Background: The Covid-19 pandemic currently represents a foremost global contemporary public health challenge, with alarming death rate. Pregnant women by virtue of reduced immunity may be at increased risk of contracting the disease. Objective: To elicit the knowledge of, and behavior, in response to the covid-19 pandemic among pregnant Nigerian Igbo women. Subjects and methods: Cross-sectional questionnaire-based study of 370 pregnant women from health facilities in Anambra state Nigeria, to elicit information on their knowledge of causes, mode of transmission, availability of vaccines, treatment modalities, and behavioural changes consequent on covid-19. Data obtained was analyzed using SPSS IBM windows version 26. Result: The modal age, parity and gestational age of the respondents were 25-29 years (49.2%); Para 1-4(89.5%) and <28 weeks (44.1%) respectively. Majority of the participants had tertiary education (54.1%) and of modal social class 5. All (100%) of the participants knew about covid-19; 91.4% recognized it was of viral aetiology; and 75.1% agreed it is an infectious disease. Indicated modes of transmission include air, droplets, faeces, urine, dust, ingested foods, and drinks. Most of the participants recognized the unavailability of drugs (88.6%) and vaccine (80%) for covid-19 management. Stated treatment modalities include symptomatic therapy; inhalation of steam from hot water, herbs, and roots; consumption of spices; antimalarial, Antibiotics, Multivitamins therapy; physical exercises; rest; and prayer. Majority of the respondents (67%) believed that covid-19 had affected their general behavior and most adhered to covid-19 safety measures - wearing of face mask; hand washing; use of hand-sanitizers and social distancing. The most common source of information to participants on covid-19 was electronic media. Conclusion: The knowledge of covid-19 among the respondents was high and their behavior, satisfactory. There is need to maintain the public enlightenment tempo to sustain the good behavior in response to covid-19 amongst pregnant women.

Background: Although changes of the main lymphocyte subsets (T cells, T helper, T cytotoxic, B cells, NK cells) and lymhocyte activation status in COVID-19 patients have been reported, the results of the studies differ each other. Therefore, we aimed to determine lymphocyte subgroups and activation status of them with flow cytometry at the time of diagnosis in COVID-19 patients and examine the relation of them with disease stage and length of hospital stay. Methods: Fourty patients included in the study were compared with the age and sex matched 40 healthy controls. COVID-19 patients were divided into 2 groups as mild and severe stage disease. Flow cytometry assay was performed to examine the numbers of lymphocyte subsets and activation status of them. Total lymphocyte count was calculated and CD45, CD3, CD4, CD8, CD19, CD27, CD38, CD56, CD57, IgD were studied on lymphocyte gate. T helper / T cytotoxic rates and length of hospital stay were recorded. Results: The patients’ CD3(+)CD4(+) ( T helper) count and CD27 expression on T cells counts were significantly lower, and CD57 expression on CD3(+)CD8(+) T cytotoxic cells were significantly higher (p<0.05) than control gruop. When the patients were divided into mild and severe stages, it was observed that CD38 expression on T cells were significantly lower in severe stage patients (p< 0.05) Total lymphocyte count and CD3(+) T lymphocyte count were negatively correlated with the lengt of hospital stay as statistically significant (p <0.05). Conclusion: Our data showed that the SARS-CoV-2 primarly effects on T lymphocytes. It was thought that this effect occured by impairment of development and activation of T lymphocytes. There are some discordances among the studies on T lympocytes in the literature. Studies with more patients are needed to make this information more reliable.

Background The global effect of the COVID-19 pandemic has had an impact on pregnancy and outcomes. There has been recently some conflicting evidence on the stillbirths during the COVID-19 pandemic. This meta-analysis attempts to resolve this through a systematic approach. Objectives To analyse and determine the impact of COVID-19 on the stillbirth rate. Search strategy We searched PubMed, Embase, Cochrane library, ClinicalTrials.gov and Web of Science from inception to 05 March 2021 with no language restriction for this meta-analysis. Selection criteria Publications (a) with stillbirth data on pregnant women with COVID-19 (b) comparing stillbirth rates in pregnant women with and without COVID-19 and (c), comparing stillbirth rates before and during the pandemic. Data collection and Analysis The included studies were all observational studies, and we used the Newcastle Ottawa score for risk of bias. We performed the meta-analysis using Comprehensive meta-analysis software, version 3. Main results A total of 29 studies were included in the meta-analysis; from 17 of these, the SB rate was 7 per 1000 in pregnant women with COVID-19. This rate was much higher (34/1000) in low- and middle-income countries. The odds ratio of stillbirth in pregnant women with COVID-19 compared to those without was 1.89. However, there was no significant difference in population SB rates before and during the pandemic. Conclusions There is some evidence that the stillbirth rate has increased during the COVID-19 pandemic, but this is mainly in low- and middle-income countries. Inadequate access to healthcare during the pandemic could be a contributing factor.

Aims: The COVID-19 pandemic led to hospitals in the United Kingdom substituting face-to-face (FtF) clinics with virtual clinic (VC) appointments. We evaluated the impact of virtual two-week wait (2-ww) lower gastrointestinal (LGI) consultations on stakeholders at a district general hospital in England. Methods: Patients undergoing index outpatient 2-ww LGI clinic assessment between 01/06/2019-31/10/2019 (FtF group) and 01/06/2020-31/10/2020 (VC group) were identified. Relevant data were obtained using electronic patient records. Compliance with national cancer waiting time targets (WTT) was assessed. Environmental and financial impact analyses were performed. Results: In total, 1531 patients were analysed (median age=70, male=852, 55.6%). Of these, 757 (49.4%) were assessed virtually via telephone; the remainder were seen FtF (n=774, 50.6%). Ninety two (6%, VC=44, FtF=48) patients had malignant pathology and 64 (4.2%) had colorectal cancer (CRC); of these, 46 (71.9%, VC=26, FtF=20) underwent treatment with curative intent. The median waiting times to index appointment, investigation and diagnosis were significantly lower following VC assessment (p<0.001). The cancer detection rates (p=0.749), treatments received (p=0.785) and median time to index treatment for CRC patients (p=0.156) were similar. A significantly higher proportion of patients were seen within two weeks of referral in the VC group (p<0.001). VC appointments saved patients a total of 9288 miles, 0.7 metric tonnes of CO2 emissions and £7482.97. Taxpayers saved £80,242.00 from VCs. No adverse events or complaints were reported in the VC group. Conclusion: Virtual 2-ww LGI clinics were effective, safe and were associated with tangible environmental and financial benefits for stakeholders.

Purpose: An Expert Panel on Breast Cancer and COVID-19 was convened to address the impact of the COVID-19 pandemic for early breast cancer management. Methods: In order to ensure the most clinically relevant information was addressed, essential information was drawn from several of the latest national and international guidelines and another technical document. The Expert Panel met in five virtual closed sessions from November 2020 to May 2021 to consult on the relevant data from evidence-based results. The data gathered were discussed on an online platform (Within3 ®). Results: This paper reports the Expert Panel's highlights of these meetings' discussions. In addition, it provides practical recommendations covering topics regarding diagnosis, treatment, and management of breast cancer patients in clinical settings routinely encountered by HCPs amid the COVID-19 pandemic. Conclusions: It was provided guidance on several topics regarding eBC management amid the COVID-19 pandemics to inform safer care practices.

Aim: Mask use has a substantial role in reducing the spread of COVID-19 in confined spaces. However, the use of masks is controversial in cases where intense effort is required, such as the treadmill exercise test. Since the majority of subjects undergoing this test are elderly individuals with comorbidities, the safety and reliability of the test are critical matters that must be elucidated in the post-COVID-19 era. In this study, the safety of the treadmill exercise test performed using a mask and the diagnostic reliability of the test were questioned. Methods: In our clinic, before March 11, 2020, treadmill exercise tests were performed without a mask; whereas, after this date, patients were supplied with a standard surgical mask during the test. These two groups were compared with regard to various characteristics to assess diagnostic reliability and safety. Results: The diagnostic reliability and the safety of the stress test performed with a mask was found to be similar to that of tests performed without a mask. However, we noted that shortness of breath was more common in the mask-wearing group. Conclusion: The treadmill exercise test performed by wearing surgical masks is safe and its results are reliable for diagnosis.

The COVID-19 pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) increases the need for rapid development of efficient vaccines. Among other vaccines in clinical trials, a recombinant VSV-∆G-spike vaccine was developed by the Israel Institute for Biological, Chemical and Environmental sciences (IIBR) and is being evaluated. Development of an efficient downstream purification process (DSP) enables advancing the vaccine to clinical trials. The DSP must eliminate impurities, either process- or product -related, to yield sufficient product with high purity, potency, and quality. To acquire critical information on process restrictions and qualities, incorporation of on-line monitoring is vital. Application of on-line monitoring should significantly impact process yield, product quality and economy of the entire process. Here, we describe an on-line monitoring technique that was applied in the DSP of the VSV-∆G-spike vaccine. The technique is based on determining concentrations of metabolites, nutrients and a host cell protein (HCP) by the automatic chemistry analyzer Cobas Integra 400 Plus. The analysis revealed critical information on process parameters and significantly impacted purification processes. The technique is rapid, easy and efficient. Adaptation of this technique during the purification process improves process yield, product quality and enhances the economy of the entire downstream process of biotechnology and bio pharmaceutical products.

Neurological manifestation and complications are common due to COVID-19. It affects higher functions, cranial nerves and the motor system. The authors report a case of GBS as an example of a success story in managing a complicated case of COVID-19 in an elderly male with signs of a poor prognosis.

Background: We hypothesized that the geographic distributions of COVID-19 prevalence and risky alpha-1-antitrypsin allele prevalence are similar. We aimed to investigate whether there is a relationship between the geographical density of the COVID-19 pandemic and the distributions of risky alpha-1-antitrypsin alleles. Methods: This research is a cross-sectional study. Alpha-1-antitrypsin PI*SZ and PI*ZZ genotypes frequencies of European and American countries were compared with the case and death data related to the COVID-19 pandemic as of March 30, 2021. The relationship between the data was evaluated using Linear regression analysis. Results: According to the linear regression analysis results, a significant relationship was found between the number of COVID-19 cases in both European and American countries and the sum of PI*SZ and PI*ZZ genotypes. Similarly, according to the linear regression analysis results, a significant relationship was found between the COVID-19 death numbers in both European and American countries and the sum of PI*SZ and PI*ZZ genotypes. Conclusions: The findings showed that the prevalence distribution of the risky alleles of the gene defect that causes alpha-1-antitrypsin insufficiency is related to the prevalence of COVID-19 pandemic data.

A document by Andrea Leonardi, written on Authorea.

Many publications on COVID-anosmia and asymptomatic COVID-stroke have been released, and plenty of studies on novel therapeutic approach have been published. Here we report an atypical case, our findings from review the medical literature, and comment on the treatment modalities

BACKGROUND: This study aims to determine nicotine dependence levels in pre and during pandemic and its correlations with COVID-19 phobia among healthy men during controlled social life: a sample of primary care population. METHODS: This cross-sectional study was conducted with 472 healthy men in Çorum, Black Sea Region, Turkey between February 2019 and October 2020. An online questionnaire was used to collect data including demographic profile, smoking behavior, intention to quit, Fagerström Nicotine Dependence test (FTND) pre and during COVID-19 pandemic and COVID-19 phobia scale. RESULTS: In this study, a percentage change of +6.2, +0.8, +1.9, -2.7, -5.1 was found in very low, low, medium, high and very high dependence categories respectively between pre-pandemic and during controlled social life in pandemic. A percentage change of +2.8 was seen in terms of intention to quit smoking. The mean score for COVID-19 phobia was 65.9 ± 15.8 and almost two-thirds of the participants (62%) had medium and high COVID-19 phobia. Men with high/very high dependence had significantly more COVID-19 phobia than the other two groups. There was a significant correlation between FTND scores and COVID-19 phobia. CONCLUSIONS: There were considerable changes in dependence levels and COVID-19 phobia was more common in high/very high dependence group. Controlled social life should be considered a golden opportunity for predicting levels of nicotine dependence and will bring benefit for lower smoking prevalence. COVID-19, Nicotine dependence, Phobia, men, Primary health care.

A document by Rehab Elhiny, written on Authorea.

Aims: It is evident that COVID-19 pandemic have affected the medical practice and training of residents. In this study, we evaluated the Physical Examination (PE) habits of residents working in a university hospital and how their PE practices did change during the pandemic. Methods: This single-center, non-interventional, cross-sectional descriptive study was conducted in a university hospital using an online survey questionnaire from 5 to 20 October 2020. Results: 308 residents participated in the study of whom 172 of them (55.8%) were female and the median age was 27 (IQR:3). Among all, 263 participants (85.4%) declared that they have worked in the areas where suspected/confirmed COVID-19 patients were being served. A total of 262 (85%) residents stated that PE habits have changed generally during the pandemic. There was a significant difference between those residents who have worked in the COVID-19 areas (n=230,87.5%) and those who have not (n=32, 71.1%) (p=0.004). PE habits of Internal Medicine Residents were more changed than others (p<0.001). The main reason for the change in PE habits in general (77.9%) and during the examination of suspected/confirmed COVID-19 patients (89.7%) were ‘’self-protection”. Reliance on laboratory and radiologic investigations during practice and not having a thought that less PE will disrupt the diagnosis and course of COVID-19 were also independent risk factors for performing less PE in suspected/confirmed COVID-19 patients. Discussion: This study clearly demonstrated that the COVID-19 pandemic has had a serious impact on the PE habits of the residents while examing patients in general and with COVID-19.

There is limited data about various effect of COVID-19 in pregnancy. The Covid-19 pandemic can increase anxiety or schizophrenia exacerbation. Neonatal malformations from antipsychotic drugs exposures during first trimester of pregnancy have been reported. However, their effect near delivery have been less studied. Keywords: Covid-19, pregnancy, mental health, neonatal malformations

A document by Mina Kelleni, written on Authorea.

Objective: This study was conducted to determine healthcare professionals’ fear of COVID-19 in and their attitudes towards being vaccinated against COVID-19. Method: The sample of this descriptive study was composed of 302 healthcare professionals working in a university research and training hospital. The data were collected with the help of an online survey method created with the help of Google Forms using the “Form for Determining Healthcare Professionals’ Attitudes towards Being Vaccinated” and “The Fear of COVID-19 Scale” between December 28, 2020 and January 13, 2021. Results: The mean total Fear of COVID-19 Scale score of the healthcare professionals participating in the study was found to be 17.20 ± 6.015. A significant relationship was found between the Fear of COVID-19 Scale total score and participating healthcare professionals’ gender, status of education, status of flu vaccination and status of being diagnosed with COVID-19 (p <0.005). Conclusion: According to research results, it was found that healthcare professionals experienced moderate fear, almost half of them were undecided about the COVID-19 vaccine, their thoughts about vaccination were positive and they were mostly concerned about the side effects of the vaccine.

Objective: This study aims to investigate the mortality factors in hemodialysis patients and kidney transplant patients with COVID-19 patients. Method: The demographic, clinic, laboratory, and radiologic signs of the kidney transplant and hemodialysis patients diagnosed with COVID-19 between 11 March 2020-11 March 2021 were evaluated. Results: To this study, 72 hemodialysis (median age, 57.5 Q1-Q3:43-65; female:36/50%) and 58 kidney transplant (median age, 44.5 Q1-Q3:28.75-55.25; female:21/36.2%) were included. Fifteen HD patients (20.8%) died. To identify the independent predictors of in-hospital mortality, multivariable logistic regression analyses were performed using the variables in the univariate analyses including age, female gender, diabetes mellitus, ferritin, d-dimer, albumin, CRP, procalcitonin, dyspnea. Age (OR:1.12, 95% [CI]: 1.03-1.21, p=0.004), and dyspnea (OR: 9,7 95% CI 1.80-52.2, p=0.008) were found to be associated with in-hospital mortality. Nine (15.5%) of transplant patients died. The median time from the beginning of symptoms to the time of admission was 3 days (2-5). And this rate was 2 (2-3) and 5 (4-5.75) days, respectively, for patients followed up in our center and the external centers (p<0.001). Although an increase in CRP, ferritin, D-dimer levels, dyspnea, and bilateral involvement in CT images was statistically significant in the univariate analysis, no single factor was found to be related to mortality in multivariate analysis. Conclusion: Both HD and renal transplant patients should be followed closely. Early admission of HD and RT patients might be life-saving when suspected. Early inclusion of these patients into the vaccination program might reduce mortality. However, large-scale prospective randomized studies are needed.

Pulmonary artery and pulmonary valve sarcoma are malignant and very rare vascular tumors with aggressive clinical course and very poor outcomes. Patients affected by coronavirus disease of 2019 (COVID-19) are at higher risk for thromboembolism complication. we describe young woman with history of corona virus pneumonia and progressive dyspnea, hemodynamic disturbance, edema with initial evaluation and clinical diagnosis of pulmonary thromboembolism. But further imaging study and pathology demonstrated, Giant sarcoma of pulmonary valve, obstructing pulmonary valve and extending to right ventricular outflow tract and main of pulmonary artery.

The psychological impact of COVID-19 pandemic in patients with genetic diseases such as Tuberous sclerosis complex remains to be misunderstood. We report a case of a patient with Tuberous sclerosis who presented with hallucinations, delusions, and disorganized behavior. He developed psychotic symptoms directly triggered by stress derived from COVID-19 pandemic.

Impact of COVID-19 on Coronary Artery Surgery: Hard lessons learnedAuthor: Luis Alberto O. Dallan1; Luiz Augusto F. Lisboa1; Luis Roberto P. Dallan1; Fabio B. Jatene1.1 Department of Cardiovascular Surgery, Heart Institute from University of São Paulo Medical School (InCor), São Paulo, São Paulo, Brazil.Corresponding author:  Luis Alberto O. Dallan, Dr. Enéas de Carvalho Aguiar, 44, Postal Code:05403-900. Pinheiros, São Paulo, SP – Brazil. Phone: +55 (11) 2661-5014. E-mail: dcidallan@incor.usp.br.Since March 11th, 2020 when coronavirus disease 2019 (COVID-19) was declared a pandemia, hospitals had to be adapted quickly to increase the assistance capacity for a large part of the population that needed hospitalization for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (1,2). Major disruptions on routine hospital services have occurred, with health professionals needed to assume functions beyond their usual routines and beds were adapted for intensive care due to the increased demand in the treatment of severe acute respiratory failure. Cardiovascular surgery was particularly affected by the coronavirus outbreak, since most of the elective surgeries were canceled and ICU beds, normally dedicated to the postoperative period of cardiac surgery, were transferred to patients with COVID-19 (3-5).In this context, Kalil and Col.(6) examine the impact of the Covid-19 pandemic in the number of procedures and death rate of CABG performed in 2020 in Brazil. They analyzed patients undergoing CABG in the public health system between 2008 and 2020. The data were collected from DATASUS, the data processing system of the Brazilian Ministry of Health, which collects information from every patient who needs in-hospital care and was admitted to a public hospital. Patients operated on the private system were not captured in the database and were excluded from the analysis. The results showed that in 2020, during the pandemic period, there was an average reduction of 25% in the number of CABG performed in Brazil, with the majority of procedures (75%) being performed in the south and southeast regions of the country. Regarding postoperative mortality, they observed an opposite effect with an increase in mortality from 5.6% to 6.3% during this pandemic period (6).This study has some limitations due to results extracted from an administrative database, good for epidemiological analysis such as gender, age, number and type of surgeries performed. Considering the reduction in surgical volume during the pandemic period, surgical status was analyzed altogether (whether elective, or urgent or emergency CABG), expressing a general view of the situation.Brazil was the epicenter of the coronavirus outbreak in Latin America and other publications from Brazil showed different and more detailed results in relation to the pandemic period (7,8). One by Omar et al. (7) who used data from the São Paulo Registry of Cardiovascular Surgery (REPLICCAR), a multicenter registry, showed a 60% reduction in surgical CABG volume during COVID-19 pandemic. Regarding mortality, CABG surgeries had a 2.8-fold increased mortality risk (CI95%,1-7.6, P=0.041), patients who evolved with COVID-19 had a 11-fold increased mortality risk (CI95%, 2.2-54.9, P<0.003), rates of morbidities and readmission to the intensive care unit. (7), compared to 2019.In our own series at the Heart Institute University of Sao Paulo Medical School - Brazil, we observed a 65.8% reduction in cardiac surgery volume in 2020, during the pandemic period, and 2/3 of these were urgent or emergency procedures. Regarding the CABG in-hospital mortality, there was increased from 1.2% (2019) to 3.0% (2020) among elective procedures and from 4.5% (2019) para 18.2% (2020) among urgent or emergency procedures. Patients who had postoperative COVID-19, the in-hospital mortality rate was significantly higher (38.5%).Other publications reported a reduction in surgical volume of more than 70% during the peak disruption due to COVID-19 (9,10). Salenger et al. (11) reported that the volume of cardiac surgery fell to 54% of baseline after the restrictions were implemented and they also estimated a necessity of 2.5 times increase in numbers of procedures in post-COVID-19 era to restore balance to elective surgeries waiting lists. In the COVIDSurg collaborative, in a multi centric cohort of surgeries performed in 24 countries (235 hospitals), found that 75% of the procedures from 1 January and 31 March 2020, were non-elective and the mortality was 24%. Their cohort included 50 patients who underwent cardiac surgery and 30-day mortality was 34%, among the patients who had perioperative SARS-CoV-2 infection (12). Clinical studies have shown that in addition to severe acute respiratory distress syndrome, the coronavirus-2 infection also affects micro-circulation, has prothrombotic state and can cause myocardial injury, even in patients without coronary artery disease (13-14). This may be one of the reasons for the high mortality among patients who undergo surgery and present COVID-19 in the perioperative period, particularly in CABG surgery, where there is also a higher incidence of elderly, hypertensive and diabetic patients.While the COVID-19 pandemic continues to increase globally, measures to control SARS-CoV-2 infection and patient safety need to be established to maintain cardiovascular surgery, even if in small numbers. The consequences of delayed recognition of a patient with COVID-19 are significant. Protocols for triage, early diagnosis, isolation in specific areas and treatment of patients with COVID-19 with cardiovascular complications should be developed to minimize the risk of in-hospital transmission and greater safety for hospitalized patients without COVID-19 and healthcare professionals (15,16).A large number of operations were canceled or postponed due to interruptions caused by COVID-19. Coincidentally, our institution have reported an increased number of mechanical complications, that maybe related to decreased number of patients seeking for medical assistance (17).Studies conducted in the first months of the pandemic showed that if countries increased their normal surgical volume by 20%, it would take an average of 45 weeks to balance the backlog of operations resulting from the interruption of COVID-19 (18). Patients awaiting elective cardiac surgery need to be proactively managed, reprioritizing those with high-risk anatomy or whose clinical status is deteriorating. In this regard, governments must mitigate this heavy burden on patients by developing recovery plans and implementing strategies to safely restore surgical activity as soon as possible.

Objective: To explore the effect of anxiety, depression and hypertension on quality of life (QOL) of patients with gynecological tumor and the interaction among them, and the moderating effect of social support. Design: Cross-sectional design Setting: December 2019 to July 2020, the COVID-19 outbreak phase. Population or Sample: A total of 695 gynecological cancer patients were collected. Methods: The study used the Self-Rating Anxiety Scale (SAS), the Self-Rating Depression Scale (SDS), the Functional Assessment of Cancer Therapy Genera tool (FACT-G), and the Multidimensional Scale of Perceived Social Support Scale (MSPSS). Regression analysis and the simple slope analysis were conducted. Results: QOL of patients with anxiety and hypertension had seriously deteriorated [OR=10.297, 95%CI (5.647-18.775)]. And QOL of patients with depression and hypertension also had seriously deteriorated [OR=11.846, 95%CI (6.597-21.271)]. Calculated by crossover analysis, the synergy index, attributable proportion and relative excess risk due to interact of anxiety and hypertension were1.698,0.371 and 3.822, and the correlation index of interaction between depression and hypertension were 1.475, 0.295, and 3.493. The Social Support &Depression interaction term and Social Support &Anxiety interaction term were negatively correlated with QOL (p<0.01), and explained an extra 5.7% and 5.6% of the variance respectively (p<0.01). Conclusion: Anxiety, depression and hypertension have interaction on the QOL of patients with gynecological tumors. Social support can significantly moderate the relationship between depression, anxiety and QOL respectively. Funding: National Key R&D Program of China (Grant #2018YFC1311600). Keywords: quality of life, depression, anxiety, social support, hypertension, moderating effect

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic has had a variable worldwide impact, likely related to country-level characteristics. In this ecological study, we explored the association of COVID-19 case rates (per 100,000 people) and death rates (per 100,000 people) with country-level population health characteristics, economic and human development indicators, and habitat-related variables. Methods: To calculate country-level COVID-19 case and death rates, the number of cases and deaths were extracted from the Johns Hopkins Coronavirus Resource Center for 2020. Country-level population health characteristics, economic and human development indicators, and habitat-related variables were extracted from several publicly available online sources of international organizations. Results were tabulated according to world zones and country economies. Univariate and multivariable linear regression analyses were performed to examine determinants of COVID-19 case rates and death rates. Results: A total of 187 countries and territories were analyzed, with an aggregate COVID-19 case rate of 779 per 100,000 people, a death rate of 19 per 100,000 people, and a case-fatality rate of 2.4%. For country-level population health characteristics, a higher percentage rate of adults with obesity and a higher percentage rate of adults with high blood pressure was independently associated with a higher COVID-19 case rate, and a higher percentage rate of adults with obesity was associated with a higher COVID-19 death rate. For country-level economic and human development indicators, only a higher gross domestic product percentage rate spent on total health expenditure and a higher human development index was independently associated with a higher COVID-19 case rate and death rate. A higher percentage of urban population was independently associated with a higher COVID-19 death rate, whereas a higher income per capita was independently associated with a lower COVID-19 death rate. For country-level habitat-related variables, a higher average household size and a higher percentage rate of population with primary reliance on polluting fuels and technologies was independently associated with a lower COVID-19 case rate and death rate whereas a higher percentage rate of households with at least one-member age 65 years or over was associated with a higher case rate and death rates. Conclusion: This ecological study informs the need to develop country-specific public health interventions to better target populations at high risk for COVID-19, and test environmental interventions to prevent indoor transmission of SARS-CoV-2, taking into consideration population health characteristics, economic and human development indicators, and habitat-related variables that are unique to each country.

Seasonal epidemics of influenza and the respiratory syncytial virus are the cause of substantial morbidity and mortality among children. During the global COVID-19 pandemic, the epidemiology of these viruses seems to have changed dramatically. In Australia and New Zealand, a significant decrease in both influenza and bronchiolities have been noticed during usual peak seasons. Data from early months of winter seasons in Europe are showing similar trends. This current scenario imposes a reconsideration of the paradigm that toddlers and young schoolchildren are the main drivers of seasonal RSV outbreaks and respiratory epidemics in general. In this paper, we summarize current literature, address current knowledge or role of adults in the respiratory syncitial virus epidemiology, describe the lessons learned from pertussis epidemics and call the international community to better understand the community transmission dynamics of respiratory infections in all age-groups. This can allow the establishment of better and more affordable preventive measures in the whole population level, which can ultimately save millions of child lives.