Background/Objectives: Post-pandemic, real-world evidence on COVID-19 in elderly patients in Germany is limited. This study describes the clinical characteristics, treatment patterns, quality of life, and healthcare resource use among elderly patients with COVID-19. Methods: Data were derived from the Adelphi Real World COVID Disease-Specific Programme™, a cross-sectional survey of physicians and patients aged ≥60 years with acute (≤4 weeks post-diagnosis) or persistent (symptom duration ≥ 12 weeks) COVID-19 from January to July 2024. Analyses were descriptive; comparisons between groups were not performed. Results: 151 physicians provided data for 400 patients (acute COVID-19, n = 200; persistent COVID-19, n = 200). The mean patient age was 68.1 (acute) and 70.1 (persistent) years. Most patients were male (acute, 56.0%; persistent, 58.5%) and retired (acute, 68.0%; persistent, 78.5%). The most common concomitant condition was hypertension (acute, 37.5%; persistent, 35.5%). Tiredness/fatigue was the most common physician-reported symptom (57.5% acute; 67.5% persistent). For patients with acute COVID-19 that received prescribed treatment (n = 62/200, 31.0%), antivirals were most commonly used (n = 59/62, 95.2%). Mean number of consultations from the index COVID-19 diagnosis to survey date was 2.7 over a median of 17.0 days (Q1–Q3: 7.0–44.0) and 5.0 over a median of 164.0 days (Q1–Q3: 128.0–225.0) for patients with acute or persistent COVID-19, respectively. Self-reported data were provided by 98 (acute) and 107 (persistent) patients. The most common patient-reported worst symptoms were headaches (n = 15/98, 15.3%; acute) and tiredness (n = 14/107, 13.1%; persistent). Mean EQ-5D-5L index score (German weighting) was 0.79 for both groups. EQ-VAS scores were 66.1 (acute) and 66.0 (persistent). Conclusions: Elderly patients with acute or persistent COVID-19 have a notable burden of illness. Prioritizing care and interventions in these populations in the post-pandemic era is warranted.
Background: Conservative Protestant communities have exhibited various COVID-19 risks, including some evidence of elevated pandemic mortality, and have long had a lackluster overall mortality track record. Are there distinct patterns of conservative Protestant COVID-19 mortality within U.S. counties? Building on previous religion and COVID-19 research, along with insights from religious ecology and social network theories, we hypothesize that counties with greater proportions of denominational conservative Protestants (i.e., evangelicals, fundamentalists, and Pentecostals combined) will exhibit significantly higher mortality rates than those in which other religious groups and the non-religious have a more substantial market share. We further anticipate that counties populated by larger proportions of nondenominational conservative Protestants will not be subject to the same COVID-19 mortality risks because these groups exhibit network fragmentation, whereby they are outside the conservative denominational orbit. Methods: Data for this study come from multiple sources. COVID-19 mortality data were drawn from the New York Times COVID Tracking Project, 2021, and are supplemented with CDC data when needed. County-level religious market share was obtained from the 2020 U.S. Religion Census via the ARDA. Sociodemographic controls were taken from County Health Rankings, 2023, which integrates U.S. Census, ACS, NCHS, and AHRF data. County-level presidential election results were sourced from the MIT Election Data Science Lab. The final analytic sample includes 3032 counties with complete data. Results: Our findings reveal significantly higher rates of COVID-19 mortality in counties with a greater share of denominational conservative Protestant adherents, net of controls. We find similar fatality rates for counties populated by different conservative Protestant subgroups (evangelical, fundamentalist, and Pentecostal adherents). Additionally, some evidence of reduced COVID-19 mortality in counties with greater concentrations of fragmented (mostly nondenominational) conservative Protestants was observed. No significant association was observed for counties with greater isolationist conservative Protestant (Amish and Mennonite) market shares. Conclusion: The social ecology of religion proves to be an important determinant of public health in the form of COVID-19 mortality. Our findings have direct implications for ongoing research and practice concerning religion, health, and longevity.
There is no clear consensus regarding optimal use of oxygen therapy for patients with type 1 respiratory failure secondary to COVID-19. This retrospective observational cohort study evaluates high-flow nasal oxygen (HFNO) delivery in adults with COVID-19 and compares potential predictors of treatment success. Adults receiving HFNO in two tertiary hospitals in Hull, UK, between 1 March 2020 and 1 March 2021 were included. Demographic, clinical, and biochemical data were extracted from hospital records; prognostic scores were calculated retrospectively. HFNO success was defined as an improvement in oxygenation with subsequent discontinuation of HFNO without escalation to non-invasive or mechanical ventilation, or death. In total, 108 patients received HFNO (mean age 64.1 years; 66% male; 94% White/White British). Of the 65% (70/108) considered suitable for ICU, 59% (41/70) achieved HFNO success. Among patients not suitable for ICU (38/108), 24% (9/38) achieved HFNO success. Multivariate analysis identified older age (adjusted OR 1.049, 95% CI 1.015–1.085; p = 0.005) and higher CRP (adjusted OR 1.007, 95% CI 1.002–1.011; p = 0.003) as independent predictors of HFNO failure. The ISARIC 4C score demonstrated 70% positive and 71% negative predictive value for HFNO success (AUROC 0.726, 95% CI 0.628–0.823). These factors may help guide appropriate use of HFNO in patients with COVID-19.
Long-term neurofunctional outcomes after pediatric SARS-CoV-2 infection remain incompletely understood, particularly in relation to acute antiviral immune responses. This exploratory observational pilot study assessed neurofunctional performance approximately six months after infection and its association with acute nasopharyngeal interferon-related gene expression. Sixteen children aged 3–10 years with RT-qPCR-confirmed mild COVID-19 underwent cognitive, gross motor, and functional exercise assessments. Transcript abundance of IFNA2, IFNB1, IFNL2/3, IFI6, and OAS2 was evaluated by qPCR. Five children (31.25%) scored below the age-specific MMSE cutoff, and five of 14 children (35.71%) had below-average TGMD-2 performance. Thirteen completed the ISWT, achieving 53.95 ± 13.55% of the individually predicted distance. IFNB1, IFI6, and OAS2 were detected in all acute-phase samples, whereas IFNA2 and IFNL2/3 were not detected. No statistically significant associations were identified between the detected transcripts and subsequent neurofunctional outcomes. Although the small sample size, absence of pre-infection assessments, and lack of an uninfected comparison group limit interpretation of the findings, this pilot study provides preliminary descriptive data integrating acute mucosal interferon-related gene expression with subsequent neurofunctional assessments in children, supporting further investigation in larger, controlled cohorts.
COVID-19 is a multisystem disease with important gastrointestinal (GI) involvement. Diarrhea, nausea or vomiting, reduced appetite, and abdominal pain are among the most frequently reported GI manifestations during acute infection, although their prevalence varies across populations, viral variants, disease severity, and study designs. The biological basis of intestinal involvement is supported by the expression of angiotensin-converting enzyme 2 (ACE2) and host proteases required for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) entry into intestinal epithelial cells. Viral RNA and antigens have also been detected in intestinal tissues after respiratory clearance, indicating persistence of viral material in some individuals; these findings do not by themselves demonstrate replication-competent virus. Uncommon but potentially severe GI complications include acute mesenteric ischemia, ischemic colitis, gastrointestinal bleeding, ileus, intestinal perforation, and acute pancreatitis. Although COVID-19 is associated with worse outcomes in acute pancreatitis, direct viral causation remains uncertain. Persistent GI manifestations have also emerged as an important component of post-COVID disease. Studies using Rome criteria have identified new-onset disorders of gut–brain interaction, including irritable bowel syndrome, functional dyspepsia, functional diarrhea, and functional constipation. Candidate mechanisms include intestinal viral antigen persistence, epithelial barrier dysfunction, sustained immune activation, gut microbial dysbiosis, and altered tryptophan–serotonin signaling; most links remain associative rather than causally established. Altered microbial signaling may also contribute to mucosal inflammation and disturbances in gut–lung and gut–brain communication. Overall, current evidence supports GI involvement in both acute and post-acute COVID-19. Further studies integrating microbiome, metabolic, and immune profiling are needed to clarify the mechanisms underlying post-COVID GI disorders and identify potential biomarkers and therapeutic targets.
