US Pharm. 2021;46(6):44-46.

Study: Culture Influences Mask Wearing

Around the world and within the United States, the percentage of people wearing masks during the COVID-19 pandemic has varied enormously. What explains this? A new study coauthored by an MIT faculty member finds that a public sense of “collectivism” clearly predicts mask usage, adding a cultural and psychological perspective to the issue.

The study uses a series of datasets about mask usage and public attitudes, along with well-established empirical indices of collectivism, to evaluate the impact of those cultural differences on this element of the pandemic response.

“Our data both within the United States and across the world shows that collectivism is a strong and important predictor of whether people in a region wear masks or not,” says Jackson G. Lu, an assistant professor at the MIT Sloan School of Management and co-author of a new paper detailing the results.

Collectivism broadly refers to the inclination to prioritize a group’s needs over an individual’s concerns, and social scientists have often worked to measure its presence among different populations. The researchers found a culture of collectivism to be a key driver of mask use even after accounting for many other factors, including political orientation, state policies, the severity of COVID-19 outbreaks, and more.

“In collectivistic cultures, people consider wearing masks not only a responsibility or duty but also a symbol of solidarity—that we’re standing together and fighting this pandemic together,” Dr. Lu said.

The paper, “Collectivism Predicts Mask Use During COVID-19,” appeared in Proceedings of the National Academy of Sciences. The authors are Dr. Lu, who is the Mitsui Career Development Professor at MIT Sloan; Peter Jin, a research associate at MIT Sloan; and Alexander S. English, a researcher in the Department of Psychology and Behaviorial Sciences at Zhejiang University in Hangzhou, China.

To conduct the study, the researchers analyzed four datasets. The first, collected in July 2020, was a one-question survey about mask usage in the U.S., collected by The New York Times and research firm Dynata and including 248,941 Americans across all 3,141 U.S. counties. The second dataset was a survey of 16,737 Americans across all 50 U.S. states about mask usage, from April through September 2020, run by YouGov and the Institute for Global Health Innovation.

Analyzing both datasets, the researchers examined how strongly mask wearing correlated with the measures of collectivism in the 50 states. A U.S. state’s collectivism can be graded based on survey responses by representative samples of the population.

“Collectivism versus individualism is one of the most established cultural dimensions in psychology,” Dr. Lu said.

In analyzing the results, the researchers controlled for a large set of other factors that might influence mask wearing, including the severity of COVID-19 outbreaks in states, government policies, political affiliations across the public, education levels, population density, per-capita income, age, and gender.

People With HIV More Likely to Become Sick With, Die From COVID-19

Over the past year, studies have revealed that certain preexisting conditions, such as cancer, diabetes, and high blood pressure, can increase a person’s risk of dying from COVID-19. New research shows that individuals living with HIV and acquired immune deficiency syndrome (AIDS)—an estimated 38 million worldwide, according to the World Health Organization—have an increased risk of SARS-CoV-2 infection and fatal outcomes from COVID-19.

In a new study, published in Scientific Reports, Penn State College of Medicine researchers found that people living with HIV had a 24% higher risk of SARS-CoV-2 infection and a 78% higher risk of death from COVID-19 than people without HIV. They assessed data from 22 previous studies that included nearly 21 million participants in North America, Africa, Europe, and Asia to determine to what extent people living with HIV/AIDS are susceptible to SARS-CoV-2 infection and death from COVID-19.

Most of the participants (66%) were male, and the median age was 56 years. The most common comorbidities among the HIV-positive population were hypertension, diabetes, chronic obstructive pulmonary disease, and chronic kidney disease. Most patients living with HIV/AIDS (96%) were on antiretroviral therapy (ART), which helps suppress the amount of HIV detected in the body.

“Previous studies were inconclusive on whether or not HIV is a risk factor for susceptibility to SARS-CoV-2 infection and poor outcomes in populations with COVID-19,” said Dr. Paddy Ssentongo, lead researcher and assistant professor at the Penn State Center for Neural Engineering. “This is because a vast majority of people living with HIV/AIDS are on ART, some of which have been used experimentally to treat COVID-19.”

According to the researchers, certain preexisting conditions are common among people living with HIV/AIDS, which may contribute to the severity of their COVID-19 cases. The beneficial effects of antiviral drugs, such as tenofovir and protease inhibitors, in reducing the risk of SARS-CoV-2 infection and death from COVID-19 in people with living with HIV/AIDS remain inconclusive.

“As the pandemic has evolved, we’ve obtained sufficient information to characterize the epidemiology of HIV/SARS-CoV-2 coinfection, which could not be done at the beginning of the pandemic due to scarcity of data,” said Vernon Chinchilli, fellow researcher and chair of the Department of Public Health Sciences. “Our findings support the current Centers for Disease Control and Prevention guidance to prioritize persons living with HIV to receive a COVID-19 vaccine.”

Will COVID-19 Become a Seasonal Nuisance?

Within the next decade, the novel coronavirus responsible for COVID-19 could become little more than a nuisance, causing no more than common cold-like coughs and sniffles. That possible future is predicted by mathematical models that incorporate lessons learned from the current pandemic on how the body’s immunity changes over time. Scientists at the University of Utah carried out the research, published in the journal Viruses.

“This shows a possible future that has not yet been fully addressed,” says Fred Adler, PhD, professor of mathematics and biological sciences at the University of Utah. “Over the next decade, the severity of COVID-19 may decrease as populations collectively develop immunity.”

The findings suggest that changes in the disease could be driven by adaptations of our immune response rather than by changes in the virus itself. Dr. Adler was senior author on the publication with Alexander Beams, first author and graduate student in the Department of Mathematics and the Division of Epidemiology at University of Utah Health, and undergraduate co-author Rebecca Bateman.

Although SARS-CoV-2 (the sometimes-deadly coronavirus causing COVID-19) is the best-known member of that virus family, other seasonal coronaviruses circulate in the human population—and they are much more benign. Some evidence indicates that one of these cold-causing relatives might have once been severe, giving rise to the Russian flu pandemic in the late 19th century. The parallels led the scientists to wonder whether the severity of SARS-CoV-2 could similarly lessen over time.

To test the idea, they built mathematical models incorporating evidence on the body’s immune response to SARS-CoV-2 based data from the current pandemic.

“In the beginning of the pandemic, no one had seen the virus before,” Dr. Adler explains. “Our immune system was not prepared.” The models show that as more adults become partially immune, whether through prior infection or vaccination, severe infections all but disappear over the next decade. Eventually, the only people who will be exposed to the virus for the first time will be children—and they’re naturally less prone to severe disease.

Risk Factors for Severe COVID-19 Course in Patients With Diabetes

People with diabetes are at increased risk for developing a severe case of COVID-19 compared with people without diabetes. The question to be answered is whether all people with diabetes have an increased risk for severe COVID-19 or whether specific risk factors can also be identified within this group. A new study by German Center for Diabetes (DDZ) researchers focused on this question and gained relevant insights.

The COVID-19 pandemic poses unprecedented challenges to science and the health sector. While in some people with a SARS-CoV-2 infection the disease is hardly noticeable, in others it is much more severe and sometimes fatal. So far, knowledge about the course of a COVID-19 disease is still quite meager. However, diabetes has increasingly emerged as one of the risk factors determining the severity of the disease.

Several studies on diabetes and SARS-CoV-2 have already observed an approximately twofold to threefold increase in mortality due to COVID-19 in people with diabetes compared to people without diabetes. This makes it more important to conduct studies that examine the risk factors of people with diabetes for severe COVID-19 disease in more detail.

The new study by DDZ scientists, led by Dr. Sabrina Schlesinger, head of the Junior Research Group Systematic Reviews at the Institute for Biometrics and Epidemiology, examined the risk phenotypes of diabetes and their possible association with the severity of COVID-19. In their meta-analysis, the researchers combined the results from 22 published studies, and a total of more than 17,500 people with diabetes and confirmed SARS-CoV-2 infection were included.

For individuals with diabetes and SARS-CoV-2 infection, male sex, older age (>65 years), high blood glucose levels (at the time of hospital admission), chronic treatment with insulin, and existing concomitant conditions (such as cardiovascular disease or kidney disease) were identified as risk factors for a severe COVID-19 course. On the other hand, the results showed that chronic metformin treatment was associated with a reduced risk of a severe course of COVID-19.

The risk factors identified in the study—i.e., older persons, usually male, with comorbidities of diabetes and chronic insulin treatment—can therefore be seen as indicators of diabetes severity or overall poor health.

“However, some results, especially on diabetes-specific factors such as type or duration of diabetes and further treatments, are still imprecisely assessed, and the significance is low. To strengthen the significance, further primary studies are needed that examine these specific risk factors and consider other relevant influencing factors in their analysis,” said Dr. Schlesinger.

Inactivity Linked to More Severe COVID-19 Infection and Death

Physical inactivity is linked to more severe COVID-19 infection and a heightened risk of dying from the disease, a large U.S. study published online in the British Journal of Sports Medicine finds. Patients with COVID-19 who were consistently inactive during the 2 years preceding the pandemic were more likely to be admitted to hospital, to require intensive care, and to die than were patients who had consistently met physical activity guidelines, the findings show.

As a risk factor for severe disease, physical inactivity was surpassed only by advanced age and a history of organ transplant.

Several risk factors for severe COVID-19 infection have been identified, including advanced age, male sex, and certain underlying medical conditions, such as diabetes, obesity, and cardiovascular disease. But physical inactivity is not one of them, even though it is a well-known contributory risk factor for several long-term conditions, including those associated with severe COVID-19, the researchers point out.

To explore its potential impact on the severity of the infection, including hospital admission rates, need for intensive care, and death, the researchers compared these outcomes in 48,440 adults with confirmed COVID-19 infection between January and October 2020.

The patients’ average age was 47 years; nearly two-thirds were women (62%). Their average BMI was 31, which is classified as obese. Around half had no underlying conditions, including diabetes, chronic obstructive pulmonary disease, cardiovascular disease, kidney disease, and cancer; nearly one in five (18%) had only one; and almost a third (32%) had two or more.

All of them had reported their level of regular physical activity at least three times between March 2018 and March 2020 at outpatient clinics. This was classified as consistently inactive (0-10 mins/week); some activity (11-149 mins/week); or consistently meeting physical activity guidelines (150+ mins/week).

Some 7% were consistently meeting physical activity guidelines; 15% were consistently inactive, with the remainder reporting some activity. White patients were most likely to consistently meet physical activity guidelines (10%), followed by Asian patients (7%), Hispanic patients (6%), and African American patients (5%).

Some 9% of the total were admitted to a hospital; around 3% required intensive care; and 2% died. Consistently meeting physical-activity guidelines was strongly associated with a reduced risk of these outcomes.

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