G. E. M. reports payment for expert testimony from Orlando Health, Bush Ross, Hall, Schiefflin & Smith, PA, Poole Brooks and Plumlee, PA, Hilltop Specialty Insurance, Smith, Hulsey, and Busey, PA. J. E. S. reports grants from the Food and Drug Administration (FDA), consulting fees from the Association for Professionals in Infection Control and Epidemiology (APIC), payment for presentations from the American Academy of Pediatrics, and participation on an advisory board for the American Association of Medical Colleges. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Using a transnational lens, this narrative study examines the online information literacies of six Chinese international graduate students in the United States during the COVID-19 pandemic. The data of the study were collected from phenomenological interviewing, weekly information-seeking dairies, and focus group discussions. This study illuminates Chinese international students' transnational information literacies in navigating the pandemic online information environment. These students stayed attuned with the pandemic conditions and relevant regulations in order to inform their important decision-making concerning health, safety, visa issues, and international travel. The study also highlights participants' cultural ways of information seeking and pragmatic approaches to information credibility assessment. Results from the study show the importance of understanding and empowering the information literacy of international students, especially during a global health emergency.

Topic Importance: Long COVID may occur in at least 10% of patients recovering from SARS-CoV-2 infection and often is associated with debilitating symptoms. Among the organ systems that might be involved in its pathogenesis, the respiratory and cardiovascular systems may be central to common symptoms seen in survivors of COVID-19, including fatigue, dyspnea, chest pain, cough, and exercise intolerance. Understand the exact symptomatology, causes, and effects of long COVID on the heart and lungs may help us to discover new therapies. To that end, the National Institutes of Health is sponsoring a national study population of diverse volunteers to support large-scale studies on the long-term effects of COVID-19., Review Findings: The National Institutes of Health Researching COVID to Enhance Recovery (RECOVER) initiative currently is recruiting participants in the United States to answer critical questions about long COVID. The study comprises adult and pediatric cohorts as well as an electronic health record cohort. Based on symptoms, individuals undergo prespecified medical testing to understand whether abnormalities can be detected and are followed up longitudinally. Herein, we outline current understanding of the clinical symptoms and pathophysiologic features of long COVID with respect to the cardiopulmonary system in adults and children and then determine how the clinical, electronic health record, and autopsy cohorts of the RECOVER initiative will attempt to answer the most pressing questions surrounding the long-term effects of COVID-19., Summary: Data generated from the RECOVER initiative will provide guidance about missing gaps in our knowledge about long COVID and how they might be filled by data gathered through the RECOVER initiative., Competing Interests: Financial/Nonfinancial Disclosures None declared., (Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)