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Abstract

Psychiatric disorders, and especially severe mental illness, are associated with an increased risk of severe acute respiratory syndrome coronavirus 2 infection and COVID-19-related morbidity and mortality. People with severe mental illness should therefore be prioritised in vaccine allocation strategies. Here, we discuss the risk for worse COVID-19 outcomes in this vulnerable group, the effect of severe mental illness and psychotropic medications on vaccination response, the attitudes of people with severe mental illness towards vaccination, and, the potential barriers to, and possible solutions for, an efficient vaccination programme in this population.

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... Furthermore, there is a group where VH data is particularly lacking: mental health patients. Recent studies [23,24,25] have shown that people experiencing severe mental health conditions are more likely to face longer hospitalizations due to COVID-19 and suffer worse outcomes and mortality rates, thus making it necessary to prioritize their vaccination and further explore VH in this group. ...
... Although VH has been widely explored in the general population and the development of the COVID-19 vaccine has been widely covered by the media, there have not been peer-reviewed studies exploring how the anti-vaccination movement affects people with severe mental illness, specifically those who experience persecutory delusions [24,25]. Recently, one study in the UK looked at the relationships of mental health diagnosis and symptoms of mental distress with VH in a general population sample and found no association [23]. ...
... This research gap is even more appalling since people with severe mental health disorders are at higher risk of being infected by SARS-CoV-2 and have increased COVID-19 associated mortality rates, as also previously mentioned [24,25,26]. Especially for a population group facing difficulties I n r e v i e w to access healthcare in general, we suggest that mental health practitioners should play a pivotal role in the understanding and addressing of their VH and uptake. ...
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Despite the speedy development of vaccines for COVID-19, their rollout has posed a major public health challenge, as vaccine hesitancy (VH) and refusal is high. Addressing vaccine hesitancy is a multifactorial and context-dependent challenge. This perspective focuses on VH in the world region of Latin America and the Caribbean (LAC) and includes people suffering from severe mental illness, therefore covering populations and subpopulations often neglected in scientific literature. We present an overview of VH in LAC countries, discussing its global and historical context. Vaccine uptake has shown to widely vary across different subregions of LAC. Current data points to a possible correlation between societal polarization and vaccination, especially in countries going through political crises such as Brazil, Colombia, and Venezuela. Poor accessibility remains an additional important factor decreasing vaccination rollout in LAC countries and even further, in the whole Global South. Regarding patients with severe mental illness in LAC, and worldwide, it is paramount to include them in priority groups for immunization and monitor their vaccination coverage through public health indicators.
... Importantly, several countries have already prioritized vaccination for people with severe mental illness [169,170]. The relationship between COVID-19 vaccination and mental disorders was investigated in several studies [171][172][173]. ...
... In addition, Russo et al. (1994) reported lower antibody responses to Hepatitis B vaccination in patients with schizophrenia, bipolar disorder, and depression [177]. According to the findings, which regarded other infectious agents, Mazereel et al. (2021) suggested that individuals with severe mental illness may have a reduced immune response to vaccination [171]. ...
... In addition, Russo et al. (1994) reported lower antibody responses to Hepatitis B vaccination in patients with schizophrenia, bipolar disorder, and depression [177]. According to the findings, which regarded other infectious agents, Mazereel et al. (2021) suggested that individuals with severe mental illness may have a reduced immune response to vaccination [171]. ...
Article
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In this review the authors discuss that COVID-19 has already had a direct impact on the physical health of many people and that it appears to have put at risk the mental health of large populations. In this review, we also discuss the relationship between mental disorders and the SARS-CoV-2 infection. We convey the disorders’ risk factors and the more serious mental disorder consequences of COVID-19. People with mental health disorders could be more susceptible to the emotional responses brought on by the COVID-19 epidemic. The COVID-19 pandemic may adversely influence the mental health of patients with already diagnosed mental disorders. For the aim of dealing better with the psychological problems of people afflicted by the COVID-19 pandemic, new psychological procedures are required.
... A Jewish business news source reported that 96% of patients administered an innovative drug (EXO-CD24) were cured [118]. Testing of this technology in the first clinical phase in humans showed that 29 out of 30 patients with moderate to severe disease were discharged from the hospital within 3-5 d. ...
... The protein helps to modulate the immune response and curb the lethal hyperreactivity of the immune system known as a cytokine storm. The administration of EXO-CD24 by direct aspiration into the lungs inhibited immune hyperreactivity resulting from cytokine amplification following SARS-CoV-2 infection [118]. Cytokine storms are a physiological reaction in humans, in which the innate immune system causes uncontrolled and excessive release of pro-inflammatory signaling molecules called cytokines. ...
... Cytokine storms are a physiological reaction in humans, in which the innate immune system causes uncontrolled and excessive release of pro-inflammatory signaling molecules called cytokines. EXO-CD24 is moving into further testing phases [118]. ...
Article
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The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which triggered the ongoing pandemic, was first discovered in China in late 2019. SARS-CoV-2 is a respiratory virus responsible for coronavirus disease 2019 (COVID-19) that often manifests as a pneumonic syndrome. In the context of the pandemic, there are mixed views on the data provided by epidemiologists and the information collected by hospital clinicians about their patients. In addition, the literature reports a large proportion of patients free of pneumonia vs a small percentage of patients with severe pneumonia among confirmed COVID-19 cases. This raises the issue of the complexity of the work required to control or contain the pandemic. We believe that an integrative and pluralistic approach will help to put the analyses into perspective and reinforce collaboration and creativity in the fight against this major scourge. This paper proposes a comprehensive and integrative approach to COVID-19 research, prevention, control, and treatment to better address the pandemic. Thus, this literature review applies a pluralistic approach to fight the pandemic.
... Patients with major psychiatric disorders including depression may have inadequate access to accurate information about COVID-19 vaccinations [63] due, in part, to symptoms of their disorder and impaired cognitive abilities [64]. In addition, some patients may be concerned about potential sideeffects of COVID-19 vaccines on their symptoms and medications [65], a concern that is somewhat founded because there have been no specific vaccine guidelines for people with severe mental illnesses including depression [65]. ...
... Patients with major psychiatric disorders including depression may have inadequate access to accurate information about COVID-19 vaccinations [63] due, in part, to symptoms of their disorder and impaired cognitive abilities [64]. In addition, some patients may be concerned about potential sideeffects of COVID-19 vaccines on their symptoms and medications [65], a concern that is somewhat founded because there have been no specific vaccine guidelines for people with severe mental illnesses including depression [65]. ...
Article
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Abstract The association between coronavirus disease (COVID-19) vaccine acceptance and perceived stigma of having a mental illness is not clear. This study examined the association between COVID-19 vaccine acceptance and perceived stigma among patients with recurrent depressive disorder (depression hereafter) using network analysis. Participants were 1149 depressed patients (842 men, 307 women) who completed survey measures of perceived stigma and COVID-19 vaccine attitudes. T-tests, chi-square tests, and Kruskal–Wallis tests were used to compare differences in demographic and clinical characteristics between depressed patients who indented to accepted vaccines and those who were hesitant. Hierarchical multiple regression analyses assessed the unique association between COVID-19 vaccine acceptance and perceived stigma, independent of depression severity. Network analysis examined item-level relations between COVID-19 vaccine acceptance and perceived stigma after controlling for depressive symptoms. Altogether, 617 depressed patients (53.7%, 95 confidence intervals (CI) %: 50.82–56.58%) reported they would accept future COVID-19 vaccination. Hierarchical multiple regression analyses indicated higher perceived stigma scores predicted lower levels of COVID-19 vaccination acceptance (β = −0.125, P
... Patients with MPD are highly susceptible to coronavirus disease 2019 and are also at increased risk for poor clinical outcomes [6,7], primarily due to MPD-associated disorders of immune function [8][9][10][11][12], kynurenine pathway activity [13], C-reactive protein levels [14], endocrine homeostasis, and host microbiosis [15]. Consequently, COVID-19 immunization is essential to protect patients with MDP [16][17][18][19][20][21]. The World Health Organization, the US National Academies of Sciences, the American Psychological Association, the World Psychiatric Association, and other psychiatric and public health authorities urge that individuals with MDP be given priority for COVID-19 vaccination [16][17][18][19][20][21]. ...
... Consequently, COVID-19 immunization is essential to protect patients with MDP [16][17][18][19][20][21]. The World Health Organization, the US National Academies of Sciences, the American Psychological Association, the World Psychiatric Association, and other psychiatric and public health authorities urge that individuals with MDP be given priority for COVID-19 vaccination [16][17][18][19][20][21]. ...
Article
Patients with major psychiatric disorders (MPD) that include schizophrenia (SCH), bipolar disorder (BP), and major depressive disorder (MDD) are at increased risk for coronavirus disease 2019 (COVID-19). However, the safety and efficacy of COVID-19 vaccines in MPD patients have not been fully evaluated. This study aimed to investigate adverse events (AEs)/side effects and efficacy of COVID-19 vaccines in MPD patients. This retrospective study included 2034 patients with SCH, BP, or MDD who voluntarily received either BBIBP-CorV or Sinovac COVID-19 vaccines, and 2034 matched healthy controls. The incidence of AEs/side effects and the efficacy of COIVD-19 vaccinations among the two groups were compared. The risk ratio (RR) of side effects in patients with MPD was 0.60 (95% confidence interval [CI]: 0.53-0.68) after the first dose and 0.80 (95% CI: 0.65-0.99) following the second dose, suggesting a significantly lower risk in the MPD group versus healthy controls. The RRs of AEs did not differ between patients and controls. Notably, fully vaccinated patients exhibited a decreased risk of influenza with or without fever compared with controls (RR=0.38, 95% CI: 0.31-0.46; RR=0.23, 95% CI: 0.17-0.30; respectively). Further subgroup comparisons revealed a significantly lower risk of influenza with fever in MDD (RR=0.13, 95% CI: 0.08-0.21) and SCH (RR=0.24, 95% CI: 0.17-0.34) than BP (RR=0.85, 95% CI: 0.69-1.06) compared to controls. We conclude that the benefit-risk ratio of COVID-19 vaccination was more favorable in SCH or MDD versus BP when compared with controls. These data indicate that COVID-19 vaccines are safe and protective in patients with MPD from COVID-19.
... In the initial COVID-19 vaccination campaign in 2021, in some countries like Denmark, the Netherlands, the UK, and Germany populations with severe mental illness were prioritized for vaccination [9] but it remained unclear to what degree at-risk groups with mental illness were reached by vaccination campaigns in every-day routine health-care practice. Studies on vaccination rates of populations with mental illness in comparison to the general population showed heterogenous results: In some studies vaccination rates were comparable to or better than the general population [10][11][12][13] but in others people with mental illness showed much lower vaccination rates [14][15][16][17]. A common factor for vaccination rates similar to the general population seemed to be vaccination offerings by mental health institutions [10][11][12]. ...
... Studies on vaccination rates of populations with mental illness in comparison to the general population showed heterogenous results: In some studies vaccination rates were comparable to or better than the general population [10][11][12][13] but in others people with mental illness showed much lower vaccination rates [14][15][16][17]. A common factor for vaccination rates similar to the general population seemed to be vaccination offerings by mental health institutions [10][11][12]. This corresponds to studies on reasons for nonvaccination that did not show a general vaccine hesitancy among people with mental illness but were organizational access issues appeared to be the most relevant factors [15,[17][18][19]. ...
Article
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Background: Mental illness is known to come along with a large mortality gap compared to thegeneral population and it is a risk for COVID-19 related morbidity andmortality. Achieving high vaccination rates in people with mental illness is therefore important. Reports are conflicting on whether vaccination rates comparable to those of the general population can be achieved and which variables represent risk factors for nonvaccination in people with mental illness. Methods: The COVID Ψ Vac study collected routine data on vaccination status, diagnostic groups, sociodemographics, and setting characteristics from in- and day-clinic patients of 10 psychiatric hospitals in Germany in August 2021. Logistic regression modeling was used to determine risk factors for nonvaccination. Results: Complete vaccination rates were 59% (n = 776) for the hospitalized patients with mental illness versus 64% for the regionally and age-matched general population. Partial vaccination rates were 68% (n = 893) for the hospitalised patients with mental illness versus 67% for the respective general population and six percentage (n = 74) of this hospitalized population were vaccinated during the hospital stay. Rates showed a large variation between hospital sites. An ICD-10 group F1, F2, or F4 main diagnosis, younger age, and coercive accommodation were further risk factors for nonvaccination in the model. Conclusions: Vaccination rates were lower in hospitalized people with mental illness than in the general population. By targeting at-risk groups with low-threshold vaccination programs in all health institutions they get in contact with, vaccination rates comparable to those in the general population can be achieved.
... Concerns regarding safety are twofold: firstly, the c/s/x/m communities fear being doubly disabled by one of the many impairing side-effects coming to light: such as heart inflammation or paralysis (Public Health Ontario 2022). Secondly, more research is direly needed on the possible interaction between psych-meds and COVID vaccines so that the 'mentally ill' can make an educated and voluntary choice (informed consent) (Mazereel et al. 2021). Consumers/survivors and mad people may rely on psychiatric prescriptions for staying well, and taking a pill is routinized into their recovery plan. ...
... It is essential to feel confident that immunization will not throw any wellness plans into chaos. Without this critical information, the community cannot objectively weigh the health risks and benefits of taking a vaccine (Mazereel et al. 2021). A legal argument could be made to refuse the vaccine on the basis of not being able to give informed consent under section 11(2)(2) of the Health Care Consent Act (HCCA)) (1996), specifically section (3) because the material risks of vaccinations are unknown to them. ...
Article
Protecting the Section 7 autonomy rights of Canadian consumers/survivors/ex-patients and the mad (c/s/x/m), as enshrined in the Canadian Charter of Rights and Freedoms, with past experiences of enduring intrusive procedures forced upon them, to decline immunization against COVID-19 is a mad liberation issue, to which Mad Studies must not shut its eyes. To some c/s/x/m, vaccine mandates mirror traumatic moments from their psychiatric past, when they had their autonomy stripped, and their right to legal consent infringed upon by physicians of the mind claiming diminished capacity. In this article, I propose expanding categories of medical exemptions to consider mental health contexts, and accommodations be provided to those with diverging minds who are vaccine skeptic. I conclude with a clarion call to madvocates to stand against the violence of coercing vaccinations.
... Mental health problems, such as perceived stress and depression, are prevalent during the COVID-19 pandemic (Aristovnik et al., 2020;Abu Kwaik et al., 2021), which may have negative impacts on attitudes toward COVID-19 vaccination or intention toward vaccination (Mazereel et al., 2021). People with a poor mental health status may hold more pessimistic attitudes toward the vaccine and are less willing to get vaccinated. ...
... People with a poor mental health status may hold more pessimistic attitudes toward the vaccine and are less willing to get vaccinated. This may be because they are less likely to have self-efficacy in relation to health behaviors, and more likely to experience hopelessness and distress during the pandemic and adopt avoidance coping strategies instead of actively protecting themselves from being infected (Mazereel et al., 2021). Very limited studies have examined the associations between mental health status and attitudes toward the vaccine or intention toward vaccination against COVID-19, and the existing studies have reported inconsistent results. ...
Article
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PurposeThe present study examined whether and how attitudes toward the COVID-19 vaccine (i.e., safety, efficacy, and price), mental health statuses (i.e., perceived stress and depression), and interpersonal factors (i.e., online social support, perceived social support) would predict COVID-19 vaccine hesitancy.Patients and methodsThe two-wave longitudinal surveys were conducted in December 2019 and 2020 in Chinese medical college students (N = 194). Well- validated measures were used, including the Perceived Stress Scale, the Center for Epidemiologic Studies Depression Scale, the Online Social Support Questionnaire, and the Perceived Social Support Scale. Perceived safety, efficacy, price of COVID-19 vaccine, vaccine hesitancy, and actual intake were also measured.ResultsOnly 2.1% of participants had been vaccinated against COVID-19 in the early stages of the pandemic; 13.4% intended to get vaccinated in the next 3 months, and 66% intended to have it in the next 12 months upon follow-up. Multiple regression analyses revealed that perceived stress (βm = −0.15, p < 0.05) and depression (βm = −0.15, p < 0.05) were risk factors for positive attitudes toward the COVID-19 vaccine; online social support (ORm = 1.41, p < 0.01) and positive attitudes toward the COVID-19 vaccine (ORm = 1.83, p < 0.01) were protective factors of intention to get vaccinated in future.Conclusion Findings suggest that intervention efforts should be made to reduce negative attitudes toward the COVID-19 vaccine among people with poor mental health and enhance online social support to promote COVID-19 vaccination.
... Because this population has multiple disadvantages and elevated health risk factors [28], and they are less able and hence less likely to engage in social distancing, they remain more susceptible to contracting the COVID-19 virus and suffer overall higher rates of ensuing morbidity and mortality [28][29][30]. Unfortunately, in addition to lower rates of social distancing, vaccination rates also remain low in economically disadvantaged ethnic minority populations, particularly among those with diagnosed psychiatric disorders [31][32][33][34][35]. ...
... Multiple recent studies have documented that ethnic minorities with psychiatric disorders are at an increased risk of COVID-19 [1][2][3][4]. Individuals with mental illness should therefore be prioritized in risk reduction and promoting vaccine strategies [30,53]. However, the potential of mental health professionals and agencies to address barriers to COVID-19 vaccination among mentally challenged patients has received inadequate attention [54]. ...
Article
Background: Underserved ethnic minorities with psychiatric disorders are at an increased risk of COVID-19. This study aims to examine the effectiveness of one-to-one counseling on COVID-19 vaccination and vaccination readiness among underserved African American and Latinx individuals with mental illnesses and adult caregivers of children with mental illness. Methods: Through an academic-community partnered collaboration, a multidisciplinary and culturally sensitive training on COVID-19 was co-developed and delivered to 68 therapists from January to March 2021. Mental health clients and their caregivers were recruited to participate in pre- and post-intervention surveys to evaluate the impact of the intervention on their perceptions of COVID-19 public health guidelines, testing, and vaccination. Mental health therapists delivered four lessons of the COVID-19 educational intervention with 254 clients from March to June 2021, when vaccine availability was widely available. Of those clients, we collected 180 baseline and 115 follow-up surveys. The main outcome was the uptake in COVID-19 vaccine. Results: There was a positive shift in participant vaccine acceptance and receptivity. Pre-intervention survey shows that only 56% of adult clients and 48% of caregivers had indicated a likelihood of getting the vaccine for themselves at baseline. Post-intervention documented that more than 57% of each group had been vaccinated, with another 11-15% of the unvaccinated individuals reporting that they were somewhat or very likely to get the vaccine. Conclusion: This study demonstrated that multidisciplinary academic-community and theoretical-based educational intervention delivered by mental health therapists is an effective strategy in increasing COVID-19 vaccine acceptance and reducing the negative impact and disruption that COVID-19 caused in the daily life of mental health patients and caregivers.
... Several factors may be associated with the increased risk for SARS-CoV-2 breakthrough infection among individuals with psychiatric disorders. First, studies have demonstrated impaired immune function and poor response to vaccines among individuals with psychiatric disorders, [7][8][9][10] raising the possibility of reduced immunity after vaccination against SARS-CoV-2 in this group. 2,11,12 Second, emerging data indicate that individuals with psychiatric disorders may engage in more risky behaviors for contracting SARS-CoV-2, 13 which in turn may play a key role in determining risk for COVID-19, even after vaccination. ...
... Across younger and older patients, diagnoses of adjustment disorder and substance use disorders were most strongly associated with an increased incidence Our data indicate that an increased incidence of breakthrough infection among individuals with psychiatric disorders was not entirely explained by sociodemographic factors, vaccine type or timing, medical comorbidities, obesity, or smoking and that psychiatric conditions may be a risk factor for an increased incidence of breakthrough infection independent of these other factors. Psychiatric disorders (eg, depression, schizophrenia, and bipolar disorders) have been associated with impaired cellular immunity 10 and blunted responses to vaccines 8,9 ; therefore, it is possible that individuals with psychiatric disorders are exhibiting poorer responses to COVID-19 vaccination as well. Evidence has suggested that waning immunity and decrease in vaccine effectiveness against novel variants were associated with breakthrough infections, which is shown in the data on reduced antibody levels over time after vaccination 26 and lower vaccine effectiveness against new variants. ...
Article
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Importance: Psychiatric disorders may be associated with an increased risk for SARS-CoV-2 breakthrough infection after vaccination, but no studies have tested this hypothesis. Objective: To evaluate whether past diagnoses of psychiatric disorders are associated with an increased incidence of SARS-CoV-2 breakthrough infection among fully vaccinated individuals. Design, setting, and participants: This retrospective cohort study included data from the administrative and electronic health records of US Department of Veterans Affairs (VA) patients from February 20, 2020, to November 16, 2021. Participants included 263 697 patients who accessed VA health care during the study period, had at least 1 SARS-CoV-2 test recorded in the electronic health record, had no record of SARS-CoV-2 infection prior to vaccination, and had completed a full SARS-CoV-2 vaccination regimen 14 days or more prior. Exposures: Psychiatric disorder diagnoses in the past 5 years, including depressive, posttraumatic stress, anxiety, adjustment, alcohol use, substance use, bipolar, psychotic, attention-deficit/hyperactivity, dissociative, and eating disorders. Main outcomes and measures: SARS-CoV-2 breakthrough infections, defined as positive SARS-CoV-2 tests, among fully vaccinated individuals. Results: Of 263 697 fully vaccinated VA patients (239 539 men [90.8%]; mean [SD] age, 66.2 [13.8] years), 135 481 (51.4%) had at least 1 psychiatric disorder diagnosis, and 39 109 (14.8%) developed a breakthrough infection. A diagnosis of any psychiatric disorder was associated with increased incidence of breakthrough infection, both in models adjusted for potential confounders (adjusted relative risk [aRR], 1.07; 95% CI, 1.05-1.09) and additionally adjusted for medical comorbidities and smoking (aRR, 1.03; 95% CI, 1.01-1.05). Most specific psychiatric disorder diagnoses were associated with an increased incidence of breakthrough infection, with the highest relative risk observed for adjustment disorder (aRR, 1.13; 95% CI, 1.10-1.16) and substance use disorders (aRR, 1.16; 95% CI, 1.12-1.21) in fully adjusted models. Stratifying the sample at 65 years of age revealed that associations between psychiatric diagnoses and incident breakthrough infection were present in both age groups but were stronger and robust to adjustment for medical comorbidities and smoking among older patients. Conclusions and relevance: This cohort study suggests that psychiatric disorder diagnoses were associated with an increased incidence of SARS-CoV-2 breakthrough infection among VA patients, with the strongest associations observed for older individuals. Individuals with psychiatric disorders may be at heightened risk for contracting COVID-19 even after vaccination, suggesting the need for targeted prevention efforts.
... This was especially the case for severe mental health illnesses such as schizophrenia spectrum disorders. Consequently, individuals with schizophrenia should be prioritized in vaccine allocation strategies [2]. However, several important barriers could negatively affect the uptake of a COVID-19 vaccine in this population, including impaired decisionmaking capacity. ...
... It is important that healthcare professionals understand the risks and benefits of COVID-19 vaccination for people with schizophrenia, so that they can support them in reaching an informed decision. Indeed, in the end, it should be left to the individual to weigh the benefits and the risks, and to give informed consent for vaccination, even in individuals with severe mental disorders [2]. ...
Article
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Recent evidence suggests that people with schizophrenia are at high risk for severe COVID-19 and should be prioritized for vaccination. However, impaired decision-making capacities could negatively affect the uptake of COVID-19 vaccination in this population. Capacity to consent to COVID-19 vaccination was assessed in 80 outpatients with schizophrenia. Using the MacArthur Competence Assessment Tool for Treatment, 56.3% of the sample were classified as having diminished capacity to consent to the vaccination. Diminished capacity to consent to COVID-19 vaccination was associated with lower vaccination rates, poorer cognition and higher level of psychotic symptoms. Developing interventions for enhancing informed consent for vaccination is urgent within this population.
... In these people, taking the vaccine can cause anaphylaxis, polyethylene glycol allergy, and polysorbate allergy [18]. COVID-19 vaccine impacts immunocompetent patients, cancer patients, transplant recipients, human immunodeficiency virus patients, and those receiving immunomodulatory therapy for autoimmune disorders, such as rheumatoid arthritis and myasthenia gravis, multiple sclerosis, and others due to impaired immune response [19]. Cancer patients and solid-organ transplant recipients may be more liable to severe COVID-19 disease, which means if such people are infected with COVID-19, they can suffer from severe complications. ...
... People who reported mental health illnesses (depression, chronic stress, schizophrenia, bipolar disorder, etc.) had lower antibody levels in multivariable models. This association can be attributed to specific diagnoses, medications, and other underlying characteristics of those people (37,44). On the other hand, patient reporting of side effects when taking medications may be influenced by a number of factors: the patient's expectations of adverse effects at the start of treatment, a conditioning process in which the patient learns from previous experiences and associates taking medication with somatic symptoms, certain psychological characteristics such as anxiety, depression, and the tendency to somatise, and circumstantial and contextual factors (45). ...
Article
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Background: Data on the incidence rate and risk factors of covid-19 booster adverse reactions are critical to success vaccination programs. Objective: To describing the incidence rates and risk factors for covid-19 booster adverse reactions in general medicine. Methodology: An observational, longitudinal and prospective study of patients who self-report covid-19 booster adverse reactions as a reason for visiting in a general medicine office in Toledo (Spain) was carried out from December 1, 2021-September, 1 2022. Results: Statistically significant factors found for the covid-19 booster adverse reactions were: 1) Protective factors: age > = 65 years, complex family, chronic diseases of circulatory system, and vaccine booster with Comirnaty, Pfizer / BioNTech); And 2) Risk factors: age 14-64 years, presence of chronic diseases, chronic diseases of genitourinary, and vaccine booster with Moderna mRNA-1273. The incidence rates of covid-19 booster adverse reactions were: 2% >=14 years, 0.3% >= 65 years, 3% in women, 1.5% in men, 1% in Comirnaty (Pfizer / BioNTech), and 3 % in Moderna mRNA-1273. Conclusions: In the context of general medicine in Toledo (Spain), for the period December 1, 2021-September, 1 2022, the incidence rates of covid-19 booster adverse reactions was low, especially in >= 65 years and men. Risk factors focus on women aged 16-64 years, with chronic diseases, and vaccine booster with Moderna mRNA-1273. The risk estimates clearly favour vaccination. However, the small number of cases limits the conclusions that can be drawn.
... In particular, hospitalized schizophrenia patients are at high risk for acquiring and transmitting COVID-19 (Benson et al., 2020;Li, 2020;Zhu et al., 2020). A consensus view is that people with schizophrenia should be prioritized for the COVID-19 vaccine Mazereel et al., 2021;Siva, 2021). Nevertheless, schizophrenia patients are known to be less likely to make a vaccination decision (Arumuham et al., 2022;Raffard et al., 2022;Samaali et al., 2022;Tzur Bitan, 2021). ...
Article
This study aimed to examine the impact of COVID-19 vaccination on the psychiatric symptoms of hospitalized schizophrenia patients and to evaluate the association between the severity of psychiatric symptoms and the COVID-19 vaccination decision. We assessed the psychiatric symptoms of 330 hospitalized schizophrenia patients who accepted the vaccine and 114 patients who declined the vaccine option with PANSS before and after vaccination. We showed that the unwillingness to receive the vaccine is correlated with a higher level of psychiatric symptoms. COVID-19 vaccination is associated with slight deterioration of the schizophrenia symptoms of elderly hospitalized patients.
... People with mental illnesses have been identified as an at-risk group for excess morbidity and mortality from COVID-19, and there have been numerous calls for a focus on vaccination in this group, given that they have historically had lower vaccine uptake than the general population. [1][2][3] As COVID-19 vaccinations have been rolled out globally, a gap in vaccination rates has been identified between the general population and the mental health patient population. 4 Factors contributing to this gap may include a decreased ability to understand or engage with public health measures, decreased access to vaccination services, transiency, cost, and mistrust of vaccines or government authorities. ...
Article
Objective To assess the COVID-19 vaccination rates of a severe mental illness (SMI) population in Western Australia (WA) in January to March 2022, and to evaluate an inpatient COVID-19 vaccination program available to this group. Method A retrospective audit of the COVID-19 vaccination status of inpatients at the Mental Health Unit (MHU) at a tertiary hospital in WA was conducted and compared with the state average. Additionally, the medical records were interrogated to determine whether eligible inpatients were offered and received COVID-19 vaccination via the inpatient vaccination program. Results Vaccination rates for the MHU population were substantially lower than those for the WA population, particularly earlier in 2022. During January, just 49.0% of admitted patients had received two doses of the vaccine, compared to 92.8% of WA. Over the three months, 67 (47.2%) of all admissions were eligible for vaccination during their admission and 19 of the eligible patients (28.4%) were successfully vaccinated. Conclusion This audit has demonstrated a slow uptake of COVID-19 vaccinations in the SMI population, despite the wide availability for 12 months prior to this period. This indicates a significant potential for targeted, assertive programs to improve vaccination rates in this population group.
... Seon et al. confirms that there is an association between SARS-CoV-2 and COVID-19 infection and the risk of death in patients with mental illness [50]. A study shows high morbidity and mortality associated with SARS-CoV-2 and COVID-19 in people with severe mental illness [51]. Shen et al. found that pneumonia was more likely to occur in older men with more severe organ damage due to hypertension, and pneumonia and LC were highly associated with mortality in urban hypertensive men [52]. ...
Article
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The ongoing pandemic of coronavirus disease 2019 (COVID-19) has a huge influence on global public health and the economy. Lung cancer is one of the high-risk factors of COVID-19, but the molecular mechanism of lung cancer and COVID-19 is still unclear, and further research is needed. Therefore, we used the transcriptome information of the public database and adopted bioinformatics methods to identify the common pathways and molecular biomarkers of lung cancer and COVID-19 to further understand the connection between them. The two RNA-seq data sets in this study—GSE147507 (COVID-19) and GSE33532 (lung cancer)—were both derived from the Gene Expression Omnibus (GEO) database and identified differentially expressed genes (DEGs) for lung cancer and COVID-19 patients. We conducted Gene Ontology (GO) functions and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways enrichment analysis and found some common features between lung cancer and COVID-19. We also performed TFs-gene, miRNAs-gene, and gene-drug analyses. In total, 32 DEGs were found. A protein-protein interaction (PPI) network was constructed by DEGs, and 10 hub genes were screened. Finally, the identified drugs may be helpful for COVID-19 treatment.
... Tocilizumab is an effective treatment for COVID-19 in patients with evidence of hypoxia and inflammation 79 . Another strategy for combatting the global COVID-19 pandemic is to develop and produce COVID-19 vaccines 80 . Vaccination will be a key strategy for limiting the spread of SARS-CoV-2, reducing mortality, and controlling the COVID-19 pandemic 81,82 . ...
Article
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Coronavirus disease 2019 (COVID-19) poses a serious threat to human health and life. The effective prevention and treatment of COVID-19 complications have become crucial to saving patients’ lives. During the phase of mass spread of the epidemic, a large number of patients with pulmonary fibrosis and lung cancers were inevitably infected with the SARS-CoV-2 virus. Lung cancers have the highest tumor morbidity and mortality rates worldwide, and pulmonary fibrosis itself is one of the complications of COVID-19. Idiopathic lung fibrosis (IPF) and various lung cancers (primary and metastatic) become risk factors for complications of COVID-19 and significantly increase mortality in patients. Therefore, we applied bioinformatics and systems biology approaches to identify molecular biomarkers and common pathways in COVID-19, IPF, colorectal cancer (CRC) lung metastasis, SCLC and NSCLC. We identified 79 DEGs between COVID-19, IPF, CRC lung metastasis, SCLC and NSCLC. Meanwhile, based on the transcriptome features of DSigDB and common DEGs, we identified 10 drug candidates. In this study, 79 DEGs are the common core genes of the 5 diseases. The 10 drugs were found to have positive effects in treating COVID-19 and lung cancer, potentially reducing the risk of pulmonary fibrosis.
... 61 What is more, it is relatively easy to verify if someone belongs to those groups. 62 Despite that, only in five countries (Austria, Denmark, Italy, Latvia, and Malta) 63 people with comorbidities associated with extremely high risk of severe COVID-19 were prioritized in earlier phases than those between 65 and 70 years of age. In the next section, we will analyze an additional prioritarian argument stating that some groups vulnerable to COVID-19 in terms of high IFR are worse off since they are less likely to even reach senior age because of their health status. ...
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With the limited initial availability of COVID-19 vaccines in the first months of 2021, decision makers had to determine the order in which different groups were prioritised. Our aim was to find out what normative approaches to the allocation of scarce preventive resources were embedded in the national COVID-19 vaccination schedules. We systematically reviewed and compared COVID-19 vaccination prioritisation regulations in 29 countries: 27 members of the European Union, the United Kingdom, and Israel. We differentiated between two main types of priority categories: groups that have increased an infection fatality rate (IFR) compared to the average for the general population and groups chosen because their members experience increased risk of being infected (ROI). Our main findings show a clear trend: all researched schedules prioritised criteria referring to individual IFR (in particular being over 65 years old and coexisting health conditions) over the ROI criteria (e.g. occupation and housing conditions). This is surprising since, in the context of treatment, it is rather common and justifiable to adopt very different allocation principles (e.g., introducing a saving more life-years approach or prioritising younger patients). We discuss how utilitarian, prioritarian, and egalitarian principles can be applied to interpret these normative differences between the allocation of curative and preventive interventions.
... This is an area of further research because associations may be attributable to specific diagnoses, medications, and other underlying characteristics of those people such as sleep disturbances. Nonetheless, mental illness is associated with altered immune function and evidence shows a reduced immune response to vaccination for people with depression, chronic stress, schizophrenia, bipolar disorder, etc. [40]. Interestingly, people with cardiovascular disease mounted higher IgA and IgG responses after vaccination. ...
Article
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Background Heterogeneity of the population in relation to infection, COVID-19 vaccination, and host characteristics is likely reflected in the underlying SARS-CoV-2 antibody responses. Methods We measured IgM, IgA, and IgG levels against SARS-CoV-2 spike and nucleocapsid antigens in 1076 adults of a cohort study in Catalonia between June and November 2020 and a second time between May and July 2021. Questionnaire data and electronic health records on vaccination and COVID-19 testing were available in both periods. Data on several lifestyle, health-related, and sociodemographic characteristics were also available. Results Antibody seroreversion occurred in 35.8% of the 64 participants non-vaccinated and infected almost a year ago and was related to asymptomatic infection, age above 60 years, and smoking. Moreover, the analysis on kinetics revealed that among all responses, IgG RBD, IgA RBD, and IgG S2 decreased less within 1 year after infection. Among vaccinated, 2.1% did not present antibodies at the time of testing and approximately 1% had breakthrough infections post-vaccination. In the post-vaccination era, IgM responses and those against nucleoprotein were much less prevalent. In previously infected individuals, vaccination boosted the immune response and there was a slight but statistically significant increase in responses after a 2nd compared to the 1st dose. Infected vaccinated participants had superior antibody levels across time compared to naïve-vaccinated people. mRNA vaccines and, particularly the Spikevax, induced higher antibodies after 1st and 2nd doses compared to Vaxzevria or Janssen COVID-19 vaccines. In multivariable regression analyses, antibody responses after vaccination were predicted by the type of vaccine, infection age, sex, smoking, and mental and cardiovascular diseases. Conclusions Our data support that infected people would benefit from vaccination. Results also indicate that hybrid immunity results in superior antibody responses and infection-naïve people would need a booster dose earlier than previously infected people. Mental diseases are associated with less efficient responses to vaccination.
... In 2021, the Centers for Disease Control and Prevention prioritized vaccination for mentally ill individuals as psychiatric illness was added to the list of COVID-19 risk factors (Mazereel et al., 2021). Currently, there are very few studies on mRNA vaccine efficacy in patients with SPI in treatment with psychotropic drugs. ...
Article
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The messenger RNA (mRNA) vaccines for COVID-19, Pfizer-BioNTech and Moderna, were authorized in the US on an emergency basis in December of 2020. The rapid distribution of these therapeutics around the country and the world led to millions of people being vaccinated in a short time span, an action that decreased hospitalization and death but also heightened the concerns about adverse effects and drug-vaccine interactions. The COVID-19 mRNA vaccines are of particular interest as they form the vanguard of a range of other mRNA therapeutics that are currently in the development pipeline, focusing both on infectious diseases as well as oncological applications. The Vaccine Adverse Event Reporting System (VAERS) has gained additional attention during the COVID-19 pandemic, specifically regarding the rollout of mRNA therapeutics. However, for VAERS, absence of a reporting platform for drug-vaccine interactions left these events poorly defined. For example, chemotherapy, anticonvulsants, and antimalarials were documented to interfere with the mRNA vaccines, but much less is known about the other drugs that could interact with these therapeutics, causing adverse events or decreased efficacy. In addition, SARS-CoV-2 exploitation of host cytochrome P450 enzymes, reported in COVID-19 critical illness, highlights viral interference with drug metabolism. For example, patients with severe psychiatric illness (SPI) in treatment with clozapine often displayed elevated drug levels, emphasizing drug-vaccine interaction.
... Concerns have led to calls for people with schizophrenia and certain other severe mental illnesses to be prioritized for access to vaccinations 15 ; advice which has been followed by several countries, including the United Kingdom. 16 However, given the combination of biopsychosocial factors that may affect vaccine uptake and immune response among people with mental illness, 17,18 evidence is still needed to demonstrate whether these disparities in COVID-19 mortality risks still persist following vaccination. In England, the NHS started administering COVID-19 vaccinations on December 8, 2020, with people with SMI prioritized for vaccination alongside people aged 70 years and over on advice from an independent expert advisory committee. ...
Article
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Background and Hypothesis Previous studies show that people with severe mental illness (SMI) are at higher risk of COVID-19 mortality, however limited evidence exists regarding risk postvaccination. We investigated COVID-19 mortality among people with schizophrenia and other SMIs before, during and after the UK vaccine roll-out. Study Design Using the Greater Manchester (GM) Care Record to access routinely collected health data linked with death records, we plotted COVID-19 mortality rates over time in GM residents with schizophrenia/psychosis, bipolar disorder (BD), and/or recurrent major depressive disorder (MDD) from February 2020 to September 2021. Multivariable logistic regression was used to compare mortality risk (risk ratios; RRs) between people with SMI (N = 193 435) and age–sex matched controls (N = 773 734), adjusted for sociodemographic factors, preexisting comorbidities, and vaccination status. Study Results Mortality risks were significantly higher among people with SMI compared with matched controls, particularly among people with schizophrenia/psychosis (RR 3.18, CI 2.94–3.44) and/or BD (RR 2.69, CI 2.16–3.34). In adjusted models, the relative risk of COVID-19 mortality decreased, though remained significantly higher than matched controls for people with schizophrenia (RR 1.61, CI 1.45–1.79) and BD (RR 1.92, CI 1.47–2.50), but not recurrent MDD (RR 1.08, CI 0.99–1.17). People with SMI continued to show higher mortality rate ratios relative to controls throughout 2021, during vaccination roll-out. Conclusions People with SMI, notably schizophrenia and BD, were at greater risk of COVID-19 mortality compared to matched controls. Despite population vaccination efforts that have prioritized people with SMI, disparities still remain in COVID-19 mortality for people with SMI.
... In 2021, the Centers for Disease Control and Prevention prioritized vaccination for mentally ill individuals as psychiatric illness was added to the list of COVID-19 risk factors (9). Currently, there are very few studies on mRNA vaccine efficacy in patients with severe psychiatric illness (SPI) in treatment with psychotropic drugs. ...
Preprint
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Journal website link: www.frontiersin.org
... [11][12][13] In a systematic review of people experiencing homelessness, increased risk of SARS-CoV-2 infection, morbidity and mortality has been suggested, but the literature is scarce. 14 However, the importance of preventing infections in marginalised sub-groups has been claimed, [15][16][17] and vaccination against COVID-19 has in some countries, e.g. in Denmark and the UK, been prioritised also for people with severe mental disorders, 15,18 and people experiencing homelessness. 7 COVID-19 outbreaks have been reported in shelters for homeless people, 14,19 but representative data on individuals experiencing homelessness, imprisonment, supported psychiatric housing, and substance abuse is lacking. ...
Article
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Background: Knowledge of the adverse problems related to SARS-CoV-2 infection in marginalised and deprived groups may help to prioritise more preventive efforts in these groups. We examined adverse outcomes associated with SARS-CoV-2 infection among vulnerable segments of society. Methods: Using health and administrative registers, a population-based cohort study of 4.4 million Danes aged at least 15 years from 27 February 2020 to 15 October 2021 was performed. People with 1) low educational level, 2) homelessness, 3) imprisonment, 4) substance abuse, 5) supported psychiatric housing, 6) psychiatric admission, and 7) severe mental illness were main exposure groups. Chronic medical conditions were included for comparison. COVID-19-related outcomes were: 1) hospitalisation, 2) intensive care, 3) 60-day mortality, and 4) overall mortality. PCR-confirmed SARS-CoV-2 infection and PCR-testing were also studied. Poisson regression analysis was used to compute adjusted incidence and mortality rate ratios (IRRs, MRRs). Findings: Using health and administrative registers, we performed a population-based cohort study of 4,412,382 individuals (mean age 48 years; 51% females). In all, 257,450 (5·8%) individuals had a PCR-confirmed SARS-CoV-2 infection. After adjustment for age, calendar time, and sex, we found that especially people experiencing homelessness had high risk of hospitalisation (IRR 4·36, 95% CI, 3·09-6·14), intensive care (IRR 3·12, 95% CI 1·29-7·52), and death (MRR 8·17, 95% CI, 3·66-18·25) compared with people without such experiences, but increased risk was found for all studied groups. Furthermore, after full adjustment, including for status of vaccination against SARS-CoV-2 infection, individuals with experiences of homelessness and a PCR-confirmed SARS-CoV-2 infection had 41-times (95% CI, 24·84-68·44) higher risk of all-cause death during the study period compared with individuals without. Supported psychiatric housing was linked to almost 3-times higher risk of hospitalisation and 60-day mortality following SARS-CoV-2 infection compared with the general population with other living circumstances. Interpretation: Socially marginalised and psychiatrically vulnerable individuals had substantially elevated risks of adverse health outcomes following SARS-CoV-2 infection. The results highlight that pandemic preparedness should address inequalities in health, including infection prevention and vaccination of vulnerable groups. Funding: Novo Nordisk Foundation.
... mbined with the Covid-19 vaccine. Influential antipsychotics have differential effects on several cytokines in people with psychosis, resulting in anti-inflammatory effects in some individuals. This anti-inflammatory effect is undesirable when an individual is vaccinated, as it is likely to suppress antibody formation and trigger Covid-19 symptoms (Mazereel et. al., 2021). The impact of vaccination that causes physical symptoms may trigger the appearance of hallucinatory symptoms and affect the client's level of anxiety, because the client has experienced sexual harassment at the hospital when she was diagnosed with Covid-19. The client were very afraid if she is confirmed as Covid-19 positive and must b ...
Article
Schizoaffective is a mental disorder that exhibits psychotic symptoms of schizophrenia and mood disorders which can be depressive episodes, manic episodes, or a mixture of the two episodes. This paper reported a case study of Ms. R, a 24-year-old woman diagnosed with schizoaffective disorder. She has self-esteem problems, hallucinations, and post-traumatic syndrome that interfere with her productivity and social life functions. The generalist psychiatric nursing care process and expressive writing therapy were implemented for her treatment for 18 days. The result supports that the combination of the two interventions positively impacted reducing signs and symptoms of low self-esteem, hallucinations, and anxiety symptoms in a client with schizoaffective.
... Finally, the Italian Society of Psychiatry (SIP), in addition to underlining the importance of making the vaccination procedure available as quickly as possible to these subjects (to be considered as priority vaccinations), has taken steps to encourage adherence through the intervention of all disease care facilities, where staff have been asked to provide each patient with appropriate counseling, following the indications of recent literature concerning the topic (30). ...
Article
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The adoption of restrictive measures aimed at curtailing the spread of SARS-CoV2 has had a harmful impact on socio-affective relationships, while limiting the scope of interventions and activities to promote social inclusion, with considerable negative repercussions for patients with mental disorders. Vaccination has been and will continue to be a valid tool to overcome the barriers of social isolation and to protect the health of this category of patients. In this paper we present an overview of the Italian network of social and healthcare services for COVID-19 vaccination among patients with mental disorders. Some aspects ofmedical ethics are discussed in order to share good practices for improving the health of this vulnerable group of people. We then consider the measures implemented by the health system in Italy to deal with the phenomenon of vaccine hesitancy before addressing the issue of autonomy and restricted access to vaccination points. Finally, we illustrate some of the perspectives already adopted by the Italian system, which may be useful to the global scientific community.
... Evidence has been found that people having mental illness are at higher affliction of getting infected with COVID-19 (Mazereel et al., 2021). If they had any previous history of mental disorder then the relative risk of having infection is little more (Taquet et al., 2021). ...
Article
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The SARS-CoV-2 (COVID 19) paroxysm is a dominant health exigency that caused significant distress, affecting physical and mental health. Increased mortality, a stressed healthcare system, financial crisis, isolation, and new living and working styles enhanced societal commiseration leading to poor health outcomes. Though people try to maintain good physical health but unfortunately the mental affliction is still ignored. Poor psychological health has emerged as a burgeoning social issue and demands attention. Henceforth, the fundamental objective of this review article is to collate information about COVID-linked physical and psychological agony in diverse population groups with related symptoms and accessible diagnosis techniques. Recent studies have unraveled the fragile mental states of people who have either contracted COVID 19 or had near and dear ones falling prey to it. The impact of the epidemic on the human mind both in short and long-term, with possible risk and preventive factors together with suggested solutions for maintaining good health have also been discussed here. It also enlists the available medications, vaccines and investigational research in the form of patents and clinical trials. This article can be taken as an updated information sheet for COVID 19, accompanied by its management techniques with special emphasis on coping strategies for mental health. Further, it may also assist the policymakers to devise approaches that could enable the public to overcome the pandemic-driven adversity not only in the given situation but also futuristically.
... This is an area of further research because associations may be attributable to speci c diagnoses, medications and other underlying characteristics of those people such as sleep disturbances. Nonetheless, mental illness is associated with altered immune function and evidence shows a reduced immune response to vaccination for people with depression, chronic stress, schizophrenia, bipolar disorder etc. (34). Interestingly, people with cardiovascular disease mounted higher IgA and IgG responses after vaccination. ...
Preprint
Full-text available
Background Heterogeneity of the population in relation to infection, COVID-19 vaccination and host characteristics is likely reflected in the underlying SARS-CoV-2 antibody responses. Methods We measured IgM, IgA and IgG levels against SARS-CoV-2 spike and nucleocapsid antigens in 1,076 adults of a cohort study in Catalonia between June-November 2020 and a second time between May-July 2021. Questionnaire data and electronic health records on vaccination and COVID-19 testing were available in both periods. Results Antibody seroreversion occurred in 35.8% of the 64 participants infected almost a year ago and non-vaccinated, and was related to asymptomatic infection, age above 60 years and smoking. Among vaccinated, 2.1% did not present antibodies at the time of testing. In previously infected individuals, vaccination boosted the immune response and there was a slight but statistically significant increase in responses after a 2nd compared to 1st dose. Infected vaccinated participants had superior antibody levels across time compared to naïve vaccinated people. mRNA vaccines and, particularly the Spikevax, induced higher antibodies after 1st and 2nd doses compared to Vaxzevria or Janssen COVID-19 vaccines. In multivariable regression analyses, antibody responses after vaccination were predicted by type of vaccine, infection age, sex, smoking, mental and cardiovascular diseases. Conclusions Our data support that infected people would benefit from vaccination. Results also indicate that hybrid immunity results in superior antibody responses and infection-naïve people would need a booster dose earlier than previously infected people. Mental diseases are associated with less efficient response to vaccination.
... Having negative emotional affect as a reaction to the pandemic, which was a composite score of feelings of stress, helplessness, fear and depression in our analysis, strongly predicted positive vaccine intentions. This could be reflective of the reality that those suffering from severe mental illness more likely bear an increased risk of COVID-19 infection, as well as COVID-19 related morbidity and mortality, and have therefore been recommended for prioritization in vaccine allocation strategies [26]. This link between negative affect and positive vaccine intentions could also reflect a greater awareness of the severity of the disease, as was recently shown in a Finnish sample [27]. ...
Article
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Objectives: To investigate country-specific drivers and barriers of positive COVID-19 vaccine intentions in the Federation of Bosnia and Herzegovina (FBiH), one of the two entities comprising Bosnia and Herzegovina. Methods: A cross-sectional study design was used, using an online behavioural insights survey tool adapted to the context of FBiH. Three survey waves, each including approximately 1,000 adults, were conducted in July, September and December 2020. Fixed-effects regression analysis was used to explore the drivers, barriers and attitudes towards accepting a future COVID-19 vaccine. Results: COVID-19 risk perception, trust in health institutions and negative affect were positive predictors of positive COVID-19 vaccine intentions, as were living in urban areas and having a college education (versus having primary or secondary education). Conversely, being female, feeling that the pandemic was overhyped by the media and the country of vaccine production were negative predictors. Conclusion: This study provided snapshots on the state of attitudes regarding a future COVID-19 vaccine acceptance and hesitancy in 2020. These findings provided useful insights into the efforts to introduce and roll out the COVID-19 vaccines in FBiH. Further efforts should focus on better understanding the demographic, cultural and behavioural contexts of COVID-related vaccination perceptions in FBiH.
... 20 Due to these extra risks, as well as a high risk of COVID-19 in clozapine users, vaccination against SARS-CoV-2 is even more imperative for this patient group than for people with SMI in general. 21,22 Since we know that in the general population, inflammation and fever may occur after administration of a COVID-19 vaccine, with a higher risk of fever after the second dose due to a stronger immune response, complications such as high clozapine blood levels or WBC count abnormalities can be expected in clozapine users. 23 At present, there is not much evidence as to whether COVID-19 vaccination is more dangerous for clozapine users than for the general population. ...
Article
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Objective: To investigate the safety of COVID-19 vaccination in patients on clozapine as regards plasma clozapine concentration and haematological parameters. Methods: We conducted a multicentre observational cohort study from 22 February 2021 to 2 September 2021. Primary outcomes were clinically relevant increase in clozapine blood levels (>100μg/L increase compared to baseline) and clozapine alert levels (>1000μg/L). Secondary outcomes were granulocytopenia, leukocytopenia and lymphocytopenia. Outcomes were measured approximately 5 days after the first and (where applicable) second dose of COVID-19 vaccine. Results: This study included 139 patients. Compared to baseline, clozapine blood levels increased significantly (ES=0.28, p=0.003) after the second vaccination. Clinically relevant increases in clozapine blood levels occurred in 20/92 patients (22%) and in 16/56 patients (29%) during the first and second phases, respectively. Clozapine alert levels developed in one patient (1%) following the first dose and in three patients (5%) after the second dose. In both phases, changes in white blood cells (WBC) were limited to mild granulocytopenia (3% and 5%), moderate granulocytopenia (1% and 0%) and leukocytopenia (2% and 3%) without cause for extra monitoring according to the guideline. Conclusion: In general, as regards WBC counts COVID-19 vaccination seems to be safe in patients with SMI using clozapine. Changes in WBC had no clinical implications. Psychoeducation on the symptoms of clozapine intoxication is recommended, especially in patients with clozapine blood levels approaching the upper limit of the therapeutic range. Increase in the C-reactive protein (CRP) level can signal inflammation rapidly and help to prevent clozapine intoxication following vaccination.
... In Japan, female suicide rates have increased during the COVID-19 pandemic. The evidence of this study reveals that vaccination can cure women with mental illness (Mazereel et al. 2021a(Mazereel et al. , 2021bSiva 2021;Warren et al. 2021). Based on the findings, policymakers should display appropriate messages that are targeted to unvaccinated females. ...
Preprint
Vaccination has been promoted to mitigate the spread of the coronavirus disease 2019 (COVID-19). Vaccination is expected to reduce the probability of and alleviate the seriousness of COVID-19 infection. Accordingly, this might significantly change an individuals subjective well-being and mental health. However, it is unknown how vaccinated people perceive the effectiveness of COVID-19 and how their subjective well-being and mental health change after vaccination. We thus observed the same individuals on a monthly basis from March 2020 to September 2021 in all parts of Japan. Then, large sample panel data (N=54,007) were independently constructed. Using the data, we compared the individuals perceptions of COVID-19, subjective well-being, and mental health before and after vaccination. Furthermore, we compared the effect of vaccination on the perceptions of COVID-19 and mental health for females and males. We used the fixed-effects model to control for individual time-invariant characteristics. The major findings were as follows: First, the vaccinated people perceived the probability of getting infected and the seriousness of COVID-19 to be lower than before vaccination. This was observed not only when we used the whole sample, but also when we used sub-samples. Second, using the whole sample, subjective well-being and mental health improved. The same results were also observed using the sub-sample of females, whereas the improvements were not observed using a sub-sample of males.
... However, symptoms (such as paranoia and amotivation) and healthcare inequalities (such as poor integration of mental health and primary care services leading to difficulty in accessing primary care) that affect people with SMI living in the community may act as barriers to accessing COVID-19 vaccines. 1,2 In view of this, we hypothesised that COVID-19 vaccination rates would be lower in people with SMI relative to other groups offered vaccination at the same time. However, vaccination rates in this group are unknown. ...
... Although several articles have focused on the neuro-psychiatric implications of the pandemic [17,18], few have investigated the attitudes of people with mental illness towards vaccination. Mazereel et al. [19] did not find articles about this issue at the time of their review and state that research on this topic is urgently needed. Given the novelty of this research topic, the aim of the current study is to report an overview of the articles examining COVID-19 vaccination in relation to mental disorders, and discuss how scientific research has addressed this topic, in order to provide suggestions for further research and direction. ...
Article
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The consequences of the pandemic on mental health are among the most important side effects of COVID-19. Wide concerns have emerged both regarding vaccine hesitation in the general population, and the vaccine’s implementation plan. The aim of this study is to evaluate how the scientific community has investigated the relationship between the COVID-19 vaccine and mental disorders. Contrary to expectations, having a full-blown psychiatric pathology seems to positively affect the attitude towards the vaccine, except for PTSD. The intense fear that accompanied the current world emergency has made this pandemic unique; we discuss how it might be one of the factors involved in this result. Further experimental investigations are needed to estimate how personality traits, hyperarousal, and negative emotions influence vaccine compliance both in the general population and in people living with mental disorders
... Whereas it was established early in the COVID-19 pandemic that people with chronic physical illness experienced higher rates of hospitalisation for, and death from, the disease [1][2][3][4], more recent evidence suggests that the same may also be the case for people with mental health problems and those with a higher prevalence of psychological distress symptoms (anxiety and depression) [4][5][6][7]. There have therefore been calls to test the link between mental health and vaccine hesitancy [8], the concern being that any elevated burden of the disease in individuals with poor psychological health would be compounded if they were also reluctant to take up the vaccine. ...
Article
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Background Although several predictors of COVID-19 vaccine hesitancy have been identified, the role of physical health and, particularly, mental health, is poorly understood. Methods We used individual-level data from a pandemic-focused investigation (COVID Survey), a prospective cohort study nested within the UK Understanding Society (Main Survey) project. In the week immediately following the announcement of successful testing of the first efficacious inoculation (Oxford University/AstraZeneca, November/December 2020), data on vaccine intentionality were collected in 12,035 individuals aged 16–95 years. Pre-pandemic, study members had responded to enquiries about diagnoses of mental and physical health, including the completion of the 12-item General Health Questionnaire for symptoms of psychological distress (anxiety and depression). Peri-pandemic, individuals indicated whether they or someone in their household was shielding; that is, people judged by the UK National Health Service as being particularly clinically vulnerable who were therefore requested to remain at home. Intention to take up vaccination for COVID-19 was also self-reported. Results In an analytical sample of 11,955 people (6741 women), 15.4% indicated that they were vaccine-hesitant. Relative to their disease-free counterparts, shielding was associated with a 24% lower risk of being hesitant (odds ratio; 95% confidence interval: 0.76; 0.59, 0.96), after adjustment for a range of covariates which included age, education, and ethnicity. Corresponding results for cardiometabolic disease were 22% (0.78; 0.64, 0.95), and for respiratory disease were 26% (0.74; 0.59, 0.93). Having a pre-pandemic diagnosis of anxiety or depression, or a high score on the distress symptom scale, were all unrelated to the willingness to vaccine-hesitancy. Conclusions People with a physical condition were more likely to take up the potential offer of a COVID-19 vaccination. These effects were not apparent for indices of mental health. • Key messages • In understanding predictors of COVID-19 vaccine hesitancy, the role of physical and mental health has not been well-examined despite both groups seemingly experiencing an elevated risk of the disease. • In a large UK cohort study, people with a pre-pandemic physical condition were more likely to take up the theoretical offer of vaccination. • There were no apparent effects for indices of pre-pandemic mental health.
... Similar to generalized trust, studies that explore the attitudes of people with mental illness toward vaccination against COVID-19 are scarce [40] and inconsistent. To our knowledge, there have been five studies in the United States, China, Germany, and Japan [15,17,22,41,42]. ...
Article
Full-text available
Background Although numerous studies have been published on the predictors of COVID-19 vaccine hesitancy, some possible predictors remain underexplored. In this study, we explored the associations of unwillingness and indecisiveness regarding COVID-19 vaccination with generalized trust, mental health conditions such as depression and generalized anxiety, and fear of COVID-19. Methods Data of wave 1 (from October 27 till November 6, 2020) and wave 3 (from April 23 till May 6, 2021) of a longitudinal online study conducted in Japan were used for the analyses. Unvaccinated participants were asked at wave 3 about their willingness to be vaccinated, with possible responses of willing, unwilling, or undecided. These three responses were used as the outcome variable, and multinomial logistic regression analyses were conducted with willingness to be vaccinated as the reference group. Explanatory variables included generalized trust, depression, generalized anxiety, and fear of COVID-19 both at wave 1 and 3, and sociodemographic and health-related variables. Results Of the 11,846 valid respondents, 209 (1.8%) answered that they had already been vaccinated against COVID-19, 7089 (59.8%) responded that they were willing to be vaccinated, 3498 (29.5%) responded that they were undecided, and 1053 (8.9%) responded that they were unwilling to be vaccinated. After adjusting for covariates, we found that: (1) participants with lower levels of generalized trust at wave 1 and 3 were more likely to be undecided or unwilling at wave 3; (2) respondents with moderately severe or severe depression at wave 1 and 3 were more likely to be undecided at wave 3; (3) participants with moderate or severe levels of generalized anxiety at wave 3 but not at wave 1 were more likely to be unwilling at wave 3; and (4) respondents with high levels of fear of COVID-19 at wave 1 and 3 were less likely to be undecided and unwilling at wave 3. Conclusions Generalized trust, mental health conditions such as depression and generalized anxiety, and low level of fear of COVID-19 are associated with unwillingness or indecision regarding being vaccinated against COVID-19.
Chapter
The global disease burden of mental, neurological, and substance use disorders is high, and an estimated one in four individuals globally will experience mental illness within their lifetimes. Increasingly, an appreciation of the need to better understand, prevent, and treat these disorders has gained traction as a matter of policy. The United Nations General Assembly adopted the World Health Organization’s Sustainable Development Goals (SDGs) in 2015, codifying global health targets, including those for mental illness and addiction, as a priority for the upcoming 15 years. At a national level, the United States’ National Institute of Health’s BRAIN Initiative has awarded over $1.3 billion towards the goal of developing innovative tools and technologies fundamental to deepening our understanding of the structure and functioning of the brain. These novel methods hold great promise for better understanding, and ameliorating, the causes and consequences of mental disorders, including addiction.KeywordsGlobal burdenMental illnessSubstance use disorderBRAIN initiativeInnovation
Article
The psyche about the adverse effects of the Covid-19 pandemic has got fixed to a level of conviction that committing suicide is directly linked to coronavirus infection. The statistics of suicidal hangings for the pre-Covid-19 and the Covid-19 periods were compared in the Indian capital. The data analysis of the autopsy records showed the absence of temporal association between the incidence rates of suicides between these two periods. The study concludes that there was no net increase in suicide rates in the study population of this lower-middle-income group country during the Covid-19 pandemic.
Article
Background/objectives: There have been concerns that clozapine treatment may undermine the capacity of the body to fight infection and increase the vulnerability to contracting COVID-19. This review of recent cohort studies investigated (1) whether people with a severe psychiatric disorder are at increased risk of COVID-19 and complications, (2) the immunological response of clozapine-users who contract COVID-19, and (3) patients' perspectives on COVID-19 and the pandemic response. Methods: A systematic search of EMBASE, Medline, Pubmed, and PsycINFO databases using PRISMA guidelines using "COVID-19", "clozapine", and "vaccination" terms. Results: 18 studies (out of 330 identified) met all criteria (N = 119 054 including 8045 on clozapine). There was no strong evidence that clozapine users may be at increased risk of contracting COVID-19 or developing complications after adjusting for medical comorbidities. Hematological studies showed temporary reductions in neutrophils in COVID-19-positive patients and vaccination suggesting a clozapine effect in defence against infection. Vaccination studies did not report major adverse effects. Increased plasma levels of clozapine and neutropenia however point to COVID-19-related interference of clozapine metabolism. Patient surveys reported limited impact on mental health and positive attitudes regarding pandemic response. Conclusion: This review did not find compelling evidence that the immune system of clozapine users put them at risk of COVID-19 and further complications. Evidence of drug-infection interactions however points to the importance of adhering to consensus guidelines about clozapine therapy during the pandemic. More evidence using longitudinal designs is required to examine the longer-term effects of COVID-19 and vaccination in this vulnerable population.
Article
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As COVID-19 becomes endemic, identifying vulnerable population groups for severe infection outcomes and defining rapid and effective preventive and therapeutic strategies remains a public health priority. We performed an umbrella review, including comprehensive studies (meta-analyses and systematic reviews) investigating COVID-19 risk for infection, hospitalization, intensive care unit (ICU) admission, and mortality in people with psychiatric disorders, and outlined evidence- and consensus-based recommendations for overcoming potential barriers that psychiatric patients may experience in preventing and managing COVID-19, and defining optimal therapeutic options and current research priorities in psychiatry. We searched Web of Science, PubMed, and Ovid/PsycINFO databases up to 17 January 2022 for the umbrella review. We synthesized evidence, extracting when available pooled odd ratio estimates for the categories “any mental disorder” and “severe mental disorders.” The quality of each study was assessed using the AMSTAR-2 approach and ranking evidence quality. We identified four systematic review/meta-analysis combinations, one meta-analysis, and three systematic reviews, each including up to 28 original studies. Although we rated the quality of studies from moderate to low and the evidence ranged from highly suggestive to non-significant, we found consistent evidence that people with mental illness are at increased risk of COVID-19 infection, hospitalization, and most importantly mortality, but not of ICU admission. The risk and the burden of COVID-19 in people with mental disorders, in particular those with severe mental illness, can no longer be ignored but demands urgent targeted and persistent action. Twenty-two recommendations are proposed to facilitate this process.
Article
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The COVID-19 pandemic continues to impact daily life, including health system operations, despite the availability of vaccines that are effective in greatly reducing the risks of death and severe disease. Misperceptions of COVID-19 vaccine safety, efficacy, risks, and mistrust in institutions responsible for vaccination campaigns have been reported as factors contributing to vaccine hesitancy. This study investigated COVID-19 vaccine hesitancy globally in June 2021. Nationally representative samples of 1,000 individuals from 23 countries were surveyed. Data were analyzed descriptively, and weighted multivariable logistic regressions were used to explore associations with vaccine hesitancy. Here, we show that more than three-fourths (75.2%) of the 23,000 respondents report vaccine acceptance, up from 71.5% one year earlier. Across all countries, vaccine hesitancy is associated with a lack of trust in COVID-19 vaccine safety and science, and skepticism about its efficacy. Vaccine hesitant respondents are also highly resistant to required proof of vaccination; 31.7%, 20%, 15%, and 14.8% approve requiring it for access to international travel, indoor activities, employment, and public schools, respectively. For ongoing COVID-19 vaccination campaigns to succeed in improving coverage going forward, substantial challenges remain to be overcome. These include increasing vaccination among those reporting lower vaccine confidence in addition to expanding vaccine access in low- and middle-income countries. Vaccine hesitancy is a public health challenge. Here the authors examine COVID-19 vaccine hesitancy in June 2021 using a survey including individuals from 23 countries, and report differences compared to a year earlier.
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Depression is a factor that probably affect not only the sensation of pain, but also the pain experiences. The aim of the study was to analyze and summarize the specific experiences during pain in patients with chronic pain and depression. Materials and methods: A phase study of a sample of 120 patients with chronic pain was performed in two stages with a period of three months between them. According to the presence of a depressive episode, the sample was organized into two groups – 61 patients without depression and 59 patients with symptoms of depression. All patients with depression were treated with antidepressants between the two stages. Two types of methods were used to assess the sample: 1) quantitative methods – HAM-D-17 – to assess the severity of depression, Spielberger questionnaire – to assess the degree of state and trait anxiety and VAS – to assess the pain intensity; 2) qualitative method – content-analysis of the answers to the question "How do you feel during pain?". Results: The mean age of the sample was 51.90 ± 11.94. The share of women predominated (81.7%) over that of men (18.3%). The group with depression had high mean values of state and trait anxiety during the two stages of the study. In the first stage, when the mean value of the severity of depression was moderate, the content-analysis revealed specific experiences during pain of despair, low self-esteem, guilt, and suicidal ideation. The reduction of the mean value of the severity of depression from moderate to mild in the second stage, led to a decrease in the number of specific experiences. Conclusion: Depression affects the specifics of experiences during pain, revealing a potential risk of auto-aggressive behavior. Therefore, the search for symptoms of depression and specific experiences during pain and their intervention can be substantial in the coping with chronic pain.
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Precautionary measures (e.g., social distancing, mask wearing, washing hands regularly) to limit the transmission of the Coronavirus 19 (COVID-19) have been put in place worldwide. However, a limited understanding of precautionary measures and low compliance with them has been observed in older adults with neurocognitive disorders, persons with intellectual disability, or mental illness. The objective of this study is to create and evaluate a robot-mediated activity to deliver information on COVID-19 precautionary measures in an accessible and engaging way using the humanoid robot Nao. An interactive scenario explaining and demonstrating COVID-19 precautionary measures is created using the verbal and non-verbal behaviours of the robot. The scenario (≈5 min) is presented to 124 users of a geriatric hospital, including the following: older patients (n = 45), accompanying persons (n = 39), and health professionals (n = 40). The data regarding perceived usefulness, acceptability, and accessibility are collected using a questionnaire. A video analysis of the participants’ behaviour during the interaction with the robot is performed to examine the quality of engagement in the activity. The results show a good acceptance, satisfaction, and perceived usefulness of the robot-mediated activity. These findings suggest that robot-mediated interventions using humanoid robots can be an effective tool for the delivery of health promotion information.
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Background: The coronavirus disease 2019 (COVID-19) pandemic has been a global challenge. High mortality rates have been reported in some risk groups, including patients with pre-existing mental disorders. Methods: We used electronic health records to retrospectively identify people infected due to COVID-19 (between March 2020 and March 2021) in the three territories of the Basque Country. COVID-19 cases were defined as individuals who had tested positive on a reverse transcription-polymerase chain reaction (PCR) test. Univariate and multivariate logistic regression models and multilevel analyses with generalized estimated equations were used to determine factors associated with COVID-19-related mortality and hospital admission. Results: The COVID-19 mortality rate was increased for patients with psychotic disorders [odds ratio (OR) adjusted: 1.45, 95% confidence interval (CI) (1.09-1.94), p = 0.0114] and patients with substance abuse [OR adjusted: 1.88, 95% CI (1.13-3.14, p < 0.0152)]. The mortality rate was lower for patients with affective disorders [OR adjusted: 0.80, 95% CI (0.61-0.99), p = 0.0407]. Hospital admission rates due to COVID-19 were higher in psychosis [OR adjusted: 2.90, 95% CI (2.36-3.56), p < 0.0001] and anxiety disorder groups [OR adjusted: 1.54, 95% CI (1.37-1.72), p < 0.0001]. Among admitted patients, COVID-19 mortality rate was decreased for those with affective disorders rate [OR adjusted: 0.72, 95% CI (0.55-0.95), p = 0.0194]. Conclusions: COVID-19-related mortality and hospitalizations rates were higher for patients with a pre-existing psychotic disorder.
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Abstract. Normally, the process of adolescence is quite painful and complicated, and it is important to distinguish those conditions that do not require long-term treatment and psychiatric care from pathological states requiring accurate diagnosis. This report aims to raise the issue of difficulties and specifics in assessing personality in adolescence with the standard methods used in clinical practice in Bulgaria. For this purpose, the results from the application of two of the most commonly used methods in clinical practice in our country are presented: the short form of a questionnaire for the study of personality MMPI (71) and the Thematic apperception test. The studied sample of adolescents (N=230, 55% girls), between 14 and 16 years, was divided into two subgroups: adolescents with “psychotic” type of profile and adolescents with “neurotic” type of profile. The data was collected in the course of twelve years (2010-2022), in multi-profile hospital “Sv. Marina” – Varna, both from the child and adolescent psychiatric clinic and from consultations of adolescents in the pediatric clinic. The study found good indicators of the reliability of MMPI short-term scales (71) in the adolescent group between 14 and 16 years of age (Cronbach’s alpha values from 0.53 to 0.73), while for a more detailed assessment of personality predisposition, experiences, and feelings, the combination of self-assessment and projective methods might be helpful.
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Zusammenfassung: Hintergrund Seit Beginn der COVID-19-Pandemie mehren sich Befunde zu deren negativem Einfluss auf die psychische Gesundheit von Kindern und Jugendlichen. Dennoch ist wenig darüber bekannt, ob und wie sich diese auf die psychotherapeutische Versorgung niederschlägt. Ziel der Arbeit Die vorliegende Studie hat zum Ziel, die psychische Situation von Kindern und Jugendlichen und deren psychotherapeutische Versorgung seit Beginn der COVID-19-Pandemie aus Sicht von Kinder-und JugendlichenpsychotherapeutInnen (KJP) zu erfassen. Material und Methoden Es wurden 324 KJP aus ganz Deutschland mittels online-Umfrage gebeten, die letzten 6 Monate mit einem 6-monatigen Zeitraum vor 2 Jahren zu vergleichen. Es wurden 5-und 7-stufige Likert-Skalen mit Mehr-und Einfachauswahl sowie numerische und ein freies Antwortformat verwendet. Ergebnisse Seit Pandemiebeginn haben sich die Wartezeiten nahezu verdoppelt. Es werden mehr Behandlungsstunden angeboten, v.a. mehr Erstgespräche durchgeführt. Therapieverlängerungen kommen häufiger,-abbrüche seltener vor. Bei der Hälfte der PatientInnen ist eine pandemieassoziierte Symptomverschlechterung aufgetreten. Alle erfragten psychischen Störungen treten z.T. deutlich häufiger auf (v.a. Depressionen, Angststörungen, Medienabhängigkeit, Schlaf-, Anpassungs-, Zwangs-und Essstörungen). Es gibt mehr Telefon-und Videositzungen als vor der Pandemie. Die Zusammenarbeit mit Eltern hat sich erhöht, die mit externen Personen des interdisziplinären Netzwerkes verringert. Diskussion Die Pandemie hat einen deutlichen Einfluss auf die psychische Verfassung und die psychotherapeutische Versorgung von Kindern und Jugendlichen in Deutschland. Es sollte eine Anpassung des Versorgungssystems an den gestiegenen Bedarf erfolgen, um Folgeschäden der Pandemie zu begrenzen. (1794 / 1800 Zeichen) Abstract: Background
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Background: Individuals with severemental disorder (SMD) have a higher risk of somatic comorbidity and mortality than the rest of the population. We set up a population-based study to assess whether individuals with SMD had a higher risk of death associated with a COVID-19 infection (COVID-19 associated death) than individuals without SMD. Methods: Exploratory analysis with a cross-sectional design in the framework of a population-based register study covering the entire Swedish population. The Swedish Board for Health and Welfare (Socialstyrelsen) provided anonymized tabulated summary data for further analysis. We compared numbers of COVID-19 associated death in individuals with SMD (cases) and without SMD (controls). We calculated the odds ratio (OR) for the whole sample and by age group and four comorbidities, namely diabetes, cardiovascular disease, hypertension, chronic lung disease. Results: The sample comprised of 7,923,859 individuals, 103,999 with SMD and 7,819,860 controls. There were 130 (0.1%) COVID-19 associated deaths in the SMD group and 4,945 (0.06%) in the control group, corresponding to an OR of 1.98 (CI 1.66- 2.35; p < 0.001). The odds were 4-fold for the age groups between 60 and 79 years and 1.5-fold for cardiovascular diseases. Individuals with SMD without any of the risk factors under study had 3-fold odds of COVID-19 associated death. Conclusion: Our preliminary results identify individuals with SMD as a further group at increased risk of COVID-19 associated death. In regard to comorbidities, future studies should explore the potential confounding or mediation role in the relationship between SMD and COVID-19 associated deaths.
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People with serious mental illness (SMI), including schizophrenia, bipolar disorder, and major depressive disorder, have a higher mortality rate and shortened life expectancy. This is mainly attributable to physical diseases, particularly cardiovascular diseases (CVDs). Important risk factors for CVDs are obesity and other metabolic abnormalities, which are especially prevalent in people with SMI. Several factors contribute to this increased risk, including unhealthy lifestyles. Psychotropic medication independently further increases this risk. In this review we want to examine the relationship between obesity and other components of the metabolic syndrome and psychotropic medication in people with SMI.
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Background Adverse mental health consequences of COVID-19, including anxiety and depression, have been widely predicted but not yet accurately measured. There are a range of physical health risk factors for COVID-19, but it is not known if there are also psychiatric risk factors. In this electronic health record network cohort study using data from 69 million individuals, 62 354 of whom had a diagnosis of COVID-19, we assessed whether a diagnosis of COVID-19 (compared with other health events) was associated with increased rates of subsequent psychiatric diagnoses, and whether patients with a history of psychiatric illness are at a higher risk of being diagnosed with COVID-19. Methods We used the TriNetX Analytics Network, a global federated network that captures anonymised data from electronic health records in 54 health-care organisations in the USA, totalling 69·8 million patients. TriNetX included 62 354 patients diagnosed with COVID-19 between Jan 20, and Aug 1, 2020. We created cohorts of patients who had been diagnosed with COVID-19 or a range of other health events. We used propensity score matching to control for confounding by risk factors for COVID-19 and for severity of illness. We measured the incidence of and hazard ratios (HRs) for psychiatric disorders, dementia, and insomnia, during the first 14 to 90 days after a diagnosis of COVID-19. Findings In patients with no previous psychiatric history, a diagnosis of COVID-19 was associated with increased incidence of a first psychiatric diagnosis in the following 14 to 90 days compared with six other health events (HR 2·1, 95% CI 1·8–2·5 vs influenza; 1·7, 1·5–1·9 vs other respiratory tract infections; 1·6, 1·4–1·9 vs skin infection; 1·6, 1·3–1·9 vs cholelithiasis; 2·2, 1·9–2·6 vs urolithiasis, and 2·1, 1·9–2·5 vs fracture of a large bone; all p<0·0001). The HR was greatest for anxiety disorders, insomnia, and dementia. We observed similar findings, although with smaller HRs, when relapses and new diagnoses were measured. The incidence of any psychiatric diagnosis in the 14 to 90 days after COVID-19 diagnosis was 18·1% (95% CI 17·6–18·6), including 5·8% (5·2–6·4) that were a first diagnosis. The incidence of a first diagnosis of dementia in the 14 to 90 days after COVID-19 diagnosis was 1·6% (95% CI 1·2–2·1) in people older than 65 years. A psychiatric diagnosis in the previous year was associated with a higher incidence of COVID-19 diagnosis (relative risk 1·65, 95% CI 1·59–1·71; p<0·0001). This risk was independent of known physical health risk factors for COVID-19, but we cannot exclude possible residual confounding by socioeconomic factors. Interpretation Survivors of COVID-19 appear to be at increased risk of psychiatric sequelae, and a psychiatric diagnosis might be an independent risk factor for COVID-19. Although preliminary, our findings have implications for clinical services, and prospective cohort studies are warranted. Funding National Institute for Health Research.
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Background Psychiatric morbidities have been associated with a risk of severe infections through compromised immunity, health behaviours, or both. However, data are scarce on the association between multiple types of pre-pandemic psychiatric disorders and COVID-19. We aimed to assess the association between pre-pandemic psychiatric disorders and the subsequent risk of COVID-19 using UK Biobank. Methods For this cohort analysis, we included participants from UK Biobank who were registered in England and excluded individuals who died before Jan 31, 2020, (the start of the COVID-19 outbreak in the UK) or had withdrawn from UK Biobank. Participants diagnosed with a psychiatric disorder before Jan 31 were included in the group of individuals with pre-pandemic psychiatric disorders, whereas participants without a diagnosis before the outbreak were included in the group of individuals without pre-pandemic psychiatric disorders. We used the Public Health England dataset, UK Biobank hospital data, and death registers to collect data on COVID-19 cases. To examine the relationship between pre-pandemic psychiatric disorders and susceptibility to COVID-19, we used logistic regression models to estimate odds ratios (ORs), controlling for multiple confounders and somatic comorbidities. Key outcomes were all COVID-19, COVID-19 specifically diagnosed in inpatient care, and COVID-19-related deaths. ORs were also estimated separately for each psychiatric disorder and on the basis of the number of pre-pandemic psychiatric disorders. As a positive disease control, we repeated analyses for hospitalisation for other infections. Findings We included 421 014 UK Biobank participants in our study and assessed their COVID-19 status between Jan 31 and July 26, 2020. 50 809 participants were diagnosed with psychiatric disorders before the outbreak, while 370 205 participants had no psychiatric disorders. The mean age at outbreak was 67·80 years (SD 8·12). We observed an elevated risk of COVID-19 among individuals with pre-pandemic psychiatric disorders compared with that of individuals without such conditions. The fully adjusted ORs were 1·44 (95% CI 1·28–1·62) for All COVID-19 cases, 1·55 (1·34–1·78) for Inpatient COVID-19 cases, and 2·03 (1·59–2·59) for COVID-19-related deaths. We observed excess risk, defined as risk that increased with the number of pre-pandemic psychiatric disorders, across all diagnostic categories of pre-pandemic psychiatric disorders. We also observed an association between psychiatric disorders and elevated risk of hospitalisation due to other infections (OR 1·74, 95% CI 1·58–1·93). Interpretation Our findings suggest that pre-existing psychiatric disorders are associated with an increased risk of COVID-19. These findings underscore the need for surveillance of and care for populations with pre-existing psychiatric disorders during the COVID-19 pandemic. Funding National Natural Science Foundation of China.
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Limited knowledge is available on the relationship between antigen-specific immune responses and COVID-19 disease severity. We completed a combined examination of all three branches of adaptive immunity at the level of SARS-CoV-2-specific CD4+ and CD8+ T cell and neutralizing antibody responses in acute and convalescent subjects. SARS-CoV-2-specific CD4+ and CD8+ T cells were each associated with milder disease. Coordinated SARS-CoV-2-specific adaptive immune responses were associated with milder disease, suggesting roles for both CD4+ and CD8+ T cells in protective immunity in COVID-19. Notably, coordination of SARS-CoV-2 antigen-specific responses was disrupted in individuals > 65 years old. Scarcity of naive T cells was also associated with ageing and poor disease outcomes. A parsimonious explanation is that coordinated CD4+ T cell, CD8+ T cell, and antibody responses are protective, but uncoordinated responses frequently fail to control disease, with a connection between ageing and impaired adaptive immune responses to SARS-CoV-2.
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The global pandemic of COVID-19 is colliding with the epidemic of opioid use disorders (OUD) and other substance use disorders (SUD) in the United States (US). Currently, there is limited data on risks, disparity, and outcomes for COVID-19 in individuals suffering from SUD. This is a retrospective case-control study of electronic health records (EHRs) data of 73,099,850 unique patients, of whom 12,030 had a diagnosis of COVID-19. Patients with a recent diagnosis of SUD (within past year) were at significantly increased risk for COVID-19 (adjusted odds ratio or AOR = 8.699 [8.411-8.997], P < 10-30), an effect that was strongest for individuals with OUD (AOR = 10.244 [9.107-11.524], P < 10-30), followed by individuals with tobacco use disorder (TUD) (AOR = 8.222 ([7.925-8.530], P < 10-30). Compared to patients without SUD, patients with SUD had significantly higher prevalence of chronic kidney, liver, lung diseases, cardiovascular diseases, type 2 diabetes, obesity and cancer. Among patients with recent diagnosis of SUD, African Americans had significantly higher risk of COVID-19 than Caucasians (AOR = 2.173 [2.01-2.349], P < 10-30), with strongest effect for OUD (AOR = 4.162 [3.13-5.533], P < 10-25). COVID-19 patients with SUD had significantly worse outcomes (death: 9.6%, hospitalization: 41.0%) than general COVID-19 patients (death: 6.6%, hospitalization: 30.1%) and African Americans with COVID-19 and SUD had worse outcomes (death: 13.0%, hospitalization: 50.7%) than Caucasians (death: 8.6%, hospitalization: 35.2%). These findings identify individuals with SUD, especially individuals with OUD and African Americans, as having increased risk for COVID-19 and its adverse outcomes, highlighting the need to screen and treat individuals with SUD as part of the strategy to control the pandemic while ensuring no disparities in access to healthcare support.
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The Fair Priority Model offers a practical way to fulfill pledges to distribute vaccine fairly and equitably.
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Would compulsory treatment or vaccination for COVID-19 be justified? In England, there would be significant legal barriers to it. However, we offer a conditional ethical argument in favour of allowing compulsory treatment and vaccination, drawing on an ethical comparison with external constraints—such as quarantine, isolation and ‘lockdown’—that have already been authorised to control the pandemic in this jurisdiction. We argue that, if the permissive English approach to external constraints for COVID-19 has been justified, then there is a case for a similarly permissive approach to compulsory medical interventions.
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Vaccine hesitancy remains a barrier to full population inoculation against highly infectious diseases. Coincident with the rapid developments of COVID-19 vaccines globally, concerns about the safety of such a vaccine could contribute to vaccine hesitancy. We analyzed 1941 anonymous questionnaires completed by healthcare workers and members of the general Israeli population, regarding acceptance of a potential COVID-19 vaccine. Our results indicate that healthcare staff involved in the care of COVID-19 positive patients, and individuals considering themselves at risk of disease, were more likely to self-report acquiescence to COVID-19 vaccination if and when available. In contrast, parents, nurses, and medical workers not caring for SARS-CoV-2 positive patients expressed higher levels of vaccine hesitancy. Interventional educational campaigns targeted towards populations at risk of vaccine hesitancy are therefore urgently needed to combat misinformation and avoid low inoculation rates.
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Background: Clozapine, an antipsychotic with unique efficacy in treatment-resistant psychosis, is associated with increased susceptibility to infection, including pneumonia. Aims: To investigate associations between clozapine treatment and increased risk of COVID-19 infection in patients with schizophrenia-spectrum disorders who are receiving antipsychotic medications in a geographically defined population in London, UK. Method: Using information from South London and Maudsley NHS Foundation Trust (SLAM) clinical records, via the Clinical Record Interactive Search system, we identified 6309 individuals who had an ICD-10 diagnosis of schizophrenia-spectrum disorders and were taking antipsychotics at the time of the COVID-19 pandemic onset in the UK. People who were on clozapine treatment were compared with those on any other antipsychotic treatment for risk of contracting COVID-19 between 1 March and 18 May 2020. We tested associations between clozapine treatment and COVID-19 infection, adjusting for gender, age, ethnicity, body mass index (BMI), smoking status and SLAM service use. Results: Of 6309 participants, 102 tested positive for COVID-19. Individuals who were on clozapine had increased risk of COVID-19 infection compared with those who were on other antipsychotic medication (unadjusted hazard ratio HR = 2.62, 95% CI 1.73-3.96), which was attenuated after adjusting for potential confounders, including clinical contact (adjusted HR = 1.76, 95% CI 1.14-2.72). Conclusions: These findings provide support for the hypothesis that clozapine treatment is associated with an increased risk of COVID-19 infection. Further research will be needed in other samples to confirm this association. Potential clinical implications are discussed.
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A close interaction between the virus SARS-CoV-2 and the immune system of an individual results in a diverse clinical manifestation of the COVID-19 disease. While adaptive immune responses are essential for SARS-CoV-2 virus clearance, the innate immune cells, such as macrophages, may contribute, in some cases, to the disease progression. Macrophages have shown a significant production of IL-6 suggesting they may contribute to the excessive inflammation in COVID-19 disease. Macrophage Activation Syndrome may further explain the high serum levels of CRP, which are normally lacking in viral infections. In adaptive immune responses, it has been revealed that cytotoxic CD8+ T cells exhibit functional exhaustion patterns, such as the expression of NKG2A, PD-1, and TIM-3. Since SARS-CoV-2 restrains antigen presentation by downregulating MHC class I and II molecules and, therefore, inhibits the T cell-mediated immune responses, humoral immune responses also play a substantial role. Specific IgA response appears to be stronger and more persistent than IgM response. Moreover, IgM and IgG antibodies show similar dynamics in COVID-19 disease.
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Respiratory immune characteristics associated with Coronavirus Disease 2019 (COVID-19) severity are currently unclear. We characterized bronchoalveolar lavage fluid immune cells from patients with varying severity of COVID-19 and from healthy people by using single-cell RNA sequencing. Proinflammatory monocyte-derived macrophages were abundant in the bronchoalveolar lavage fluid from patients with severe COVID-9. Moderate cases were characterized by the presence of highly clonally expanded CD8⁺ T cells. This atlas of the bronchoalveolar immune microenvironment suggests potential mechanisms underlying pathogenesis and recovery in COVID-19.
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Purpose of review: The outbreak of the novel coronavirus disease 2019 (COVID-19) has emerged to be the biggest global health threat worldwide, which has now infected over 1.7 million people and claimed more than 100,000 lives around the world. Under these unprecedented circumstances, there are no well-established guidelines for cancer patients. Recent findings: The risk for serious disease and death in COVID-19 cases increases with advancing age and presence of comorbid health conditions. Since the emergence of the first case in Wuhan, China, in December 2019, tremendous research efforts have been underway to understand the mechanisms of infectivity and transmissibility of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a fatal virus responsible for abysmal survival outcomes. To minimize the mortality rate, it becomes prudent to identify symptoms promptly and employ treatments appropriately. Even though no cure has been established, multiple clinical trials are underway to determine the most optimal strategy. Managing cancer patients under these circumstances is rather challenging, given their vulnerable status and the aggressive nature of their underlying disease. In this comprehensive review, we discuss the impact of COVID-19 on health and the immune system of those affected, reviewing the latest treatment approaches and ongoing clinical trials. Additionally, we discuss challenges faced while treating cancer patients and propose potential approaches to manage this vulnerable population during this pandemic.
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The novel coronavirus SARS-CoV-2, the causative agent of COVID-19 respiratory disease, has infected over 2.3 million people, killed over 160,000, and caused worldwide social and economic disruption1,2. There are currently no antiviral drugs with proven clinical efficacy, nor are there vaccines for its prevention, and these efforts are hampered by limited knowledge of the molecular details of SARS-CoV-2 infection. To address this, we cloned, tagged and expressed 26 of the 29 SARS-CoV-2 proteins in human cells and identified the human proteins physically associated with each using affinity-purification mass spectrometry (AP-MS), identifying 332 high-confidence SARS-CoV-2-human protein-protein interactions (PPIs). Among these, we identify 66 druggable human proteins or host factors targeted by 69 compounds (29 FDA-approved drugs, 12 drugs in clinical trials, and 28 preclinical compounds). Screening a subset of these in multiple viral assays identified two sets of pharmacological agents that displayed antiviral activity: inhibitors of mRNA translation and predicted regulators of the Sigma1 and Sigma2 receptors. Further studies of these host factor targeting agents, including their combination with drugs that directly target viral enzymes, could lead to a therapeutic regimen to treat COVID-19.
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Background and aims High prevalence of diabetes makes it an important comorbidity in patients with COVID-19. We sought to review and analyze the data regarding the association between diabetes and COVID-19, pathophysiology of the disease in diabetes and management of patients with diabetes who develop COVID-19 infection. Methods PubMed database and Google Scholar were searched using the key terms ‘COVID-19’, ‘SARS-CoV-2’, ‘diabetes’, ‘antidiabetic therapy’ up to April 2, 2020. Full texts of the retrieved articles were accessed. Results There is evidence of increased incidence and severity of COVID-19 in patients with diabetes. COVID-19 could have effect on the pathophysiology of diabetes. Blood glucose control is important not only for patients who are infected with COVID-19, but also for those without the disease. Innovations like telemedicine are useful to treat patients with diabetes in today's times.
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To identify factors associated with the death for patients with COVID-19 pneumonia caused by a novel coronavirus SARS-CoV-2. All clinical and laboratory parameters were collected prospectively from a cohort of patients with COVID-19 pneumonia who were hospitalised to Wuhan Pulmonary Hospital, Wuhan City, Hubei Province, China, between December 25, 2019 and February 7, 2020. Univariate and multivariate logistic regression was performed to investigate the relationship between each variable and the risk for death of COVID-19 pneumonia patients. A total of 179 patients with COVID-19 pneumonia (97 male and 82 female) were included in the present prospective study, of whom 21 died. Univariate and multivariate logistic regression analysis revealed that age ≥65 years (odd ratio, 3.765; 95% confidence interval, 1.146‒17.394; p=0.023), preexisting concurrent cardiovascular or cerebrovascular diseases (2.464; 0.755‒8.044; p=0.007), CD3 ⁺ CD8 ⁺ T cells ≤75 cell·μL ⁻¹ (3.982; 1.132‒14.006; p<0.001), and cardiac troponin I≥0.05 ng·mL ⁻¹ (4.077; 1.166‒14.253; p<0.001) were associated with an increase in risk of mortality of COVID-19 pneumonia. In the sex‒, age‒, and comorbid illness-matched case study, CD3 ⁺ CD8 ⁺ T cells ≤75 cell·μL ⁻¹ and cardiac troponin I≥0.05 ng·mL ⁻¹ remained to be the predictors for high mortality of COVID-19 pneumonia. We identified four risk factors, age ≥65 years, preexisting concurrent cardiovascular or cerebrovascular diseases, CD3 ⁺ CD8 ⁺ T cells ≤75 cell·μL ⁻¹ , and cardiac troponin I≥0.05 ng·mL ⁻¹ , especially the latter two factors, were predictors for mortality of COVID-19 pneumonia patients.
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A novel and highly pathogenic coronavirus (SARS-CoV-2) has caused an outbreak in Wuhan city, Hubei province of China since December 2019, and soon spread nationwide and spilled over to other countries around the world1–3. To better understand the initial step of infection at an atomic level, we determined the crystal structure of the SARS-CoV-2 spike receptor-binding domain (RBD) bound to the cell receptor ACE2 at 2.45 Å resolution. The overall ACE2-binding mode of the SARS-CoV-2 RBD is nearly identical to that of the SARS-CoV RBD, which also utilizes ACE2 as the cell receptor⁴. Structural analysis identified residues in the SARS-CoV-2 RBD that are critical for ACE2 binding, the majority of which either are highly conserved or share similar side chain properties with those in the SARS-CoV RBD. Such similarity in structure and sequence strongly argue for convergent evolution between the SARS-CoV-2 and SARS-CoV RBDs for improved binding to ACE2, although SARS-CoV-2 does not cluster within SARS and SARS-related coronaviruses1–3,5. The epitopes of two SARS-CoV antibodies targeting the RBD are also analysed with the SARS-CoV-2 RBD, providing insights into the future identification of cross-reactive antibodies.
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Background The coronavirus disease 2019 (Covid-19) outbreak is evolving rapidly worldwide. Objective To evaluate the risk of serious adverse outcomes in patients with coronavirus disease 2019 (Covid-19) by stratifying the comorbidity status. Methods We analysed the data from 1590 laboratory-confirmed hospitalised patients 575 hospitals in 31 province/autonomous regions/provincial municipalities across mainland China between December 11 th , 2019 and January 31 st , 2020. We analyse the composite endpoints, which consisted of admission to intensive care unit, or invasive ventilation, or death. The risk of reaching to the composite endpoints was compared according to the presence and number of comorbidities. Results The mean age was 48.9 years. 686 patients (42.7%) were females. Severe cases accounted for 16.0% of the study population. 131 (8.2%) patients reached to the composite endpoints. 399 (25.1%) reported having at least one comorbidity. The most prevalent comorbidity was hypertension (16.9%), followed by diabetes (8.2%). 130 (8.2%) patients reported having two or more comorbidities. After adjusting for age and smoking status, COPD [hazards ratio (HR) 2.681, 95% confidence interval (95%CI) 1.424–5.048], diabetes (HR 1.59, 95%CI 1.03–2.45), hypertension (HR 1.58, 95%CI 1.07–2.32) and malignancy (HR 3.50, 95%CI 1.60–7.64) were risk factors of reaching to the composite endpoints. The HR was 1.79 (95%CI 1.16–2.77) among patients with at least one comorbidity and 2.59 (95%CI 1.61–4.17) among patients with two or more comorbidities. Conclusion Among laboratory-confirmed cases of Covid-19, patients with any comorbidity yielded poorer clinical outcomes than those without. A greater number of comorbidities also correlated with poorer clinical outcomes.
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In December 2019, a coronavirus 2019 (COVID-19) disease outbreak occurred in Wuhan, Hubei Province, China, and rapidly spread to other areas worldwide. Although diffuse alveolar damage and acute respiratory failure were the main features, the involvement of other organs needs to be explored. Since information on kidney disease in patients with COVID-19 is limited, we determined the prevalence of acute kidney injury (AKI) in patients with COVID-19. Further, we evaluated the association between markers of abnormal kidney function and death in patients with COVID-19. This was a prospective cohort study of 701 patients with COVID-19 admitted in a tertiary teaching hospital that also encompassed three affiliates following this major outbreak in Wuhan in 2020 of whom 113 (16.1%) died in hospital. Median age of the patients was 63 years (inter quartile range, 50-71), including 367 men and 334 women. On admission, 43.9% of patients had proteinuria and 26.7% had hematuria. The prevalence of elevated serum creatinine, elevated blood urea nitrogen and estimated glomerular filtration under 60 ml/min/1.73m² were 14.4, 13.1 and 13.1%, respectively. During the study period, AKI occurred in 5.1% patients. Kaplan–Meier analysis demonstrated that patients with kidney disease had a significantly higher risk for in-hospital death. Cox proportional hazard regression confirmed that elevated baseline serum creatinine (hazard ratio: 2.10, 95% confidence interval: 1.36-3.26), elevated baseline blood urea nitrogen (3.97, 2.57-6.14), AKI stage 1 (1.90, 0.76-4.76), stage 2 (3.51, 1.49-8.26), stage 3 (4.38, 2.31-8.31), proteinuria 1+ (1.80, 0.81-4.00), 2+∼3+ (4.84, 2.00-11.70), and hematuria 1+ (2.99, 1.39-6.42), 2+∼3+ (5.56,2.58- 12.01) were independent risk factors for in-hospital death after adjusting for age, sex, disease severity, comorbidity and leukocyte count. Thus, our findings show the prevalence of kidney disease on admission and the development of AKI during hospitalization in patients with COVID-19 is high and is associated with in-hospital mortality. Hence, clinicians should increase their awareness of kidney disease in patients with severe COVID-19.
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Since the SARS outbreak 18 years ago, a large number of severe acute respiratory syndrome-related coronaviruses (SARSr-CoV) have been discovered in their natural reservoir host, bats1–4. Previous studies indicated that some of those bat SARSr-CoVs have the potential to infect humans5–7. Here we report the identification and characterization of a novel coronavirus (2019-nCoV) which caused an epidemic of acute respiratory syndrome in humans in Wuhan, China. The epidemic, which started from 12 December 2019, has caused 2,050 laboratory-confirmed infections with 56 fatal cases by 26 January 2020. Full-length genome sequences were obtained from five patients at the early stage of the outbreak. They are almost identical to each other and share 79.5% sequence identify to SARS-CoV. Furthermore, it was found that 2019-nCoV is 96% identical at the whole-genome level to a bat coronavirus. The pairwise protein sequence analysis of seven conserved non-structural proteins show that this virus belongs to the species of SARSr-CoV. The 2019-nCoV virus was then isolated from the bronchoalveolar lavage fluid of a critically ill patient, which can be neutralized by sera from several patients. Importantly, we have confirmed that this novel CoV uses the same cell entry receptor, ACE2, as SARS-CoV.
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