Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

A global experiment on motivating social distancing during the COVID-19 pandemic

Finding communication strategies that effectively motivate social distancing continues to be a global public health priority during the COVID-19 pandemic. This cross-country, preregistered experiment (n = 25,718 from 89 countries) tested hypotheses concerning generalizable positive and negative outcomes of social distancing messages that promoted personal agency and reflective choices (i.e., an autonomy-supportive message) or were restrictive and shaming (i.e., a controlling message) compared with no message at all. Results partially supported experimental hypotheses in that the controlling message increased controlled motivation (a poorly internalized form of motivation relying on shame, guilt, and fear of social consequences) relative to no message. On the other hand, the autonomy-supportive message lowered feelings of defiance compared with the controlling message, but the controlling message did not differ from receiving no message at all. Unexpectedly, messages did not influence autonomous motivation (a highly internalized form of motivation relying on one’s core values) or behavioral intentions. Results supported hypothesized associations between people’s existing autonomous and controlled motivations and self-reported behavioral intentions to engage in social distancing. Controlled motivation was associated with more defiance and less long-term behavioral intention to engage in social distancing, whereas autonomous motivation was associated with less defiance and more short- and long-term intentions to social distance. Overall, this work highlights the potential harm of using shaming and pressuring language in public health communication, with implications for the current and future global health challenges

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

The global challenges of the long COVID-19 in adults and children

Institución Universitaria Visión de las Américas. Fundación Universitaria Autónoma de las Américas. Faculty of Medicine. Grupo de Investigación Biomedicina. Pereira, Risaralda, Colombia / Universidad Científica del Sur. Faculty of Health Sciences. Lima, Peru / Lebanese American University. Gilbert and Rose-Marie Chagoury School of Medicine. Beirut, Lebanon.Fundación Universitaria Autónoma de las Américas. Faculty of Medicine. Grupo de Investigación Biomedicina. Pereira, Colombia.Fundación Universitaria Autónoma de las Américas. Faculty of Medicine. Grupo de Investigación Biomedicina. Pereira, Colombia.Fundación Universitaria Autónoma de las Américas. Faculty of Medicine. Grupo de Investigación Biomedicina. Pereira, Colombia.Fundación Universitaria Autónoma de las Américas. Faculty of Medicine. Grupo de Investigación Biomedicina. Pereira, Colombia.Fundación Universitaria Autónoma de las Américas. Faculty of Medicine. Grupo de Investigación Biomedicina. Pereira, Colombia.Fundación Universitaria Autónoma de las Américas. Faculty of Medicine. Grupo de Investigación Biomedicina. Pereira, Colombia.Fundación Universitaria Autónoma de las Américas. Faculty of Medicine. Grupo de Investigación Biomedicina. Pereira, Colombia.Fundación Universitaria Autónoma de las Américas. Faculty of Medicine. Grupo de Investigación Biomedicina. Pereira, Colombia.Universidad Científica del Sur. Faculty of Health Sciences. Lima, Peru.Lebanese American University. Gilbert and Rose-Marie Chagoury School of Medicine. Beirut, Lebanon.Lebanese American University. Gilbert and Rose-Marie Chagoury School of Medicine. Beirut, Lebanon.Lebanese American University. Gilbert and Rose-Marie Chagoury School of Medicine. Beirut, Lebanon.Lebanese American University. Gilbert and Rose-Marie Chagoury School of Medicine. Beirut, Lebanon.Lebanese American University. Gilbert and Rose-Marie Chagoury School of Medicine. Beirut, Lebanon.Lebanese American University. Gilbert and Rose-Marie Chagoury School of Medicine. Beirut, Lebanon.Lebanese American University. Gilbert and Rose-Marie Chagoury School of Medicine. Beirut, Lebanon.Lebanese American University. Gilbert and Rose-Marie Chagoury School of Medicine. Beirut, Lebanon.Lebanese American University. Gilbert and Rose-Marie Chagoury School of Medicine. Beirut, Lebanon.Lebanese American University. Gilbert and Rose-Marie Chagoury School of Medicine. Beirut, Lebanon.Municipal Autonomous Government of Cochabamba. Municipal Secretary of Health. Direction of First Level. Cochabamba, Bolivia.Franz Tamayo University. National Research Coordination. La Paz, Bolivia.Universidad Continental. Research Unit. Huancayo, Peru.Universidad Nacional de Colombia. Department of Pediatrics. Bogotá, DC, Colombia / Fundación HOMI. Hospital Pediátrico La Misericordia. Division of Infectious Diseases. Bogotá, DC, Colombia / Fundación Hospital Infantil Universitario de San José. Bogotá, DC, Colombia.Hemera Unidad de Infectología IPS SAS. Bogota, Colombia.Hospital San Vicente Fundación. Rionegro, Antioquia, Colombia.Clinica Imbanaco Grupo Quironsalud. Cali, Colombia / Universidad Santiago de Cali. Cali, Colombia / Clinica de Occidente. Cali, Colombia / Clinica Sebastián de Belalcazar. Valle del Cauca, Colombia.University of Buenos Aires. Cátedra de Enfermedades Infecciosas. Buenos Aires, Argentina.Universidade Estadual Paulista Júlio de Mesquita Filho. Botucatu Medical School. Infectious Diseases Department. São Paulo, SP, Brazil / Brazilian Society for Infectious Diseases. São Paulo, SP, Brazil.Institute of Infectious Diseases Emilio Ribas. São Paulo, SP, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil / Universidade Federal do Pará. Faculdade de Medicina. Belém, PA, Brazil.University of Buenos Aires. Cátedra de Enfermedades Infecciosas. Buenos Aires, Argentina / Hospital de Enfermedades Infecciosas F. J. Muñiz. Buenos Aires, Argentina.University of Buenos Aires. Cátedra de Enfermedades Infecciosas. Buenos Aires, Argentina / Hospital de Enfermedades Infecciosas F. J. Muñiz. Buenos Aires, Argentina.Centro de Referencia de Salud Dr. Salvador Allende Gossens. Policlínico Neurología. Unidad Procedimientos. Santiago de Chile, Chile.Hospital Salvador Bienvenido Gautier. Santo Domingo, Dominican Republic.Universidad Central del Ecuador. Jefatura de Cátedra de Enfermedades Infecciosas. Quito, Ecuador.Universidad Autónoma de Santo Domingo. Santo Domingo, Dominican Republic.Hospital Roosevelt. Guatemala City, GuatemalaNational Autonomous University of Honduras. Institute for Research in Medical Sciences and Right to Health. Tegucigalpa, Honduras.National Clinical Coordinator COVID-19-WHO Studies. Colombia / Universidad Nacional de Colombia. Facultad de Medicina. Clinica Colsanitas. Clinica Universitaria Colombia. Colombia.Think Vaccines LLC. Houston, Texas, USA.Universidad Simón Bolívar. Centro de Investigación en Ciencias de la Vida. Barranquilla, Colombia / Grupo de Expertos Clínicos Secretaria de Salud de Barranquilla. Barranquilla, Colombia.Universidad San Ignacio de Loyola. Vicerrectorado de Investigación. Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud. Lima, Peru.Hospital Evangélico de Montevideo. Montevideo, Uruguay.Fundación Universitaria Autónoma de las Américas. Faculty of Medicine. Grupo de Investigación Biomedicina. Pereira, Colombia / University of California. School of Public Health. Division of Infectious Diseases and Vaccinology. Berkeley, CA, USA.Universidad Central de Venezuela. Faculty of Medicine. Caracas, Venezuela.Universidad Central de Venezuela. Faculty of Medicine. Caracas, Venezuela / Biomedical Research and Therapeutic Vaccines Institute. Ciudad Bolivar, Venezuela.University of Colorado Anschutz Medical Campus. School of Medicine. Division of Infectious Diseases. Aurora, CO, USA.Tribhuvan University Teaching Hospital. Institute of Medicine. Kathmandu, Nepal / Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth. Dr. D. Y. Patil Medical College. Department of Microbiology. Pune, Maharashtra, India / Dr. D.Y. Patil Dental College and Hospital. Department of Public Health Dentistry. Dr. D.Y. Patil Vidyapeeth, Maharashtra, India.Universidad Cesar Vallejo. Escuela de Medicina. Trujillo, Peru.Universidad de San Martín de Porres. Facultad de Medicina Humana. Chiclayo, Peru.Friedrich Schiller University Jena. Institute of Microbiology. Beutenbergstraße, Jena, Germany / Pontificia Universidad Católica del Ecuador. School of Medicine. Postgraduate Program in Infectious Diseases. Quito, Ecuador.Universidad Simón Bolivar. Faculty of Health Sciences. Barranquilla, Colombia.Johns Hopkins Aramco Healthcare. Specialty Internal Medicine and Quality Department. Dhahran, Saudi Arabia / Indiana University School of Medicine. Department of Medicine. Infectious Disease Division. Indianapolis, IN, USA / Johns Hopkins University School of Medicine. Department of Medicine. Infectious Disease Division. Baltimore, MD, USA.Johns Hopkins Aramco Healthcare. Molecular Diagnostic Laboratory. Dhahran, Saudi Arabia / Alfaisal University. College of Medicine. Riyadh, Saudi Arabia / The University of Haripur. Department of Public Health and Nutrition. Haripur, Pakistan.VM Medicalpark Samsun Hospital. Department of Infectious Diseases. Samsun, Turkey.University of Miami. Miller School of Medicine. Department of Medicine. Division of Infectious Diseases. Miami, FL, USA.Caja Costarricense de Seguro Social. Centro de Ciencias Médicas. Hospital Nacional de Niños Dr. Carlos Sáenz Herrera. Servicio de Infectología Pediátrica. San José, Costa Rica / Instituto de Investigación en Ciencias Médicas. San José, Costa Rica / Universidad de Ciencias Médicas. Facultad de Medicina. Cátedra de Pediatría. San José, Costa Rica

A Global Experiment on Motivating Social Distancing during the COVID-19 Pandemic

Finding communication strategies that effectively motivate social distancing continues to be a global public health priority during the COVID-19 pandemic. This cross-country, preregistered experiment (n = 25,718 from 89 countries) tested hypotheses concerning generalizable positive and negative outcomes of social distancing messages that promoted personal agency and reflective choices (i.e., an autonomy-supportive message) or were restrictive and shaming (i.e. a controlling message) compared to no message at all. Results partially supported experimental hypotheses in that the controlling message increased controlled motivation (a poorly-internalized form of motivation relying on shame, guilt, and fear of social consequences) relative to no message. On the other hand, the autonomy-supportive message lowered feelings of defiance compared to the controlling message, but the controlling message did not differ from receiving no message at all. Unexpectedly, messages did not influence autonomous motivation (a highly-internalized form of motivation relying on one’s core values) or behavioral intentions. Results supported hypothesized associations between people’s existing autonomous and controlled motivations and self-reported behavioral intentions to engage in social distancing: Controlled motivation was associated with more defiance and less long-term behavioral intentions to engage in social distancing, whereas autonomous motivation was associated with less defiance and more short- and long-term intentions to social distance. Overall, this work highlights the potential harm of using shaming and pressuring language in public health communication, with implications for the current and future global health challenges

In COVID-19 health messaging, loss framing increases anxiety with little-to-no concomitant benefits: Experimental evidence from 84 countries

The COVID-19 pandemic (and its aftermath) highlights a critical need to communicate health information effectively to the global public. Given that subtle differences in information framing can have meaningful effects on behavior, behavioral science research highlights a pressing question: Is it more effective to frame COVID-19 health messages in terms of potential losses (e.g., “If you do not practice these steps, you can endanger yourself and others”) or potential gains (e.g., “If you practice these steps, you can protect yourself and others”)? Collecting data in 48 languages from 15,929 participants in 84 countries, we experimentally tested the effects of message framing on COVID-19-related judgments, intentions, and feelings. Loss- (vs. gain-) framed messages increased self-reported anxiety among participants cross-nationally with little-to-no impact on policy attitudes, behavioral intentions, or information seeking relevant to pandemic risks. These results were consistent across 84 countries, three variations of the message framing wording, and 560 data processing and analytic choices. Thus, results provide an empirical answer to a global communication question and highlight the emotional toll of loss-framed messages. Critically, this work demonstrates the importance of considering unintended affective consequences when evaluating nudge-style interventions

A global experiment on motivating social distancing during the COVID-19 pandemic

Finding communication strategies that effectively motivate social distancing continues to be a global public health priority during the COVID-19 pandemic. This cross-country, preregistered experiment (n = 25,718 from 89 countries) tested hypotheses concerning generalizable positive and negative outcomes of social distancing messages that promoted personal agency and reflective choices (i.e., an autonomy-supportive message) or were restrictive and shaming (i.e., a controlling message) compared with no message at all. Results partially supported experimental hypotheses in that the controlling message increased controlled motivation (a poorly internalized form of motivation relying on shame, guilt, and fear of social consequences) relative to no message. On the other hand, the autonomy-supportive message lowered feelings of defiance compared with the controlling message, but the controlling message did not differ from receiving no message at all. Unexpectedly, messages did not influence autonomous motivation (a highly internalized form of motivation relying on one’s core values) or behavioral intentions. Results supported hypothesized associations between people’s existing autonomous and controlled motivations and self-reported behavioral intentions to engage in social distancing. Controlled motivation was associated with more defiance and less long-term behavioral intention to engage in social distancing, whereas autonomous motivation was associated with less defiance and more short- and long-term intentions to social distance. Overall, this work highlights the potential harm of using shaming and pressuring language in public health communication, with implications for the current and future global health challenges