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The rapid transition from face-to-face to online teaching due to the COVID-19 pandemic provided unprecedented experiences for Adapted Physical Education (APE) teachers while they have had many different emerging roles, demands, and expectations related to program delivery. The purpose of this study was to examine APE teachers' experiences teaching online during COVID-19. Participants included 11 APE teachers from the south region of the United States (8 females, 3 males). Data were collected through semi-structured interviews with each participant. Thematic analysis was used to analyse the data. Data analysis resulted in five themes: 'initial thought: how are we going to even do this?', 'challenges in teaching online', 'collaboration: key to overcome challenges', 'Parents' support is critical', and 'it's doable, but I am over it'. Despite the challenges experienced by the participants during COVID-19, they were able to navigate and adapt the online teaching; however, the quality and delivery of instruction declined.

Background: This study aimed to understand parents' concerns about their adult child with intellectual disabilities due to the restriction of community-based services amid the COVID-19 pandemic in South Korea. Methods: In-depth interviews were conducted face-to-face or by telephone with 19 parents of adult children with intellectual disabilities who had to stop using community-based services. Results: Participants worried that their adult child was not aware of the seriousness of COVID-19, was more susceptible to the COVID-19 virus, could not recognize self-infection and could have fatal consequences of getting infected with COVID-19. They expected challenges in their adult child's life (losing a daily routine, being isolated, regression in skills, becoming bored, lacking physical activities and increased behavioural challenges) but also experienced adjustments and hopes. Conclusion: The study demonstrated parents' worry about their adult child becoming infected with COVID-19, highlighting the urgent need for community-based services to address psychosocial challenges during the pandemic.

Individual's risk perception regarding specific hazards is a dynamic process that evolves over time. This study analyzed the relationship between the number of COVID‐19 cases and the South Korean public's risk perceptions from the outset of the pandemic to the recent past. More than 70 repeated cross‐sectional surveys were conducted biweekly to measure individuals' risk perception. An autoregressive integrated moving average with explanatory variable time series analysis was used to characterize the relationship between the number of COVID‐19 cases and level of risk perceptions. It revealed that individuals' risk perception and the number of COVID‐19 cases were not linearly related but were logarithmically correlated. This finding can be understood as a psychic numbing effect, suggesting that people's perception of risk is not linear but rather exponentially sensitive to changes. The findings also revealed a significant influence of individuals' trust in local governments on their risk perceptions, highlighting the substantial role played by local governments in direct risk management during the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Neurological complications after the coronavirus disease 2019 (COVID-19) vaccine administration have been reported. However, the incidence rates of these complications have not been compared in vaccinated and unvaccinated individuals. This study used a nationwide cohort from South Korea to investigate the incidence and prognostic factors of facial-related neurological disorders, such as facial palsy, trigeminal neuralgia, and hemifacial spasms, after COVID-19 vaccination. A population-based cohort design was used to examine data from a randomly selected 50% of the adult population in Seoul, South Korea. Information on demographics, vaccination status, vaccination type, and medical history was collected. The incidence rates and adjusted hazard ratios (aHRs) for facial-related neurological disorders were calculated. This study included 2,482,481 adults, 85.94% of whom were vaccinated. Vaccinated individuals showed a higher incidence of facial palsy, hemifacial spasm, and trigeminal neuralgia than unvaccinated individuals, with significant aHRs of 1.821, 3.203, and 6.621, respectively. Dyslipidemia, female sex, and young age were identified as risk factors for hemifacial spasms and trigeminal neuralgia. This study demonstrates an increased incidence of facial-related neurological disorders after COVID-19 vaccination, particularly among individuals with dyslipidemia and younger women. These findings underscore the need for further investigations into the mechanisms and management of vaccine-related neurological issues. [ABSTRACT FROM AUTHOR]

COVID-19 infection and subsequent quarantine experiences during the pandemic may have profoundly affected many aspects of life among COVID-19 survivors. However, limited research has explored the changes these survivors experienced once they returned to their daily lives. This study aimed to explore COVID-19 survivors' psychosocial impacts and their lives following infection and social quarantine during the initial phase of the pandemic in South Korea. Semistructured telephone interviews were conducted in June 2021, involving 15 COVID-19 survivors. All participants contracted COVID-19 between February 2020 and April 2021 in South Korea. This study used a qualitative methodology from phenomelogical perspectives to explore and understand the participants' shared lived experiences. Thematic analysis identified four overarching themes and 12 subthemes among Korean COVID-19 survivors: (a) self-concept transformation; (b) changed relationship dynamics; (c) life perspective shifts; and (d) health awareness evolution. Recognizing the life changes experienced by COVID-19 survivors can inform the development of targeted peer support services and person-centered education. Focusing on health awareness and empowerment, these initiatives can promote personal growth, facilitate positive changes, and alleviate traumatic experiences for future survivors of diverse infectious diseases. Future research could investigate the long-term impact of COVID-19 on individuals' lives and explore the mechanisms underlying these effects. [ABSTRACT FROM AUTHOR]

There is growing evidence that the coronavirus disease 2019 (COVID-19) vaccination can affect the regulation of the immune system, leading to the development of autoimmune diseases. However, the autoimmune adverse events (AEs) after COVID-19 vaccination remain largely unclear. We sought to investigate the autoimmune AEs after COVID-19 vaccination from a population-based cohort in South Korea. A total of 4,203,887 participants, representing 50% of the population residing in Seoul, were recruited from the National Health Insurance Service database and then divided into 2 groups on the basis of COVID-19 vaccination. The cumulative incidence, hazard ratios (HRs), and 95% CIs of autoimmune AEs were assessed following COVID-19 vaccination. The incidence of vitiligo has been observed to be significantly higher in the vaccination group compared with the no vaccination group. The cumulative incidence of vitiligo began to show a significant difference starting 2 weeks after vaccination, and it reached 2.2% in the vaccination group and 0.6% in the no vaccination group by 3 months after COVID-19 vaccination. Vitiligo (HR, 2.714; 95% CI, 1.777-4.146) was an increased risk among autoimmune AEs. Furthermore, the risk of vitiligo was the highest for heterologous vaccination (HR, 3.890; 95% CI, 2.303-6.573) compared with using cDNA vaccine (HR, 2.861; 95% CI, 1.838-4.453) or mRNA vaccine (HR, 2.475; 95% CI, 1.607-3.813). Vitiligo as an autoimmune AE was noted to be substantially higher in the COVID-19–vaccinated group compared with the controls. Therefore, the occurrence of vitiligo could be considered as one of the significant AEs post–COVID-19 vaccination. [ABSTRACT FROM AUTHOR]

Considering the significant burden of post-acute COVID-19 conditions among patients infected with SARS-CoV-2, we aimed to identify the risk of acute respiratory complications or post-acute respiratory sequelae. A binational population-based cohort study was conducted to analyze the risk of acute respiratory complications or post-acute respiratory sequelae after SARS-CoV-2 infection. We used a Korean nationwide claim-based cohort (K-COV-N; n = 2,312,748; main cohort) and a Japanese claim-based cohort (JMDC; n = 3,115,606; replication cohort) after multi-to-one propensity score matching. Among 2,312,748 Korean participants (mean age, 47.2 years [SD, 15.6]; 1,109,708 [48.0%] female), 17.1% (394,598/2,312,748) were infected with SARS-CoV-2. The risk of acute respiratory complications or post-acute respiratory sequelae is significantly increased in people with SARS-CoV-2 infection compared to the general population (acute respiratory complications: HR, 8.06 [95% CI, 6.92-9.38]; post-acute respiratory sequelae: 1.68 [1.62-1.75]), and the risk increased with increasing COVID-19 severity. We identified COVID-19 vaccination as an attenuating factor, showing a protective association against acute or post-acute respiratory conditions. Furthermore, while the excess post-acute risk diminished with time following SARS-CoV-2 infection, it persisted beyond 6 months post-infection. The replication cohort showed a similar pattern in the association. Our study comprehensively evaluates respiratory complications in post-COVID-19 conditions, considering attenuating factors such as vaccination status, post-infection duration, COVID-19 severity, and specific respiratory conditions. Respiratory complications of SARS-CoV-2 infection have been described in the acute (within 30 days) and post-acute (after 30 days) phase. Here, the authors characterise the risk of acute and post-acute respiratory complications of SARS-CoV-2 using population-based data from South Korea and Japan. [ABSTRACT FROM AUTHOR]

Introduction: Previous studies have variably reported inconclusive trends in the prevalence of atopic dermatitis (AD) among adults, and there are limited data on the impact of the COVID-19 pandemic. We aimed to investigate the national trends and age-stratified prevalence of AD among adults from 2007 to 2021 in South Korea, focusing mainly on the impact of the COVID-19 pandemic-related factors. Methods: A nationwide cross-sectional study was conducted using the Korea National Health and Nutrition Examination Survey data from 2007 to 2021. Overall and age-stratified prevalence for AD were assessed using weighted beta coefficients or odds ratios. Results: A total of 83,566 adults over 20 years (male, 49.40%) were included. During the observation period, the prevalence of AD was stable in the overall population from 2.61% (95% CI, 2.29–2.93) in 2007–2009 to 2.15% (1.68–2.63) in 2020 and 2.38% (1.81–2.95) in 2021. However, the weighted prevalence of AD in adults aged 40–59 years old decreased during the pre-pandemic era, and the prevalence of AD in adults aged above 60 years significantly decreased during the pandemic, with a significant decline observed after the initial outbreak. From age-stratification analysis, the adults aged 40–59 years showed a significant increase after the pandemic outbreak which was evident in specific variables: individuals with rural residence, lower education, and lower household income quartiles. Adults aged above 60 years showed a significant decrease in the slope after the outbreak, evident in specific variables: individuals of female, rural residence, lower education, and lower household income quartiles. Conclusion: We observed a stable overall prevalence of AD throughout the 15-year observation period. However, the age-stratified analysis suggested significantly different trends according to age-stratified groups and the impact of the COVID-19 pandemic on the prevalence of AD. [ABSTRACT FROM AUTHOR]

Introduction: Existing studies provide insights into the prevalence and environmental factors associated with allergic rhinitis (AR) and chronic rhinosinusitis (CRS) globally. However, limitations still persist in these studies, particularly regarding cohort sizes and the duration of follow-up periods, indicating a need for more comprehensive and long-term research in these fields. Our study aimed to investigate the prevalence, long-term trends, and underlying factors of these conditions in the general population of adult participants (≥19 years) in Korea. Method: We analyzed data from adult participants (≥19 years) from the Korea National Health and Nutrition Examination Survey (KNHANES) study to determine the prevalence of AR and CRS from 1998 to 2021. To analyze prevalence trends before and during the COVID-19 pandemic, we employed a weighted linear regression model and obtained β-coefficients with 95% confidence intervals (CI). Results: Between 1998 and 2021, over a span of 24 years, the comprehensive KNHANES study included 146,264 adult participants (mean age: 47.80 years, standard deviation: 16.49 years; 66,177, 49.3% men). The prevalence of AR and CRS increased from 1998 to 2021, with AR prevalence rising from 5.84% (95% CI, 5.57–6.10) in 1998–2005 to 8.99% (8.09–9.91) in 2021 and CRS from 1.84% (1.70–1.97) in 1998–2005 to 3.70% (3.18–4.23) in 2021. However, the increasing trend has slowed down during the COVID-19 pandemic era. Conclusions: The significance of continuous monitoring and focused interventions for AR and CRS is underscored by this study. The observed deceleration in the rising prevalence of AR and CRS during the pandemic indicates the possibility of beneficial impacts from lifestyle modifications triggered by the pandemic. These findings call for additional research to explore potential protective effects in greater depth. [ABSTRACT FROM AUTHOR]

During the coronavirus disease 2019 (COVID-19) pandemic, 24,289 tons of infectious waste was generated in 2021 in Korea, a 320% increase compared to that generated in 2020 (5788 tons). The disposal of other healthcare waste has been delayed because COVID-19 infectious waste must be disposed of first, leading to long-term concerns related to the lack of healthcare waste disposal capacity. To solve this problem, this study investigated healthcare waste classification systems in Korea and overseas. We analyzed the current state of healthcare waste in Korea and compared the treatment methods and healthcare waste treatment systems by country. The results showed that Korea has a strict healthcare waste management system compared to other countries, which relies on dedicated incinerators and transport. It is difficult to expand incinerators exclusively for healthcare waste due to site selection issues because they incinerate infectious waste. Therefore, to solve the healthcare waste disposal problem, Korea should improve its management system to reduce treatment amounts. This study suggests that general healthcare waste that is considered less infectious should be excluded from healthcare waste-exclusive treatment and that sterilization/grinding as an intermediate treatment method should be allowed. [ABSTRACT FROM AUTHOR]

(1) Background: Respiratory virus infections, including Coronavirus disease 2019 (COVID-19), seasonal influenza (FLU), and respiratory syncytial virus (RSV) as prominent examples, can severely affect both children and adults. This study aimed to investigate the clinical characteristics of respiratory viral infections in pediatric and adult populations and to identify determinants influencing patient hospitalization. (2) Methods: This retrospective study analyzed the electronic medical records of patients admitted to a regional hospital's emergency department from 1 January 2015 to 31 December 2022, to investigate the clinical characteristics and hospitalization risk factors associated with these three viruses. (3) Results: Infants aged 1 to 11 months were most affected by COVID-19 and RSV, whereas FLU more commonly infected children aged 3 to 5 years. Key factors influencing hospitalization included age and abnormal chest X-ray findings, with higher risks observed in younger children and adults over 65. Notably, the presence of abnormal chest x-ray findings significantly increased the hospitalization risk by 1.9 times [1.5–2.4] in children and 21.4 times [2.4–189.0] in adults. (4) Conclusions: This analysis underscores the impact of COVID-19, FLU, and RSV on hospitalization risk, offering insights for managing these respiratory viral infections (RVIs). Age-related risk differences highlight the necessity for tailored strategies, improving understanding of and treatment development for RVIs. [ABSTRACT FROM AUTHOR]

Background: This study evaluated the clinical characteristics of patients with COVID-19 in Korea, and examined the relationship between severe COVID-19 cases and underlying health conditions during the Delta (September 20, 2021 to December 4, 2021) and the Omicron (February 20, 2022 to March 31, 2022) predominant period. Methods: This study assessed the association between critical COVID-19 illness and various risk factors, including a variety of underlying health conditions, using multiple logistic regression models based on the K-COV-N cohort, a nationwide data of confirmed COVID-19 cases linked with COVID-19 vaccination status and the National Health Insurance claim information. Results: We analyzed 137,532 and 8,294,249 cases of COVID-19 infection during the Delta and the Omicron variant dominant periods, respectively. During the Delta as well as the Omicron period, old age (≥80 years) showed the largest effect size among risk factors for critical COVID-19 illness (aOR = 18.08; 95% confidence interval [CI] = 14.71–22.23 for the Delta; aOR = 24.07; 95% CI = 19.03–30.44 for the Omicron period). We found that patients with solid organ transplant (SOT) recipients, unvaccinated, and interstitial lung disease had more than a two-fold increased risk of critical COVID-19 outcomes between the Delta and Omicron periods. However, risk factors such as urban residence, underweight, and underlying medical conditions, including chronic cardiac diseases, immunodeficiency, and mental disorders, had different effects on the development of critical COVID-19 illness between the Delta and Omicron periods. Conclusion: We found that the severity of COVID-19 infection was much higher for the Delta variant than for the Omicron. Although the Delta and the Omicron variant shared many risk factors for critical illness, several risk factors were found to have different effects on the development of critical COVID-19 illness between those two variants. Close monitoring of a wide range of risk factors for critical illness is warranted as new variants continue to emerge during the pandemic. [ABSTRACT FROM AUTHOR]

Coxsackievirus A6 (CV-A6) has emerged as the predominant causative agent of hand, foot, and mouth disease (HFMD) in young children. Since the declaration of coronavirus disease 2019 (COVID-19) as a global pandemic, the incidence of infectious diseases, including HFMD, has decreased markedly. When social mitigation was relaxed during the COVID-19 pandemic in 2022, the re-emergence of HFMD was observed in Gwangju, South Korea, and seasonal characteristics of the disease appeared to have changed. To investigate the molecular characteristics of enterovirus (EV) associated with HFMD during 2022, 277 specimens were collected. Children aged younger than 5 years accounted for the majority of affected individuals. EV detection and genotyping were performed using real-time RT-PCR and nested RT-PCR followed by sequence analysis. The EV detection rate was found to be 82.3%, and the main genotype identified was CV-A6. Sixteen CV-A6 samples were selected for whole genome sequencing. According to phylogenetic analysis, all CV-A6 strains from this study belonged to the sub-genotype D3 clade based on VP1 sequences. Analysis of 3D polymerase phylogeny showed that only the recombinant RF-A group was identified. In conclusion, circulating EV types should be continuously monitored to understand pathogen emergence and evolution during the post-pandemic era. [ABSTRACT FROM AUTHOR]

Preliminary evidence suggests a possible higher incidence of diagnosis of autoimmune inflammatory rheumatic diseases (AIRDs) among patients with a history of COVID-19, but whether this association is specific to SARS-CoV-2 infection is unclear. This study compared the risk for AIRD in patients with a recent SARS-CoV-2 infection versus those with recent influenza infection and those with no infection. Visual Abstract. Long-Term Autoimmune Inflammatory Rheumatic Outcomes of COVID-19: Preliminary evidence suggests a possible higher incidence of diagnosis of autoimmune inflammatory rheumatic diseases (AIRDs) among patients with a history of COVID-19, but whether this association is specific to SARS-CoV-2 infection is unclear. This study compared the risk for AIRD in patients with a recent SARS-CoV-2 infection versus those with recent influenza infection and those with no infection. Background: Some data suggest a higher incidence of diagnosis of autoimmune inflammatory rheumatic diseases (AIRDs) among patients with a history of COVID-19 compared with uninfected patients. However, these studies had methodological shortcomings. Objective: To investigate the effect of COVID-19 on long-term risk for incident AIRD over various follow-up periods. Design: Binational, longitudinal, propensity-matched cohort study. Setting: Nationwide claims-based databases in South Korea (K-COV-N cohort) and Japan (JMDC cohort). Participants: 10 027 506 Korean and 12 218 680 Japanese patients aged 20 years or older, including those with COVID-19 between 1 January 2020 and 31 December 2021, matched to patients with influenza infection and to uninfected control patients. Measurements: The primary outcome was onset of AIRD (per appropriate codes from the International Classification of Diseases, 10th Revision) 1, 6, and 12 months after COVID-19 or influenza infection or the respective matched index date of uninfected control patients. Results: Between 2020 and 2021, among the 10 027 506 Korean participants (mean age, 48.4 years [SD, 13.4]; 50.1% men), 394 274 (3.9%) and 98 596 (0.98%) had a history of COVID-19 or influenza, respectively. After propensity score matching, beyond the first 30 days after infection, patients with COVID-19 were at increased risk for incident AIRD compared with uninfected patients (adjusted hazard ratio, 1.25 [95% CI, 1.18 to 1.31]) and influenza-infected control patients (adjusted hazard ratio, 1.30 [CI, 1.02 to 1.59]). The risk for incident AIRD was higher with more severe acute COVID-19. Similar patterns were observed in the Japanese cohort. Limitations: Referral bias due to the pandemic; residual confounding. Conclusion: SARS-CoV-2 infection was associated with increased risk for incident AIRD compared with matched patients without SARS-CoV-2 infection or with influenza infection. The risk for incident AIRD was higher with greater severity of acute COVID-19. Primary Funding Source: National Research Foundation of Korea. [ABSTRACT FROM AUTHOR]

Management of pressure sores can have various environmental effects; moreover, the COVID‐19 pandemic notably affected efforts towards effective management of pressure sores. Some cases of COVID‐19 infections require long‐term hospitalization in the intensive care unit. Moreover, special protective equipment worn by physicians owing to the pandemic complicate wound management. In this study, we compared the pressure ulcer characteristics between isolated patients with and those without COVID‐19 and evaluated the effects of isolation on pressure sores. From November 2022 to February 2023, patients who had pressure sores were included and their medical records were reviewed retrospectively. The experimental group included patients with confirmed COVID‐19 infections, who received clinical treatment in an isolated unit. Wound characteristics in each group and associated risk factors were analysed. Fifty‐four isolated patients with COVID‐19 and 58 control patients were included. The Braden Scale score and Korea patient classification system‐1 did not vary significantly between the two groups. However, the number of Grade I pressure sores in the COVID‐19 isolation group was significantly lower than those in the control group (p < 0.001), while the number of lesions was significantly higher (p = 0.034). The mortality rate in the COVID‐19 isolation group was higher than that in the control group (p = 0.008), and more patients were discharged with unhealed wounds (p = 0.004). A higher treatment effect on pressure sores may be expected if the disease is more actively managed. Moreover, the wound care systems for isolated patients with COVID‐19 require further attention. [ABSTRACT FROM AUTHOR]

Many of community supports and resources were shattered in the COVID-19 pandemic, leaving parents to navigate caring for their adult child with intellectual disabilities with little support. This study explored caregiving stress experienced by parents of adult children with intellectual disabilities during the COVID-19 pandemic in Korea. In-depth interviews were conducted with 19 parents of an adult child with intellectual disabilities. Thematic analysis yielded two themes: caregiving burden and deteriorating health. Parents bore the brunt of the caregiving burden, spending much of their time helping their adult child with daily activities and managing their challenging behaviors, leaving the caregivers struggling physically and mentally. The heightened caregiver burden and associated deteriorating health among these parents raise serious concerns, indicating a need for immediate support to alleviate these issues and help parents navigate caring for their adult child with intellectual disabilities during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

The letter to the editor discusses a study conducted in South Korea that examined the immune response to COVID-19 in healthcare workers. The study found that individuals with hybrid immunity, meaning they had both natural infection and vaccination, and higher levels of certain antibodies had a lower risk of subsequent infection. The study suggests that these antibody levels can be used as an indicator of protection against infection. However, baseline saliva IgA antibodies did not show a protective role. The study concludes that further research is needed to fully understand the mechanisms involved. [Extracted from the article]

Early and accurate detection of viruses in children might help prevent transmission and severe diseases. In this study, the severe acute respiratory syndrome coronavirus 2 (SARS‐COV‐2) detection in children was evaluated using saliva specimens with a Proteinase K (PTK)‐based RNA preparation, as saliva collection is a simple and noninvasive procedure, even in young children, with fewer concerns about sample contamination. The saliva‐based PTK and the conventional paired nasopharyngeal aspiration (NPA)‐based detection methods were compared between COVID‐19‐positive and ‐negative children. In addition, the detection rate for SARS‐COV‐2 and the difference between admission and discharge by the saliva‐based PTK method was tested in COVID‐19 patients. The diagnostic accuracy of the saliva‐based PTK method was 98.8% compared to NP swab‐based reverse transcriptase polymerase chain reaction. Saliva samples showed high sensitivity (94.1%) and specificity (100%) when using the PTK method. Furthermore, the saliva‐based PTK method significantly reduced the test processing time by 2 h. Notably, Ct values at discharge increased in saliva samples compared with those at admission, which might indicate patients' clinical conditions or virus activity. In conclusion, the saliva‐based PTK implemented in this study streamlines RNA extraction, making the process faster, safer, and more cost‐effective, demonstrating that this method is a rapid and reliable diagnostic tool for SARS‐CoV‐2 detection in children. [ABSTRACT FROM AUTHOR]

Disproportionate impact of COVID-19 on socioeconomic and behavioral variables may have impacted the prevalence of diabetes. We utilized nationwide long-term serial study from the 2009 to 2021 Korea Community Health Survey (KCHS). We explored national and regional prevalence and trends of diabetes according to the socioeconomic and behavioral factors before and during the pandemic. Also, we interpreted which groups became more vulnerable to the prevalence of diagnosed diabetes during the pandemic. A total of 2,971,349 adults aged (19 to 39, 40 to 59, and ≥ 60 years) were included in the analysis. The prevalence of diagnosed diabetes increased slowly during the pandemic (11.6% [95% CI 11.5–11.7] in 2020 and 12.4% [95% CI 12.3–12.6] in 2021), compared to the pre-pandemic era (7.9% [95% CI 7.8–7.9] in 2009–2011 and 11.3% [95% CI 11.3–11.4] in 2018–2019). Also, women, low-income group, low-educational group, and infrequent walking group showed less prevalence of diagnosed diabetes than the others. The diabetic population increased slowly than expected during the pandemic. The pandemic seems to contribute to an unanticipated increase in under-diagnosis of diabetes among the already minority. This study may suggest reinforcing access to healthcare services among the minority during the pandemic. [ABSTRACT FROM AUTHOR]

To protect people from severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) infection, tremendous research efforts have been made toward coronavirus disease 19 (COVID‐19) treatment development. Externally controlled trials (ECTs) may help reduce their development time. To evaluate whether ECT using real‐world data (RWD) of patients with COVID‐19 is feasible enough to be used for regulatory decision making, we built an external control arm (ECA) based on RWD as a control arm of a previously conducted randomized controlled trial (RCT), and compared it to the control arm of the RCT. The electronic health record (EHR)‐based COVID‐19 cohort dataset was used as RWD, and three Adaptive COVID‐19 Treatment Trial (ACTT) datasets were used as RCTs. Among the RWD datasets, eligible patients were evaluated as a pool of external control subjects of the ACTT‐1, ACTT‐2, and ACTT‐3 trials, respectively. The ECAs were built using propensity score matching, and the balance of age, sex, and baseline clinical status ordinal scale as covariates between the treatment arms of Asian patients in each ACTT and the pools of external control subjects was assessed before and after 1:1 matching. There was no statistically significant difference in time to recovery between ECAs and the control arms of each ACTT. Among the covariates, the baseline status ordinal score had the greatest influence on the building of ECA. This study demonstrates that ECA based on EHR data of COVID‐19 patients could sufficiently replace the control arm of an RCT, and it is expected to help develop new treatments faster in emergency situations, such as the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

The prediction of corticosteroid responses in coronavirus disease 2019 (COVID-19) patients is crucial in clinical practice, and exploring the role of artificial intelligence (AI)-assisted analysis of chest radiographs (CXR) is warranted. This retrospective case–control study involving mild-to-moderate COVID-19 patients treated with corticosteroids was conducted from 4 September 2021, to 30 August 2022. The primary endpoint of the study was corticosteroid responsiveness, defined as the advancement of two or more of the eight-categories-ordinal scale. Serial abnormality scores for consolidation and pleural effusion on CXR were obtained using a commercial AI-based software based on days from the onset of symptoms. Amongst the 258 participants included in the analysis, 147 (57%) were male. Multivariable logistic regression analysis revealed that high pleural effusion score at 6–9 days from onset of symptoms (adjusted odds ratio of (aOR): 1.022, 95% confidence interval (CI): 1.003–1.042, p = 0.020) and consolidation scores up to 9 days from onset of symptoms (0–2 days: aOR: 1.025, 95% CI: 1.006–1.045, p = 0.010; 3–5 days: aOR: 1.03 95% CI: 1.011–1.051, p = 0.002; 6–9 days: aOR; 1.052, 95% CI: 1.015–1.089, p = 0.005) were associated with an unfavorable corticosteroid response. AI-generated scores could help intervene in the use of corticosteroids in COVID-19 patients who would not benefit from them. [ABSTRACT FROM AUTHOR]

Although coronavirus disease 2019 (COVID-19) is no longer a Public Health Emergency of International Concern (PHEIC), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has had a vast impact to date. Hence, continuous management is required, given the uncertainty caused by the potential evolution of SARS-CoV-2. Reverse transcription-quantitative PCR (RT-qPCR) diagnosis has been fundamental in overcoming this issue. In this study, the performances of two rapid RT-qPCR assays (Real-Q Direct SARS-CoV-2 Detection Kit and Allplex™ SARS-CoV-2 fast PCR Assay) with short PCR times were comparatively evaluated using a STANDARD M nCoV Real-Time Detection Kit (STANDARD M, conventional RT-qPCR assay). All kits showed a limit of detection values (102–103 copies/reaction). The evaluation showed that the two rapid assay tests had ≥97.89% sensitivity and ≥99.51% specificity (κ = 0.98) for individual samples and ≥97.32% sensitivity and ≥97.67% specificity for pooled samples compared to STANDARD M. These results indicate that the two rapid RT-qPCR kits, which showed significant time reduction in performance, are as effective as a conventional RT-qPCR assay. They are likely to increase not only the number of tests that can be performed but also the efficiency of sustainable management of COVID-19 in the long term. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the clinical implications and prognostic value of artificial intelligence (AI)-based results for chest radiographs (CXR) in coronavirus disease 2019 (COVID-19) patients. Patients who were admitted due to COVID-19 from September 2021 to March 2022 were retrospectively included. A commercial AI-based software was used to assess CXR data for consolidation and pleural effusion scores. Clinical data, including laboratory results, were analyzed for possible prognostic factors. Total O2 supply period, the last SpO2 result, and deterioration were evaluated as prognostic indicators of treatment outcome. Generalized linear mixed model and regression tests were used to examine the prognostic value of CXR results. Among a total of 228 patients (mean 59.9 ± 18.8 years old), consolidation scores had a significant association with erythrocyte sedimentation rate and C-reactive protein changes, and initial consolidation scores were associated with the last SpO2 result (estimate −0.018, p = 0.024). All consolidation scores during admission showed significant association with the total O2 supply period and the last SpO2 result. Early changing degree of consolidation score showed an association with deterioration (odds ratio 1.017, 95% confidence interval 1.005–1.03). In conclusion, AI-based CXR results for consolidation have potential prognostic value for predicting treatment outcomes in COVID-19 patients. [ABSTRACT FROM AUTHOR]

During the first outbreak of the coronavirus disease 2019 (COVID-19), many people expressed hatred toward others whom they believed were responsible for the situation. Such increase in negative affect could be resultant of the better-than-average effect (BTAE), which refers to the phenomenon of believing that one is superior to average others. This study investigated the relationship between the BTAE and emotional valence toward others and tested whether the relationship was moderated by allocentric goals (i.e., concerned with the interests of others rather than themselves) and culture. Participants from the U.S. (N = 210) and South Korea (N = 214) were asked about their perceptions on whether they were better than others at preventing the COVID-19 infection, how they felt about others regarding COVID-19, and for whom they were preventing COVID-19. The results indicated that people showing more BTAE in relation to preventing the COVID-19 infection reported more negative emotional valence toward others, but the relationship was moderated by allocentric goals. In particular, the U.S. participants with higher allocentric goals reported less negatively valenced emotions, while the same was not found in Korean participants. The findings suggest the power of allocentric goals in diminishing the BTAE in some cultures, which may possibly explain the negative emotions some people experience when following social distancing rules. [ABSTRACT FROM AUTHOR]

• Data about symptoms and viral kinetics of omicron BA.5 is lacking. • We thus compared the symptoms and viral kinetics between SARS-CoV-2 omicron BA.1/BA.2 and omicron BA.5. • Patients with omicron BA.5 had more severe initial symptoms but exhibited shortened viable viral shedding period than those with omicron BA.1/BA.2. • This finding provides evidence for the current CDC guideline about isolation period for patients with SARS-CoV-2 in omicron BA.5 era. [ABSTRACT FROM AUTHOR]

Objective: Lupus anticoagulant (LA) are commonly detected during SARS‐CoV‐2 infection. However, the relationship between LA and clinical significance is still unclear. Methods: A retrospective chart analysis was performed on COVID‐19 patients who were tested for LA at our hospital from March 2020 to November 2021. We analyzed the patient's characteristics based on the result of the LA test. In addition, subgroup analysis performed the LA‐positive group who had undergone serial LA tests. Results: A total of 219 COVID‐19 patients were enrolled in the study, 148 patients (67.6%) were positive for LA test. The LA‐positive group received more treatment of high flow nasal cannula (LA‐positive 73.0%, LA‐negative 57.7%, p = 0.024). The LA‐positive group showed prolonged aPTT, higher levels of CRP and fibrinogen (all p's < 0.05). Among 148 LA‐positive patients, 127 patients (86.5%) were found to be LA‐positive within 10 days of SARS‐CoV‐2 positive, and LA‐positive group confirmed a median time to LA loss of 10 days. However, there was a group that was negative for LA in the early stages of infection and became positive about 13 days later. A subgroup analysis showed that these patients had different characteristics due to their longer hospital stays and higher D‐dimer levels. Conclusions: In COVID‐19 patients, LA is expected to be associated to disease severity. Since the clinical significance of LA is different depending on the onset time of LA positivity, the LA test is suggested to be done at diagnosis of SARS‐CoV‐2 infection, even if LA is negative, follow‐up test should be considered within 10 days. [ABSTRACT FROM AUTHOR]

The susceptibility, risk factors, and prognosis of COVID‐19 in patients with inflammatory bowel disease (IBD) remain unknown. Thus, our study aims to assess the prevalence and clinical outcomes of COVID‐19 in IBD. We searched PubMed, EMBASE, and medRxiv from 2019 to 1 June 2022 for cohort and case‐control studies comparing the prevalence and clinical outcomes of COVID‐19 in patients with IBD and in the general population. We also compared the outcomes of patients receiving and not receiving 5‐aminosalicylates (ASA), tumour necrosis factor antagonists, biologics, systemic corticosteroids, or immunomodulators for IBD. Thirty five studies were eligible for our analysis. Pooled odds ratio of COVID‐19‐related hospitalisation, intensive care unit (ICU) admission, or death in IBD compared to in non‐IBD were 0.58 (95% confidence interval (CI) = 0.28–1.18), 1.09 (95% CI = 0.27–4.47), and 0.67 (95% CI = 0.32–1.42), respectively. Inflammatory bowel disease was not associated with increased hospitalisation, ICU admission, or death. Susceptibility to COVID‐19 did not increase with any drugs for IBD. Hospitalisation, ICU admission, and death were more likely with 5‐ASA and corticosteroid use. COVID‐19‐related hospitalisation (Odds Ratio (OR): 0.53; 95% CI = 0.38–0.74) and death (OR: 0.13; 95% CI = 0.13–0.70) were less likely with Crohn's disease than ulcerative colitis (UC). In conclusion, IBD does not increase the mortality and morbidity of COVID‐19. However, physicians should be aware that additional monitoring is needed in UC patients or in patients taking 5‐ASA or systemic corticosteroids. [ABSTRACT FROM AUTHOR]

Since the emergence of SARS-CoV-2, maintaining healthcare worker (HCW) health and safety has been fundamental to responding to the global pandemic. Vaccination with mRNA-base vaccines targeting SARS-CoV-2 spike protein has emerged as a key strategy in reducing HCW susceptibility to SARS-CoV-2, however, neutralizing antibody responses subside with time and may be influenced by many variables. We sought to understand the dynamics between vaccine products, prior clinical illness from SARS-CoV-2, and incidence of vaccine-associated adverse reactions on antibody decay over time in HCWs at a university medical center. A cohort of 296 HCWs received standard two-dose vaccination with either bnt162b2 (Pfizer/BioNTech) or mRNA-1273 (Moderna) and were evaluated after two, six, and nine months. Subjects were grouped by antibody decay curve into steep antibody decliners gentle decliners. Vaccination with mRNA-1273 led to more sustained antibody responses compared to bnt162b2. Subjects experiencing vaccine-associated symptoms were more likely to experience a more prolonged neutralizing antibody response. Subjects with clinical SARS-CoV-2 infection prior to vaccination were more likely to experience vaccination-associated symptoms after first vaccination and were more likely to have a more blunted antibody decay. Understanding factors associated with vaccine efficacy may assist clinicians in determining appropriate vaccine strategies in HCWs. [ABSTRACT FROM AUTHOR]

The fourth vaccination dose confers additional protective immunity against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection in individuals with no prior coronavirus disease‐19 (COVID‐19). However, its immunological benefit against currently circulating BA.4/5 is unclear in individuals who have received a booster shot and been infected with Omicron variant BA.1/2. We analyzed immune responses in whom had been boosted once and did not have COVID‐19 (n = 16), boosted once and had COVID‐19 when BA.1/2 was dominant in Korea (Hybrid‐6M group, n = 27), and boosted twice and did not have COVID‐19 (Vx4 group, n = 15). Antibody binding activities against RBDo BA.1 and RBDo BA.4/5, antigen‐specific memory CD4+ and CD8+ T‐cell responses against BA.4/5, and B‐cell responses against SARS‐CoV‐2 wild‐type did not differ statistically between the Hybrid‐6M and Vx4 groups. The humoral and cellular immune responses of the Hybrid‐6M group against BA.4/5 were comparable to those of the Vx4 group. Individuals who had been boosted and had an Omicron infection in early 2022 may not have high priority for an additional vaccination. [ABSTRACT FROM AUTHOR]

There are limited data comparing the transmission rates and kinetics of viable virus shedding of the Omicron variant to those of the Delta variant. We compared these rates in hospitalized patients infected with Delta and Omicron variants. We prospectively enrolled adult patients with COVID‐19 admitted to a tertiary care hospital in South Korea between September 2021 and May 2022. Secondary attack rates were calculated by epidemiologic investigation, and daily saliva samples were collected to evaluate viral shedding kinetics. Genomic and subgenomic SARS‐CoV‐2 RNA was measured by PCR, and virus culture was performed from daily saliva samples. A total of 88 patients with COVID‐19 who agreed to daily sampling and were interviewed, were included. Of the 88 patients, 48 (59%) were infected with Delta, and 34 (41%) with Omicron; a further 5 patients gave undetectable or inconclusive RNA PCR results and 1 was suspected of being coinfected with both variants. Omicron group had a higher secondary attack rate (31% [38/124] vs. 7% [34/456], p < 0.001). Survival analysis revealed that shorter viable virus shedding period was observed in Omicron variant compared with Delta variant (median 4, IQR [1−7], vs. 8.5 days, IQR [5–12 days], p < 0.001). Multivariable analysis revealed that moderate‐to‐critical disease severity (HR: 1.96), and immunocompromised status (HR: 2.17) were independent predictors of prolonged viral shedding, whereas completion of initial vaccine series or first booster‐vaccinated status (HR: 0.49), and Omicron infection (HR: 0.44) were independently associated with shorter viable virus shedding. Patients with Omicron infections had higher transmission rates but shorter periods of transmissible virus shedding than those with Delta infections. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) is a new infectious disease that has had a significant impact on daily life. This study investigated the effect of changes in family life due to COVID-19 on depressive mood and stress perception. We used data from the "Survey on changes in family life due to COVID-19" in Korea. The final study population comprised 1500 adults with children aged ≤19 years. Of the total respondents, 59.3% responded that depressive mood and stress had increased due to COVID-19. However, among them, 46.6% did not attempt to resolve or could not find a way to resolve their depressive mood and stress. In multiple logistic regression analyses, a decrease in household income and increased household expenditure due to COVID-19 were significantly associated with an increased risk of depressive mood and stress perception. Depressive mood and stress were significantly higher in respondents who had experienced family conflicts. These results could be used to assess changes in family life and manage mental health when a new infectious disease occurs. Therefore, it is necessary to assess the long-term effects of changes in family life due to COVID-19 on mental health. [ABSTRACT FROM AUTHOR]

We compared immune responses against the omicron variant of SARS-CoV-2 after a third dose of the coronavirus disease 2019 (COVID-19) vaccine between people living with human immunodeficiency (PLWH) and healthcare workers (HCWs). In this prospective observational study, PLWH and HCWs vaccinated with at least two doses of vaccine were enrolled. We analyzed neutralizing responses using the GenScript SARS-CoV-2 surrogate virus neutralization test kit. Twenty-nine PLWH and 114 HCWs were included to analyze immune responses after the third vaccination. Most PLWH (86.2%) had fully suppressed viral loads and CD4 T cell counts were well-controlled (median 670.0 cells/μL). The neutralizing responses against the omicron variant in PLWH were not significantly different from those in HCWs (43.94% vs. 51.77%, p = 0.42). However, neutralizing responses against the omicron variant were significantly impaired by about 50% compared with wild type SARS-CoV-2 in PLWH (43.94% vs. 97.46%, p < 0.001) and HCWs (51.77% vs. 97.74%, p < 0.001). Although neutralizing responses against the omicron variant in well-controlled PLWH were comparable to those of HCWs, the responses were much lower than those against wild type in both PLWH and HCWs. Therefore, the risk of breakthrough SARS-CoV-2 infection due to the currently circulating omicron variant is still high despite three doses of vaccine in PLWH and will not differ from HCWs. [ABSTRACT FROM AUTHOR]

Various hematologic side effects of the Coronavirus Disease 2019 (COVID-19) vaccination has been reported, and most of them are thought to be related to autoimmune pathways. To the best of our knowledge, only few cases of post-COVID-19 vaccination aplastic anemia (AA) have been reported and there is no reported Korean case of COVID-19 vaccine-induced AA yet. We present a case of severe immune-mediated AA that developed after the administration of a messenger ribonucleic acid (mRNA) gene-based spike protein vaccine against COVID-19, which responded well to immunosuppressive therapy, and discuss the probable pathogenesis of AA and the implication of vaccination along with a comparison of previous cases reported. A 53-year-old Korean man developed sudden pancytopenia three months after COVID-19 vaccination. To evaluate the cause of pancytopenia, a bone marrow study was performed. A diagnosis of AA was made through the bone marrow study and he received triple immunosuppressive therapy (IST). After triple IST for five months, his blood cell count was improved and maintained without transfusion and his follow-up bone marrow examination showed improved cellularity. COVID-19 vaccine might be associated with the development of immune-mediated AA. Prompt hematologic evaluation should be performed when there are symptoms or signs suggestive of cytopenia after COVID-19 vaccination. Although the clinical outcome of post-vaccination AA varies, a good prognosis can be possible for patients with COVID-19 vaccination-induced AA. [ABSTRACT FROM AUTHOR]

The frequency and clinical manifestation of lung fibrosis accompanied by coronavirus disease (COVID-19) are not well-established. We aimed to identify the factors attributed to post-COVID-19 fibrosis. This single-center prospective study included patients diagnosed with COVID-19 pneumonia from 12 April to 22 October 2021 in the Republic of Korea. The primary outcome was the presence of pulmonary fibrosis on a CT scan 3 months after discharge; the fibrosis risk was estimated by a multiple logistic regression. The mean patient age was 55.03 ± 12.32 (range 27–85) years; 65 (66.3%) were men and 33 (33.7%) were women. The age, Charlson Comorbidity Index, lactate dehydrogenase level, aspartate aminotransferase level, and Krebs von den Lungen-6 level were significantly higher and the albumin level and the saturation of the peripheral oxygen/fraction of inspired oxygen (SpO2/FiO2) ratio were significantly lower in the fibrosis group than in the non-fibrosis group; the need for initial oxygen support was also greater in the fibrosis group. An older age (adjusted odds ratio (AOR) 1.12; 95% confidence interval (CI) 1.03–1.21) and a lower initial SpO2/FiO2 ratio (AOR 7.17; 95% CI 1.72–29.91) were significant independent risk factors for pulmonary fibrosis after COVID-19 pneumonia. An older age and a low initial SpO2/FiO2 ratio were crucial in predicting pulmonary fibrosis after COVID-19 pneumonia. [ABSTRACT FROM AUTHOR]

The most effective method of limiting the coronavirus disease pandemic of 2019 (COVID-19) is vaccination. For the determination of the comparative efficacy and safety of COVID-19 vaccines and their platforms during the pre-Delta era, a systematic review and network meta-analysis was conducted. The MEDLINE, Embase, and MedRxiv databases were searched, and the gray literature was manually searched up to 8 July 2021. The review includes the phase II and III randomized controlled trials (RCTs) that assessed the efficacy, immunogenicity, and safety of the COVID-19 vaccines. The network meta-analysis used a Bayesian model and used the surface under the cumulative ranking to rank the comparisons between the vaccines. All included studies were quality appraised according to their design, and the heterogeneity of the analyses was assessed using I2. In terms of vaccine efficacy, the mRNA-1273 vaccine ranked the highest, and the CoronaVac vaccine ranked the lowest. The mRNA-1273 ranked the highest for neutralizing antibody responses to live SARS-CoV-2. The WIV04 vaccine was associated with the lowest incidence of both local and systemic adverse reactions. All studies except one had a low to moderate risk of bias. The mRNA platform vaccines showed higher efficacy and more adverse reactions than the other vaccines. [ABSTRACT FROM AUTHOR]

Considering the recent paradigm shift in sports tourism due to COVID-19, it is essential to understand the tourism needs and mentality of consumers. This study aimed to verify the relationship between tourism needs, self-monitoring, and the switching intention of golfing tourists. We used online questionnaires to survey golf tourists who experienced negative attention from other people in the context of COVID-19. The results of the structural equation modeling analysis are as follows: (1) tourism needs partially affect self-monitoring; (2) self-monitoring has a significant effect on switching intention; (3) self-monitoring did not play a mediating role between existence needs and switching intention; and (4) relatedness needs and growth needs were shown to play a mediating role. From the standpoint of tourism planning and marketing, the findings reveal a desire for tourism despite the COVID-19 infection risks. Marketers should identify the preferred tourism content, according to consumers' tourism needs, and develop customized plans. [ABSTRACT FROM AUTHOR]

• Multi-drug resistant organisms (MDRO) were isolated from 8.6% of COVID-19 pneumonia. • MDROs were detected from 28% (13/47) among patients with culture data. • Long-term care facility stay was a risk factor for isolation of resistant organisms. • Corticosteroids use in COVID-19 may increase the risk of bacterial co-infection. • Strict infection prevention strategies may be needed in patients with risk factors. Superimposed multi-drug resistant organisms (MDROs) co-infection can be associated with worse outcomes in patients with severe coronavirus disease 2019 (COVID-19), even if these patients were managed with strict airborne and contact precautions. Identifying risk factors for isolation of MDROs is critical to COVID-19 treatment. All eligible adult patients with confirmed COVID-19 pneumonia from 10 hospitals in the Republic of Korea between February 2020 and May 2020 were retrospectively enrolled. Using this cohort, epidemiology and risk factors for isolation of MDROs were evaluated. Of 152 patients, 47 with microbial culture results were included. Twenty isolates of MDROs from 13 (28%) patients were cultured. Stenotrophomonas maltophilia (5 isolates) was the most common MDRO, followed by methicillin-resistant staphylococcus aureus (4 isolates). MDROs were mostly isolated from sputum samples (80%, 16/20). The median time from hospitalization to MDRO isolation was 28 days (interquartile range, 18-38 days). In-hospital mortality was higher in patients with MDRO isolation (62% vs 15%; P =.001). Use of systemic corticosteroids after diagnosis of COVID-19 (adjusted odds ratio [aOR]: 15.07; 95% confidence interval [CI]: 2.34-97.01; P =.004) and long-term care facility (LTCF) stay before diagnosis of COVID-19 (aOR: 6.09; 95% CI: 1.02-36.49; P =.048) were associated with MDRO isolation. MDROs were isolated from 28% of COVID-19 pneumonia patients with culture data and 8.6% of the entire cohort. Previous LTCF stay and adjunctive corticosteroid use were risk factors for the isolation of MDROs. Strict infection prevention strategies may be needed in these COVID-19 patients with risk factors. [ABSTRACT FROM AUTHOR]