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Background A subset of critically ill COVID-19 patients develop a hyperinflammatory state. Anakinra, a recombinant interleukin-1 receptor antagonist, is known to be effective in several hyperinflammatory diseases. We investigated the effects of anakinra on inflammatory parameters and clinical outcomes in critically ill, mechanically ventilated COVID-19 patients with clinical features of hyperinflammation. Methods In this prospective cohort study, 21 critically ill COVID-19 patients treated with anakinra were compared to a group of standard care. Serial data of clinical inflammatory parameters and concentrations of multiple circulating cytokines were determined and aligned on start day of anakinra in the treatment group, and median start day of anakinra in the control group. Analysis was performed for day − 10 to + 10 relative to alignment day. Clinical outcomes were analyzed during 28 days. Additionally, three sensitivity analyses were performed: (1) using propensity score-matched groups, (2) selecting patients who did not receive corticosteroids, and (3) using a subset of the control group aimed to match the criteria (fever, elevated ferritin) for starting anakinra treatment. Results Baseline patient characteristics and clinical parameters on ICU admission were similar between groups. As a consequence of bias by indication, plasma levels of aspartate aminotransferase (ASAT) ( p  = 0.0002), ferritin ( p  = 0.009), and temperature ( p  = 0.001) were significantly higher in the anakinra group on alignment day. Following treatment, no relevant differences in kinetics of circulating cytokines were observed between both groups. Decreases of clinical parameters, including temperature ( p  = 0.03), white blood cell counts ( p  = 0.02), and plasma levels of ferritin ( p  = 0.003), procalcitonin ( p  = 0.001), creatinine ( p  = 0.01), and bilirubin ( p  = 0.007), were more pronounced in the anakinra group. No differences in duration of mechanical ventilation or ICU length of stay were observed between groups. Sensitivity analyses confirmed these results. Conclusions Anakinra is effective in reducing clinical signs of hyperinflammation in critically ill COVID-19 patients. A randomized controlled trial is warranted to draw conclusion about the effects of anakinra on clinical outcomes.

Delayed admission of myocardial infarction (MI) patients is an important prognostic factor. In the present nationwide registry (TURKMI-2), we evaluated the treatment delays and outcomes of patients with acute MI during the Covid-19 pandemic and compaired with a recentpre-pandemic registry (TURKMI-1). The pandemic and pre-pandemic studies were conducted prospectively as 15-day snapshot registries in the same 48 centers. The inclusion criteria for both registries were aged ≥18 years and a final diagnosis of acute MI (AMI) with positive troponin levels. The only difference between the 2 registries was that the pre-pandemic (TURKMI-1) registry (n=1872) included only patients presenting within the first 48 hours after symptom-onset. TURKMI-2 enrolled all consecutive patients (n=1113) presenting with AMI during the pandemic period. A comparison of the patients with acute MI presenting within the 48-hour of symptom-onset in the pre-pandemic and pandemic registries revealed an overall 47.1% decrease in acute MI admissions during the pandemic. Median time from symptom-onset to hospital-arrival increased from 150 min to 185 min in patients with ST elevation MI (STEMI) and 295 min to 419 min in patients presenting with non-STEMI (NSTEMI) (p-values <0.001). Door-to-balloon time was similar in the two periods (37 vs. 40 min, p=0.448). In the pandemic period, percutaneous coronary intervention (PCI) decreased, especially in the NSTEMI group (60.3% vs. 47.4% in NSTEMI, p<0.001; 94.8% vs. 91.1% in STEMI, p=0.013) but the decrease was not significant in STEMI patients admitted within 12 hours of symptom-onset (94.9% vs. 92.1%; p=0.075). In-hospital major adverse cardiac events (MACE) were significantly increased during the pandemic period [4.8% vs. 8.9%; p<0.001; age- and sex-adjusted Odds ratio (95% CI) 1.96 (1.20-3.22) for NSTEMI, p=0.007; and 2.08 (1.38-3.13) for STEMI, p<0.001]. The present comparison of 2 nationwide registries showed a significant delay in treatment of patients presenting with acute MI during the COVID-19 pandemic. Although PCI was performed in a timely fashion, an increase in treatment delay might be responsible for the increased risk of MACE. Public education and establishing COVID-free hospitals are necessary to overcome patients' fear of using healthcare services and mitigate the potential complications of AMI during the pandemic. (Anatol J Cardiol 2020; 24: 334-42).

This study compared live instructor-led training with video-based instruction in personal protective equipment (PPE) donning and doffing. It assessed the difference in performance between (1) attending 1 instructor-led training session in donning and doffing PPE at 1 month prior to assessment, and (2) watching training videos for 1 month. This randomized controlled trial pilot study divided 21 medical students and junior doctors into 2 groups. Control group participants attended 1 instructor-led training session. Video group participants watched training videos demonstrating the same procedures, which they could freely watch again at home. After 1 month, a doctor performed a blind evaluation of performance using checklists. Nineteen participants were assessed after 1 month. The mean donning score was 84.8/100 for the instructor-led group and 88/100 for the video group; mean effect size was 3.2 (95% CI: -7.5 to 9.5). The mean doffing score was 79.1/100 for the instructor-led group and 73.9/100 for the video group; mean effect size was 5.2 (95% CI: -7.6 to 18). Our study found no significant difference in donning and doffing scores between instructor-led and video lessons. Video training could be a fast and resource-efficient method of training in PPE donning and doffing in responding to the COVID-19 pandemic.

PurposeTeen dating violence (TDV) is a global public health and safety issue causing health impacts to youth people. This study aimed to examine: (1) the impact of the pandemic on TDV victimisation rates and (2) socioecological factors associated with sustained risk for TDV victimisation during the first year of COVID-19.MethodsData are from an ongoing randomised controlled trial of a TDV prevention programme in Texas (n=2768). We conducted annual assessments in 2019–2021. We used regression modelling to assess demographic, individual, peer and family factors associated with TDV risks.ResultsTDV rates declined from 11.9% in 2019 to 5.2% in 2021. While demographic, peer and family/household factors were not associated with TDV victimisation during the pandemic, individual-level factors (ie, early sexual debut, substance use, acceptance of violence and prior TDV involvement) were related to COVID-era risks. Only early sexual debut was uniquely linked to TDV victimisation risk the first year of COVID-19.ConclusionsWhile TDV rates declined during the pandemic, previous victimisation, substance use and early sexual debut remained potent risks for relationship harm.

Aims A reduction of habitual physical activity due to prolonged COVID‐19 quarantine can have serious consequences for patients with cardiovascular diseases, such as heart failure. This study aimed to explore the effect of COVID‐19 nationwide quarantine on accelerometer‐assessed physical activity of heart failure patients. Methods and results We analysed the daily number of steps in 26 heart failure patients during a 6‐week period that included 3 weeks immediately preceding the onset of the quarantine and the first 3 weeks of the quarantine. The daily number of steps was assessed using a wrist‐worn accelerometer worn by the patients as part of an ongoing randomized controlled trial. Multilevel modelling was used to explore the effect of the quarantine on the daily step count adjusted for weather conditions. As compared with the 3 weeks before the onset of the quarantine, the step count was significantly lower during each of the first 3 weeks of the quarantine (P < 0.05). When the daily step count was averaged across the 3 weeks before and during the quarantine, the decrease amounted to 1134 (SE 189) steps per day (P < 0.001), which translated to a 16.2% decrease. Conclusions The introduction of the nationwide quarantine due to COVID‐19 had a detrimental effect on the level of habitual physical activity in heart failure patients, leading to an abrupt decrease of daily step count that lasted for at least the 3‐week study period. Staying active and maintaining sufficient levels of physical activity during the COVID‐19 pandemic are essential despite the unfavourable circumstances of quarantine.

The COVID-19 pandemic likely had an effect on the outcome of the 2020 US presidential election. Was it responsible for the defeat of incumbent President Donald Trump? The present study makes an initial attempt at, and provides a model for, understanding the pandemic’s influence on Trump support. The study employed a mixed experimental and correlational design and surveyed separate samples of adults (N = 1,763) in six waves beginning March 23, 2020 and ending June 1, 2020. Participants were randomly assigned to report their Trump support either before or after being reminded of the pandemic with a series of questions gauging their level of concern about it. Results revealed complex and dynamic effects that changed over time. Depending on survey wave, the pandemic seems to have lowered Trump support among Democrats, while (marginally) raising it among independents. Republicans’ reactions also changed over time; of particular note, Republicans who were more concerned about the pandemic reported higher Trump support after being reminded of the pandemic in its early stages, but this effect reversed by the time the economy began reopening (coinciding with a dip in Trump’s approval ratings). Although the correlational results in the present study did not converge neatly with the experimental results, the combined experimental and correlational approach has the potential to increase researchers’ confidence in the causal effects of salient national and international events on political attitudes.

PurposeHydroxychloroquine, chloroquine, and azithromycin have been used for treatment of COVID-19, but may cause QT prolongation. Minority populations are disproportionately impacted by COVID-19. This study evaluates the risk of QT prolongation and subsequent outcomes after administration of these medications in largely underrepresented minority COVID-19 patients.MethodsWe conducted an observational study on hospitalized COVID-19 patients in the Montefiore Health System (Bronx, NY). We examined electrocardiograms (ECG) pre/post-medication initiation to evaluate QTc, HR, QRS duration, and presence of other arrhythmias.ResultsOne hundred five patients (mean age 67 years; 44.8% F) were analyzed. The median time from the first dose of any treatment to post-medication ECG was 2 days (IQR: 1–3). QTc in men increased from baseline (440 vs 455 ms, p < 0.001), as well as in women (438 vs 463 ms, p < 0.001). The proportion of patients with QT prolongation increased significantly (14.3% vs 34.3%, p < 0.001) even when adjusted for electrolyte abnormalities. The number of patients whose QTc > 500 ms was significantly increased after treatment (16.2% vs. 4.8%, p < 0.01). Patients with either QTc > 500 ms or an increase of 60 ms had a higher frequency of death (47.6% vs. 22.6%, p = 0.02) with an odds ratio of 3.1 (95% CI: 1.1–8.7). Adjusting for race/ethnicity yielded no significant associations.ConclusionsHydroxychloroquine, chloroquine, and/or azithromycin were associated with QTc prolongation but did not result in fatal arrhythmias. Our findings suggest that any harm is unlikely to outweigh potential benefits of treatment. Careful risk-benefit analyses for individual patients should guide the use of these medications. Randomized control trials are necessary to evaluate their efficacies.

This survey analysis of randomized clinical trials registered within 100 days of the first reported case of coronavirus disease 2019 assessed recruitment and results reporting.

This study investigates the association between the treatment with hydroxychloroquine and mortality in patients admitted with COVID-19. Routinely recorded, clinical data, up to the 24th of April 2020, from the 2075 patients with COVID-19, admitted in 17 hospitals in Spain between the 1st of March and the 20th of April 2020 were used. The following variables were extracted for this study: age, gender, temperature, and saturation of oxygen on admission, treatment with hydroxychloroquine, azithromycin, heparin, steroids, tocilizumab, a combination of lopinavir with ritonavir, and oseltamivir, together with data on mortality. Multivariable logistic regression models were used to investigate the associations. At the time of collecting the data, 301 patients had died, 1449 had been discharged home from the hospitals, 240 were still admitted, and 85 had been transferred to hospitals not included in the study. Median follow-up time was 8 (IQR 5–12) days. Hydroxychloroquine had been used in 1857 patients. Hydroxychloroquine was associated with lower mortality when the model was adjusted for age and gender, with OR (95% CI): 0.44 (0.29–0.67). This association remained significant when saturation of oxygen < 90% and temperature > 37 °C were added to de model with OR 0.45 (0.30–0.68) p < 0.001, and also when all the other drugs, and time of admission, were included as covariates. The association between hydroxychloroquine and lower mortality observed in this study can be acknowledged by clinicians in hospitals and in the community. Randomized-controlled trials to assess the causal effects of hydroxychloroquine in different therapeutic regimes are required.

Background Whether morbidity from the 1918‐19 influenza pandemic discriminated by socioeconomic status has remained a subject of debate for 100 years. In lack of data to study this issue, the recent literature has hypothesized that morbidity was “socially neutral.” Objectives To study the associations between influenza‐like illness (ILI) and socioeconomic status (SES), gender, and wave during the 1918‐19 influenza pandemic. Methods Availability of incidence data on the 1918‐19 pandemic is scarce, in particular for waves other than the “fall wave” October‐December 1918. Here, an overlooked survey from Bergen, Norway (n = 10 633), is used to study differences in probabilities of ILI and ILI probability ratios by apartment size as a measure of SES and gender for 3 waves including the waves prior to and after the “fall wave.” Results Socioeconomic status was negatively associated with ILI in the first wave, but positively associated in the second wave. At all SES levels, men had the highest ILI in the summer, while women had the highest ILI in the fall. There were no SES or gender differences in ILI in the winter of 1919. Conclusions For the first time, it is documented a crossover in the role of socioeconomic status in 1918 pandemic morbidity. The poor came down with influenza first, while the rich with less exposure in the first wave had the highest morbidity in the second wave. The study suggests that the socioeconomically disadvantaged should be prioritized if vaccines are of limited availability in a future pandemic.