Letter to the EditorFunctional decline at 1 year in hospitalized elderly pneumonia with SARS-CoV-2 Omicron variant:Comparison with the ancestral strain and Alpha variantNaoyuki Miyashita1, Yasushi Nakamori2, Makoto Ogata1, Naoki Fukuda1, and Akihisa Yamura11First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, Japan2Department of Emergency Medicine, Kansai Medical University Medical Center, Japan

Background- COVID-19 took a major toll on the healthcare system in India. Multiple vaccines were developed to prevent infection with the SARS-CoV-2 virus. Infection outcome was different among unvaccinated patients and those vaccinated. Aims and Methodology- The research aimed to find out various outcomes of COVID-19 disease and to compare these outcomes in vaccinated and unvaccinated patients. Data was collected from the records in a tertiary care hospital. The patients were segregated into mild, moderate, and severe disease according to the ICMR guidelines and the results were analysed using SPSS software. Results- Data of 816 and 2010 individuals for second and third wave respectively was collected and analysed. The results show that a higher percentage of unvaccinated individuals were asymptomatic (54.7 and 59.3%) but within symptomatic individuals, mild forms of the disease are much more common in vaccinated individuals (66.6% and 63.3%) while severe forms of the disease were more common in unvaccinated individuals (5.7% and 3.1%). This suggests that while vaccination may not have a significant effect on whether symptoms are contracted, it plays a vital role in lowering the severity of the disease form. Implications- This study proved that there exists a strong correlation between vaccination and reduced severity of disease, and further emphasized the importance of vaccines in protection from grave outcomes. Calculation of risk estimate showed that the unvaccinated individuals were more at risk for severe disease than those vaccinated with one or two doses of vaccines.

This article reviews the essential role of mathematical models in understanding and combatting the pandemic of novel coronaviruses, in particular focusing the advance in the use of mathematical models in disease control in Japan. Highlighting the integral role of mathematical models in public health, the article introduces a model that factors in the heterogeneity of infectious contacts, concentrating on the effectiveness of testing and isolation, alongside a model that involves economic losses. The models exhibit how, given such heterogeneity, milder behavioral restrictions can still achieve suppression, rigorous testing and isolation can effectively curb the spread, and containment measures can mitigate economic losses. These models aid in grasping the complicated dynamics of disease transmission and optimizing interventions. The knowledge of population ecology is also considered effective for public health in statistical analysis, organizing concepts using dynamic mathematical models, which lead to policy proposals and deepen understanding. Evolution theory may help the understanding of virulence subject to change. However, effective prevention necessitates not only models but also the practical implementation of efficacious measures. The cooperation of various disciplines is particularly crucial in achieving a balance between health measures, economic interests, and human rights. Moreover, the article acknowledges the limitations of models and underscores the significance of real-world execution. Overall, the article advocates for a broader outlook to tackle future pandemics and related challenges, underscoring the importance of ongoing academic cooperation and global governance to effectively address emerging infectious diseases and their far-reaching implications.

Early SARS-CoV-2 variant detection relies on testing and genomic surveillance. The Omicron variant (B.1.1.529) has quickly become the dominant type among the previous circulating variants worldwide. Several subvariants have emerged exhibiting greater infectivity and immune evasion. In this study we aimed at studying the prevalence of the Omicron subvariants during the flu season and beyond in Lebanon through genomic screening and at determining the overall standing and trajectory of the pandemic in the country. A total of 155 RNA samples were sequenced and 39 Omicron variants were detected. XBB.1.5 (23.29%) was the most common, followed by XBB.1.9.1 (10.96%) and XBB.1.42 (7.5%). The first batch collected between September and November 2022, included the BA.2.75.2, BA.5.2, BA.5.2.20, BA.5.2.25 and BQ.1.1.5 lineages. Between December 2022 and January 2023, those lineages were replaced by BA.2.75.5, BN.1, BN.1.4, BQ.1, BQ.1.1, BQ.1.1.23, CH.1.1, CM.4 and XBK. Starting February 2023, we observed a gradual emergence and dominance of the recombinant XBB and its sub-lineages (XBB.1, XBB.1.5, XBB.1.5.2, XBB.1.5.3, XBB.1.9, XBB.1.9.1, XBB.1.9.2, XBB.1.16, XBB.1.22 and XBB.1.42). The timely detection and characterization of SARS-CoV-2 variants is important to reduce transmission through established disease control measures and to avoid introductions into animal populations that could lead to serious public health implications.

Background: There has been an increase in the number of patients with lung cancer who had previously contracted SARS-CoV-2 and currently require surgery. This study was to share the early postoperative outcomes in patients who underwent radical lung cancer surgery after early recovery of COVID-19 infection. Methods We retrospectively collected data for 99 patients who had undergone lung cancer surgery in our hospital during January 2022 and January 2023 (including the peak of the COVID-19 crisis）. The patients were divided into two groups according to the inclusion criteria and exclusion criteria. One of these included individuals with a history of SARS-CoV-2 infection. Perioperative and follow-up data at 30-day and 90-day were recorded. Results There were no statistical differences between groups (p > 0.05) in terms of their postoperative complications or 30-day and 90-day postoperative readmission rates. However, there were significant differences between groups (p < 0.05) in terms of their tumor sizes, pathological stages, total drainage volumes, drainage diversion times, and hospital stays. Conclusions The results of the present trial suggested that it is safe to implement radical curative lung cancer surgery in patients without pulmonary impairment and in the early stages (2–4 weeks) of recovery from SARS-CoV-2 infection.

Objectives: To investigate the oral symptoms of COVID-19 ’s “positive” group in Suining City after the comprehensive liberalization of epidemic prevention and control measures in China. To explore the related influencing factors of symptom differences and provide reference for the treatment of patients in the post-epidemic era. Methods: An online survey based on a random sample of 25 questions. Results: 1768 valid questionnaires were collected. The data showed that 363 people had oral problems after an infection with novel coronavirus. The oral problems after SARS‐CoV‐2 infection mainly focused on gingiva swelling or bleeding (38.57%), toothache (37.74%), bad breath (27.55%), oral ulcer (30.30%), abnormal taste (24.24%) and some infected people had a variety of oral symptoms. A small number of infected people also have other oral problems. The incidence of oral symptoms was significantly correlated with sex, age, educational level, place of residence, smoking, basic diseases, long-term saline gargle and vaccination of COVID-19 vaccine. In addition, the age, place of residence, smoking history, basic diseases, and vaccination also showed significant differences in prognosis. Conclusions: In the post-epidemic era, the most common oral problems are gingiva swelling or bleeding, toothache, bad breath, oral ulcer, and abnormal taste. And maintaining good living habits is the basis for promoting disease recovery and oral health.

The information on the microbiome’s human pathways and active members that can affect SARS-CoV-2 susceptibility and pathogenesis in the salivary proteome is very scarce. Here, we studied samples collected from April to June 2020 from unvaccinated patients. We compared 10 infected and hospitalized patients with severe (n=5) and moderate (n=5) Coronavirus Disease (COVID-19) with 10 uninfected individuals, including Non-COVID but susceptible individuals (n=5) and Non-COVID and non-susceptible healthcare workers with repeated high-risk exposures (n=5). By performing high-throughput proteomic profiling in saliva samples, we detected 226 unique differentially expressed (DE) human proteins between groups (q-value ≤0.05) out of 2721 unambiguously identified proteins (false discovery rate ≤1%). Major differences were observed between the Non-COVID vs the non-susceptible groups. Bioinformatics analysis of DE proteins revealed human proteomic signatures related to inflammatory responses, central cellular processes, and antiviral activity associated with saliva of SARS-CoV-2 infected patients (p-value ≤0.0004). Discriminatory biomarker signatures from human saliva include cystatins, protective molecules present in the oral cavity, calprotectins, involved in cell cycle progression, and histones, related to nucleosome functions. The expression level of two human proteins related to protein transport in the cytoplasm, named DYNC1 (p-value, 0.0021) and MAPRE1 (p-value, 0.047), correlated with angiotensin-converting enzyme 2 (ACE2) plasma activity. Finally, the proteomes of microorganisms present in the saliva samples showed 4 main microbial functional features related to ribosome functioning that are overrepresented in the infected group. Our study explores potential candidates involved in pathways implicated in SARS-CoV-2 susceptibility although further studies in larger cohorts will be necessary.

Monkeypox has recently surfaced as a public health issue, and the virus has spread rapidly worldwide in the post-COVID-19 period. These emerging infections hinder human health and the advancement of the global economy. There are currently no authorized medications to treat this condition. As a result, this study gap motivates us to seek a viable inhibitor from a natural source. In the present study, 10 plant-derived compounds and commercialized drugs respectively were subjected to molecular docking and 100 ns molecular dynamics simulations to identify the potent inhibitor against MPXV E8 ectodomain protein. Punicalagin showed a greater affinity for the target protein (-9.1 kcal/mol), and maraviroc, among commercial drugs, had a binding affinity of -7.4 kcal/mol which was lower than punicalagin. MD simulations substantiated this study and showed better stability of punicalagin with the target envelope protein, compared to the control drug maraviroc. This finding was validated by decreased RMSD, RMSF, Rg, and SASA values with increased H-bonding. Therefore, we could speculate that the plant-derived natural compound, punicalagin can act as a potent therapeutic against the MPXV.

The tourism industry has been severely impacted by a series of challenges in recent years, including the COVID-19 pandemic, the Russia-Ukraine War, and supply chain disruptions. These adversities have led to economic downturns and high inflation rates, making it difficult for the industry to recover and thrive. The existing situation is characterized by decreased travel demand, reduced revenue for tourism businesses, and limited opportunities for travelers to explore new destinations. One of the major problems faced by the current problem domain is the need to revitalize the tourism industry and stimulate travel activity. Traditional approaches to revive the industry have proved insufficient, and financial constraints have made it difficult for individuals to afford travel expenses. To address these problems, a comprehensive mobile application is proposed, integrating the move-to-earn concept. This concept incentivizes travelers to engage in physical activities while exploring destinations, earning rewards like digital tokens or discounts on travel-related services based on their activity level. By encouraging physical activity and exploration, the app revitalizes the tourism industry, boosting footfall and generating revenue for local businesses. Additionally, the rewards earned through the app provide financial relief and make travel more affordable, thereby overcoming the economic challenges faced by both travelers and the industry. Overall, this solution addresses the existing situation by incentivizing travel and physical activity, promoting local businesses, and mitigating the financial burden on travelers. It offers a comprehensive and innovative approach to revitalize the tourism industry and create a win-win situation for all stakeholders involved.

Background: The Covid-19 pandemic affected healthcare delivery globally. The impact was more for individuals with chronic diseases requiring regular visits to the hospital. This study aimed to assess the impact of the pandemic on care for patients with Sickle cell disease (SCD) in Nigeria. Methods: This was a cross-sectional survey involving 435 SCD patients from the six geopolitical zones of Nigeria. Data was collected through pre-tested and validated, semi-structured questionnaires using Google forms online and face-to-face interviews at the Clinic. Results: Teaching hospitals were the most utilised health facility by the respondents 269 (61.8%). Bone pain was the most frequent crisis 318 (70.7%) with a significant increase in frequency during the pandemic when compared with the preceding year, p=0.004. Many of the respondents 227(52.2%) required hospitalization during the pandemic. Major concerns expressed for accessing care include fear of exposure to Covid-19-infected patients or health workers who have been exposed to Covid and conversion of regular health facilities to Covid-19 treatment centres. During the Pandemic, 102 (23.4%) respondents had easy access to their doctors and telemedicine was available to 87(20%) but 56 (12.9%) and 97 (22.3%, ) had difficulties in getting blood transfusion and accessing laboratory tests respectively. Up to 139(32.9%) did not have difficulties getting pain relief, 169 (38.9%) had their routine medications while 166 (38.2%) had their income significantly affected during the pandemic. Conclusion: The findings revealed challenges in accessing routine medical care, concerns about exposure to COVID-19, and disruptions in healthcare services. This article discusses the implications of the survey results and proposes strategies to strengthen sickle cell care in preparation for future pandemics.

Background: The article presents the results of a longitudinal study performed to assess the humoral immune response to the Johnson & Johnson (J&J) COVID-19 vaccine (Ad26.COV2.S) in a low-income, Hispanic patient population. In our work, we evaluate the COVID-19 health status of the patient population following vaccination. This work is a follow-up of a pilot study that analyses additional data to better understand the impact of the vaccine. Methods: Longitudinal cohort study testing the antibody responses of patients each visit within 120 days (initial, 1st follow-up, and 2nd follow-up). This study used the Clungene® SARS-CoV-2 IgG/IgM Rapid Test Cassette to determine the presence of binding antibodies resulting from the J&J COVID-19 vaccine. Results: Fifty-seven (57) patients were eligible for participation in this study after initial baseline antibodies were measured; seventy-four (74) patients were requested to participate, 17 were excluded because moderate to strong immunoglobulin G (IgG)/immunoglobulin M (IgM) responses. High loss to follow-up were multifactorial, but a predominant reason was travel out of state for work or return to country of origin.

In the present era, healthcare systems grapple with substan- tial volumes of medical data. However, a significant portion of this data is marked by incompleteness, inconsistency, er- rors, and unsuitability for training Machine Learning (ML) or Deep Learning (DL) algorithms. This necessitates preprocess- ing the data to render it amenable to utilization by ML/DL al- gorithms. Medical datasets predominantly feature two types of attributes: numerical and categorical values. The conver- sion of categorical features into numerical vectors is a crucial step in preparing the data for ML/DL algorithms, known as Feature Engineering (FE) based categorical encoding. Con- ventional and straightforward encoding of categorical fea- tures, termed one-hot encoding, generates multiple columns, thereby transforming data from a lower-dimensional to a higher- dimensional space. This approach poses challenges, includ- ing increased memory requirements due to the proliferation of columns. Considering these issues, this research proposes an encoding technique named “Weight of Evidence with En- tity Embedding” (WoEEE). The WoEEE approach bolsters the predictive capabilities of ML/DL algorithms by calculating the weight of evidence and concurrently mitigates dimension- ality issues. To empirically validate the proposed method, it is tested on six diverse datasets: Breast Cancer, Hospital Readmission, Vadu, Covid-19, Stroke, and Heartstatlog. Four distinct ML/DL algorithms—Decision Tree (DT), Random For- est (RF), Logistic Regression (LR), and a simple Feed-forward Neural Network (NN)— are employed for testing. The re- sults obtained demonstrate that the WoEEE approach yields an average improvement of 11.18%, 10.37%, 5.83%, 7.58%, 7.83%, and 6.83% across all combinations of datasets, classi- fiers, and encoding methods. Furthermore, an Anova test is performed to confirm the effectiveness of WoEEE in encod- ing categorical data, especially for tasks involving binary clas- sification. This enhances the treatment of categorical data in ML and data analytics scenarios. Overall, WoEEE shows po- tential as a valuable approach for categorical data encoding, making a positive contribution to the creation of effective techniques for handling this type of data in real-world appli- cations.

A document by Hatem Alahwal. Click on the document to view its contents.

Since a magic “polypill” – the “Environment-Sleep-Emotion-Exercise-Diet” intervention [E(e)SEEDi] was discovered in 2018, it plays a pivotal role in control and prevention of human disease due to improvement of immunity by healthy lifestyle. It can be said that it is applicable, as long as one is a human and survival. However, do plants also need the magic “polypill”? When plants need a suitable environment, rational internal exercise, and balancing nutrients (fertilizers, herbicides, nutrients, pesticides, and others), do they also need sleep? And have also emotions like humans? These are interesting questions. Currently, obvious climate change threats herbal cultivation in both China and the globe, in particular the pandemic and post-COVID-19 era. Only when we understand and confirm that plants also need sleep and have emotions, can we better protect medicinal plants and promote herb cultivation and healthy growth, since traditional Chinese herbs have a good efficacy in combating cardiovascular disease.

Nonpharmaceutical interventions (NPIs) against coronavirus disease 2019 (COVID-19) reduced the prevalence of coronavirus among children and influenced the transmission of other viruses. This study investigates the impact of NPIs on human enterovirus (HEV) among children in Hangzhou, China. We collected and analyzed the laboratory results and clinical data of children diagnosed with hand, foot, and mouth disease (HFMD) or herpangina (HA) during the following periods: pre-COVID-19 (January 2019 to December 2019), COVID-19 pandemic (January 2020 to December 2022), and post-COVID-19 (January to August 2023). A total of 38,582 specimens that met the inclusion criteria were enrolled, of which 1,777 (5.58%) tested positive for enterovirus. In comparison to the pre-COVID-19 period, which had 695 (5.63%) HEV-positive specimens, the numbers dramatically decreased to 69 (1.19%), 398 (5.12%), and 112 (1.58%) in 2020, 2021, and 2022, respectively, but significantly increased to 503 (9.00%) in 2023. Seasonal peaks of infections occurred between May and August each year, with positive rates of 10.58%, 25.27%, 31.74%, and 10.97%, respectively. Notably, June and July accounted for half of all cases, with a rate of 57.01%. The difference in the positive rates of HEV infection between males and females was statistically significant (P<0.005), with 5.12% (1,084/21,176) and 4.43% (693/15,629) testing positive, respectively, resulting in a male to female ratio of 1.56:1. Among the same age groups, children aged 3-5 years and 5-7 years had the highest positive rates at 11.03% (342/3,102) and 10.03% (205/2,024), respectively, after synthesizing five years of data. The detection rate of HEV-positive cases increased with age, but after the age of 7, the rate declined. The detected types of HEV indicated that enterovirus 71 (EV-A71) and coxsackievirus A16 (CV-A16) are no longer the two common pathogens causing HFMD and HA. In conclusion, NPIs for COVID-19 are highly effective in reducing the transmission of HEV. However, the relaxation of NPIs results in a resurgence of HEVs, surpassing prepandemic levels. Active awareness and surveillance of the epidemiological characteristics of HEV are essential for preventing, controlling, and managing the development of HFMD and HA, as well as contributing to the development of a multivalent HFMD vaccine.

Introduction: It has been reported that COVID-19 may cause severe endothelial damage. Pulmonary Artery Stiffness (PAS) is a strong predictor of right ventricular function. PAS can reveal important information about the endothelial functions of the pulmonary bed. In this study we aimed to elucidate the possible effect of COVID-19 on PAS. Materials & Method: The study was performed by measuring PAS values with transthoracic echocardiography in 130 patients, 60 of whom had COVID-19 and 70 were controls. COVID-19 patients with positive polymerase chain reaction (PCR) test results were included in the study 3-6 months after their positivity. Results: When the Maximal frequency shift (MFS) (Hz) results were examined, no significant difference was observed between the patient and control groups (2764 ± 279.24 and 2664.8 ± 673.91 p=0.340, respectively). There was a significant difference between the patient and control groups in favor of the patient group in pulmonary acceleration time (PAT) (msec) results (93.18 ± 14.99 and 126.1 ± 17.58, respectively, p<0.001) . There was a significant difference between the patient and control groups in favor of the patient group in pulmonary artery stiffness (PAS) (Hz/msec) results (30.28 ± 5.07 and 21.57 ± 7.04, respectively, p<0.001). Conclusion: It is possible that COVID19 may have adverse effects on the pulmonary artery wall and bed. As a result of endothelial damage due to COVID-19, an increase in PAS values can be observed.

The development of sensitive, fast, and more reliable diagnostic methods to prevent and control the outbreak of life-threatening pandemic infectious diseases, such as COVID-19, according to the WHO recommendations, is always in priority and necessity. Optical diagnostic methods, with their progress in technology, are central to most applications and now, in the health field, are an alternative to conventional methods because of their great sensitivity and capability utilized for SARS-CoV-2 detection such as generally applied PCR technology which is time-consuming, effortful, and has limited availability in resource-limited situations. Herein, we reviewed various optical methods engaged for virus detection such as fluorescence-based techniques, Raman spectroscopy (RS), Plasmonic methods (e.g., SPR, LSPR, SEF, and SERS), ATR-FTIR, super-resolution microscopy (SRM), and some integrated platforms like waveguides and MIP-based biosensors for the development of portable, sensitive, specific, and low-cost POC apparatus for the rapid virus detection.

An extensive arterial thrombosis with lower limb ischemia in a COVID-19 patient: a case report.Johary Andriamamonjisoa Andriamizanaka1, Etienne Rakotomijoro2, Volatiana Andriananja3, Mihaja Raberahona4, Radonirina Lazasoa Andrianasolo5, Rivonirina Andry Rakotoarivelo6, Jean de Dieu Randria Mamy7

1.Shehroz KhanJinnah Medical and Dental Collegedr.shehrozkhan@outlook.com0009-0008-9134-71282.Chanchal MaheshwariKarachi Medical and Dental Collegemaheshwarichanchal586@gmail.com0000-0002-3714-7554

Misinformation and misconceptions about certain diseases and infections have always triumphed in the world creating a sense of horror among people. Without proper guidance and counseling, ties with these myths cause panic and agitation giving an incentive to believe in them thoughtlessly. SARS-COV2, globally known as Coronavirus disease 19 emerged as a dreadful viral condition affecting millions of people all across the globe. With the rise in the frequency of cases of COVID-19, myths started to escalate resulting in a reduction in actually needed practices and precautionary measures. With passage of time various facts and invalid information has emerged disrupting the course of life. This paper highlights the role of misconceptions that spread like wildfire during COVID-19 pandemic.

Digital health, also known as digitalization in healthcare is a growing industry that is bringing several benefits to people around the globe. Online healthcare services are playing a major role in the digital transformation of the health sector. While there are various advantages of digitalization of health services including sharing medical history, easier and faster access of healthcare services, electronic data collection, reduced costs of building infrastructure, and efficiency in the delivery of healthcare services. On the other hand, this also poses challenges in the acceptance of customers and their decision-making towards online health services So, this research focuses on customer acceptance and customer decision-making for online healthcare services with digital transformation. There are two dependent variables in this research including customer acceptance and customer decision making and one independent variable of online healthcare service. The variable of digital transformation plays the role of mediator between online healthcare service and customer acceptance and decision making. Technology acceptance model is the underpinning theory of this research with the consumer decision-making model as a supporting theory. Quantitative research methodology was used by utilizing a survey strategy via questionnaire and data were collected from the customers of online healthcare services residing in Lahore. Moreover, SEM has been used for data analysis via AMOS. Out of four hypotheses of this study, three hypotheses (H2, H3, and H4) have been accepted and one hypothesis (H1) has been rejected as explained in the findings. The findings of this research are beneficial for future researchers as it adds to the existing knowledge and provides recommendations for future research. The findings of this research are beneficial for hospital administration and policymakers to help customers in catering their problems regarding online healthcare services and making lives better for society.

Background: Unlike other pediatric cancers, acute lymphoblastic leukemia (ALL) treatment includes a prolonged maintenance phase during which children typically resume regular activities. As COVID-19 transmission persists despite the end of the public health emergency declaration, physicians need data regarding the impact of COVID-19 in this population to guide families in managing risk. Procedure: The Pediatric Oncology COVID-19 Case Report (POCC) collected de-identified clinical and sociodemographic data on children with cancer and COVID-19. This subset analysis compares 481 children (≤21yo at COVID-19 infection) with ALL in maintenance (ALL-MTN) to other children with cancer and COVID-19 (n=1,190). Results: Children in ALL-MTN had fewer hospitalizations, (23% vs 29%, p=0.01), intensive care unit admissions (ICU: 3% vs 5%, p=0.01), and were less likely to die (0% vs 2%, p=<0.01). However, they more often had cancer therapy changed (50% vs 33%, p=<0.01). Lower odds of hospitalization and ICU admission persisted in multivariable analyses adjusting for age, race/ethnicity, insurance, ANC, and comorbidities. There were independent associations among children in ALL-MTN with sociodemographic factors (Hispanic ethnicity, public insurance) and clinical characteristics (comorbid conditions, neutropenia) and both hospitalization and ICU admission. Vaccination decreased odds of hospitalization. Conclusions: Children in ALL-MTN continue to have significant COVID-19 risks, with less hospitalization and ICU admission but more therapy changes than other children with cancer. These risks should be addressed when discussing participation in activities (school, camp, sports, etc.), prevention (COVID-19 vaccination) and mitigation (masking) strategies. The high level of therapy modifications could have long-term consequences and should continue to be followed.

COVID-19, caused by the novel coronavirus (SARS-CoV-2), is an emerging infectious disease (EID) with a relatively high infectivity and mortality rate. During the state of emergency announced by the Japanese government in the spring of 2020, citizens were requested to stay home, the number of infected people was drastically reduced without a legally-binding lockdown. It is well-acknowledged that there is a trade-off between maintaining economic activity and preventing the spread of infectious diseases. We aimed to reduce the total loss caused by the epidemic of an EID like COVID-19 in the present study. We focused on early and late stages of the epidemic and proposed a framework to reduce the total loss resulted from the damage by infection and the cost for the countermeasure. Mathematical epidemic models were used to estimate the effect of interventions on the number of deaths by infection. The total loss was converted into the monetary base and different policies were compared. In the early stage, we calculated the damage by infection when behavioral restrictions were implemented. The favorable intensity of the intervention depended on the basic reproduction number, infection fatality rate, and the economic impact. In the late stage, we calculated indicators and showed it depended on the ratio of the cost to maintain the hospitalization system to the monetary loss per deaths by infection which strategies should be adopted.

Background:Invasive mechanical ventilation is a crucial intervention for the management of critical COVID-19 patients. However, the impact of prone position (PP) on patients undergoing invasive mechanical ventilation remains uncertain. This study aims to investigate the potential benefits of PP in terms of improving the oxygenation index and prognosis. Methods:A total of 289 critically ill COVID-19 patients were retrospectively gathered from ICU of three general hospitals located in Taizhou, Zhejiang Province from December 1, 2022 to February 1, 2023, all patients were invasive mechanical ventilated. 78 cases of PP group and 78 cases of non-PP group were matched with propensity score matching. The study compared clinical data, laboratory results, and hospitalization survival rate between two groups of patients. Furthermore, we compared the laboratory results, and hospitalization survival across varying numbers of PPs. Results:The mean oxygenation index exhibited a greater increase in PP group compared to non-PP group (48 vs 32mmHg). Hospital survivors of PP group (63 patients) demonstrated more substantial decrease in their Sequential Organ Failure Assessment scores and C-reactive protein levels compared to non-PP group (51 patients). The initial PP cycle resulted in a significant elevation of the oxygenation index by 30.8 (-16.4,46.9) mmHg; the second PP cycle demonstrated a maximum increase of 56.3 (13.0,92.8) mmHg. A higher frequency of PP yielded a more pronounced improvement in oxygenation and had the potential to enhance the survival rate. Additionally, the eight patients who was improvements in their oxygenation index during the initial three PP cycles and successfully survived had higher lymphocyte counts (0.2-2.4) vs (0.1-0.5)×10 9/L and a longer duration of PP (53.0-113.5) vs (36.0-98.5)h. Conclusion:PP has the potential to enhance the oxygenation index and survival rates among critically ill COVID-19 patients invasive mechanical ventilated. Notably, a positive correlation was observed between the frequency of PP and the improvement of oxygenation. Our investigation further revealed that the efficacy of the PP may be influenced by lymphocyte count and duration of PP.