Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

The pandemic of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused an unprecedented global social and economic impact, and high numbers of deaths. Many risk factors have been identified in the progression of COVID-19 into a severe and critical stage, including old age, male gender, underlying comorbidities such as hypertension, diabetes, obesity, chronic lung diseases, heart, liver and kidney diseases, tumors, clinically apparent immunodeficiencies, local immunodeficiencies, such as early type I interferon secretion capacity, and pregnancy. Possible complications include acute kidney injury, coagulation disorders, thoromboembolism. The development of lymphopenia and eosinopenia are laboratory indicators of COVID-19. Laboratory parameters to monitor disease progression include lactate dehydrogenase, procalcitonin, high-sensitivity C-reactive protein, proinflammatory cytokines such as interleukin (IL)-6, IL-1β, Krebs von den Lungen-6 (KL-6), and ferritin. The development of a cytokine storm and extensive chest computed tomography imaging patterns are indicators of a severe disease. In addition, socioeconomic status, diet, lifestyle, geographical differences, ethnicity, exposed viral load, day of initiation of treatment, and quality of health care have been reported to influence individual outcomes. In this review, we highlight the scientific evidence on the risk factors of severity of COVID-19.

Risk factors for severe and critically ill COVID-19 patients: A review.

South Australia is presently in the throes of major changes to its regulatory system governing land use, development of land and the development of planning policy against which development assessment decisions are to be made. Eventually the planning and development control system established under the Development Act 1993 (SA) will be replaced by a new system implemented by the Planning, Development and Infrastructure Act 2016 (SA) (the new Act).

COVID-19 Generated Changes to Planning and Development Controls in South Australia (preprint)

The coronavirus disease 2019 pandemic (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused an unprecedented global social and economic impact, and numerous deaths. Many risk factors have been identified in the progression of COVID-19 into a severe and critical stage, including old age, male gender, underlying comorbidities such as hypertension, diabetes, obesity, chronic lung disease, heart, liver and kidney diseases, tumors, clinically apparent immunodeficiencies, local immunodeficiencies, such as early type-I interferon secretion capacity, and pregnancy. Possible complications include acute respiratory distress syndrome, shock, disseminated coagulopathy, acute kidney injury, pulmonary embolism, and secondary bacterial pneumonia. The development of lymphopenia and eosinopenia are laboratory indicators of COVID-19. Laboratory parameters to monitor disease progression include lactate dehydrogenase, procalcitonin, high-sensitivity C-reactive protein, proinflammatory cytokines such as interleukin (IL)-6, IL-1, Krebs von den Lungen-6 (KL-6) and ferritin. The development of a cytokine storm and extensive chest computed tomography imaging patterns are indicators of a severe disease. In addition, socioeconomic status, diet, lifestyle, geographical differences, ethnicity, exposed viral load, day of initiation of treatment, and quality of health care have been reported to influence individual outcomes. In this review, we highlight the scientific evidence on the risk factors of COVID-19.

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Risk factors for severe and critically ill COVID-19 patients: a review

Importance
Older patients and those with comorbidities who are infected with SARS-CoV-2 may be at increased risk of hospitalization and death. Sotrovimab is a neutralizing antibody for the treatment of high-risk patients to prevent COVID-19 progression.


Objective
To evaluate the efficacy and adverse events of sotrovimab in preventing progression of mild to moderate COVID-19 to severe disease.


Design, Setting, and Participants
Randomized clinical trial including 1057 nonhospitalized patients with symptomatic, mild to moderate COVID-19 and at least 1 risk factor for progression conducted at 57 sites in Brazil, Canada, Peru, Spain, and the US from August 27, 2020, through March 11, 2021; follow-up data were collected through April 8, 2021.


Interventions
Patients were randomized (1:1) to an intravenous infusion with 500 mg of sotrovimab (n = 528) or placebo (n = 529).


Main Outcomes and Measures
The primary outcome was the proportion of patients with COVID-19 progression through day 29 (all-cause hospitalization lasting >24 hours for acute illness management or death); 5 secondary outcomes were tested in hierarchal order, including a composite of all-cause emergency department (ED) visit, hospitalization of any duration for acute illness management, or death through day 29 and progression to severe or critical respiratory COVID-19 requiring supplemental oxygen or mechanical ventilation.


Results
Enrollment was stopped early for efficacy at the prespecified interim analysis. Among 1057 patients randomized (median age, 53 years [IQR, 42-62], 20% were ≥65 years of age, and 65% Latinx), the median duration of follow-up was 103 days for sotrovimab and 102 days for placebo. All-cause hospitalization lasting longer than 24 hours or death was significantly reduced with sotrovimab (6/528 [1%]) vs placebo (30/529 [6%]) (adjusted relative risk [RR], 0.21 [95% CI, 0.09 to 0.50]; absolute difference, -4.53% [95% CI, -6.70% to -2.37%]; P < .001). Four of the 5 secondary outcomes were statistically significant in favor of sotrovimab, including reduced ED visit, hospitalization, or death (13/528 [2%] for sotrovimab vs 39/529 [7%] for placebo; adjusted RR, 0.34 [95% CI, 0.19 to 0.63]; absolute difference, -4.91% [95% CI, -7.50% to -2.32%]; P < .001) and progression to severe or critical respiratory COVID-19 (7/528 [1%] for sotrovimab vs 28/529 [5%] for placebo; adjusted RR, 0.26 [95% CI, 0.12 to 0.59]; absolute difference, -3.97% [95% CI, -6.11% to -1.82%]; P = .002). Adverse events were infrequent and similar between treatment groups (22% for sotrovimab vs 23% for placebo); the most common events were diarrhea with sotrovimab (n = 8; 2%) and COVID-19 pneumonia with placebo (n = 22; 4%).


Conclusions and Relevance
Among nonhospitalized patients with mild to moderate COVID-19 and at risk of disease progression, a single intravenous dose of sotrovimab, compared with placebo, significantly reduced the risk of a composite end point of all-cause hospitalization or death through day 29. The findings support sotrovimab as a treatment option for nonhospitalized, high-risk patients with mild to moderate COVID-19, although efficacy against SARS-CoV-2 variants that have emerged since the study was completed is unknown.


Trial Registration
ClinicalTrials.gov Identifier: NCT04545060.

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Effect of Sotrovimab on Hospitalization or Death Among High-risk Patients With Mild to Moderate COVID-19: A Randomized Clinical Trial.

To the Editor, Allergic asthma (AA) and allergic rhinitis (AR) might be protective against SRAS‐CoV‐2 infection and progress to severe disease of coronavirus disease 2019 (COVID‐19). COVID‐19 vaccination was safe and well tolerated in patients receiving allergen immunotherapy (AIT), and the adherence to subcutaneous immunotherapy (SCIT) was not affected during COVID‐19 pandemic. AIT induces allergen‐ specific tolerance by attenuating allergen‐specific T helper 2 (Th2) cells and inducing regulatory T and B cells and interleukin (IL)‐10. We hypothesized that AIT may have a protective impact on the susceptibility and severity of COVID‐19. In December 2022, China ended its ‘Zero‐COVID’ policy and more than 70% of the population got infected with SARS‐CoV‐2 within one month. We conducted an online WeChat questionnaire between 3 January and 10 January 2023 in order to investigate the infection and hospitalization rates and symptom duration of COVID‐ 19 in patients with AR and/or AA receiving SCIT with house‐dust mite (HDM) extract. The patients with AR and AA receiving HDM‐ SCIT were from three allergy centers (Tongji Hospital, Zhongnan Hospital, and Central Hospital of Huangshi City) in Hubei province, China. In this study, HDM‐induced AR was diagnosed according to ARIA (allergic rhinitis and its impact on asthma): typical symptoms of nasal pruritus, sneezing, rhinorrhea, and nasal congestion in combination with evidence of HDM sensitization (positive skin prick test and/or specific IgE). HDM‐associated AA was diagnosed according to GINA (global initiative of asthma) and the evidence of HDM sensitization. Since the aim of this study was to investigate the effect of AIT on COVID‐19, only those patients with AR and AA receiving HDM‐SCIT were invited to participate in this study. In the three allergy centers, both Dermatophagoides pteronyssinus extract (Alutard SQ Der p, ALK‐Abelló, Hørsholm, Denmark) and Der p/Dermatophagoides farinae (Der f) extract (NovoHelisen Depot [NHD]; Allergopharma, Reinbek, Germany) were used for HDM‐SICT in AR and AA patients. The questionnaire was designed by the authors with the App Wenjuanxin, and a two‐dimensional barcode was generated and dispensed in the WeChat group of AR and AA patients receiving HDM‐SCIT. The data of questionnaire were also collected with the App Wenjuanxin. The relatives of these SCIT patients, who did not receive SCIT, were also surveyed with the same questionnaire and divided into two groups: allergy group, when they did not report any of physician‐ diagnosed allergic diseases, including AR, AA, food allergy, and atopic dermatitis, and non‐allergy group, when they did not report a history of any aforementioned allergic diseases. The study was approved by the Medical Ethic Committee of Tongji Hospital of Huazhong University of Science and Technology (Approval Number: TJ‐IRB20230204). The informed consent was waived since the voluntary nature of responding to the questionnaire. A total of 1246 patients receiving SCIT and 1078 of their relatives (370 allergic and 708 non‐allergic) responded to the questionnaire. Patients with SCIT were generally younger than allergy and non‐allergy groups. The proportion of male was higher in patients with SCIT than allergy and non‐allergy groups. About 82.4% of the patients with SCIT were diagnosed with AR, only 5.3% were asthmatics, and the rest were AR with asthma (12.3%). The average duration of SCIT was 1.4 � 1.3 years. Patients with SCIT had a lower proportion of both at least one dose and completed three doses of COVID‐19 vaccines when compared to allergy and non‐allergy groups (p = 0.000) (Table S1). Most respondents had been infected with SARS‐CoV‐2. HDM‐ SCIT was associated with a lower infection rate (78.6%) compared to allergy (81.4%) and non‐allergy groups (81.5%) (p < 0.0001) (Figure 1 and Table S2). The duration of COVID‐19 symptoms was shorter in the SCIT group (5.7 � 4.0 days) than the allergy group (7.0 � 4.5 days, p = 0.000) and the non‐allergy group (7.7 � 4.4 days, p = 0.000) (Figure 1 and Table S2). The hospitalization rate was 0.4% in the SCIT group, which was significantly lower than that in the non‐ allergy group (1.73%) (p = 0.008) (Figure 1 and Table S2). We then performed a two‐to‐one matching of the SCIT group with allergy and non‐allergy groups to adjust age, sex, and vaccination difference between the three groups. As shown in Table 1, 396 patients with SCIT and 199 patients in allergy and non‐allergy groups were included in the final analysis. The standardized mean differences for age, sex, and COVID‐19 vaccination status were 0.000, 0.000, and 0.005, suggesting that these parameters were well matched among the three groups. However, the difference of

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/clt2.12247

Hui-ling Liang

Papers

Risk factors for severe and critically ill COVID-19 patients: A review.

Risk factors for severe and critically ill COVID-19 patients: a review

Does allergen immunotherapy impact the susceptibility and severity of COVID‐19?