A chief concern over the first months of the coronavirus disease 2019 (COVID-19) pandemic was the capacity to provide care for acutely ill patients in hospitals and intensive care units (ICUs). The variability in outcomes of patients with COVID-19 internationally has been striking, with some reports describing ICU mortality in ranges between 40 and 90%. 1-3 Systematic reviews including Characteristics and outcomes of patients with COVID-19 admitted to hospital and intensive care in the first phase of the pandemic in Canada: a national cohort study

Background The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men.

IMPORTANCE Patients undergoing hemodialysis have a high mortality rate associated with COVID-19, and this patient population often has a poor response to vaccinations. Randomized clinical trials for COVID-19 vaccines included few patients with kidney disease; therefore, vaccine immunogenicity is uncertain in this population. OBJECTIVE To evaluate the SARS-CoV-2 antibody response in patients undergoing chronic hemodialysis following 1 vs 2 doses of BNT162b2 COVID-19 vaccination compared with health care workers serving as controls and convalescent serum.

Background: Differences in immuno-tein (anti-NP) at 6-7 and 12 weeks afer than in those who received mRNA-1273. genicity between mRNA SARS-CoV-2 the second dose of vaccine and com-For anti-spike, 70 of 122 patients (57.4%) vaccines have not been well character-pared those levels with the median con-who received BNT162b2 maintained the ized in patients undergoing dialysis. We valescent serum antibody levels from convalescent level versus 68 of 71 (96%) of compared the serologic response in 211 controls who were previously those who received mRNA-1273 (p < patients undergoing maintenance infected with SARS-CoV-2. 0.001). For anti-RBD, 47 of 122 patients hemodialysis afer vaccination against (38.5%) who received BNT162b2 main-SARS-CoV-2 with BNT162b2 (Pfizer-Results: At 6-7 weeks afer 2-dose vaccin-tained the anti-RBD convalescent level BioNTech) and mRNA-1273 (Moderna). ation, we found that 51 of 70 patients versus 45 of 71 (63%) of those who (73%) who received BNT162b2 and 83 of received mRNA-1273 (p = 0.002). Methods: We conducted a prospective 87 (95%) who received mRNA-1273 observational cohort study at 2 academic attained convalescent levels of anti-spike Interpretation: In patients undergoing centres in Toronto, Canada, from Feb. 2, antibody (p < 0.001). In those who hemodialysis, mRNA-1273 elicited a stron-2021, to July 20, 2021, which included received BNT162b2, 35 of 70 (50%) ger humoral response than BNT162b2. 129 and 95 patients who received the reached the convalescent level for anti-Given the rapid decline in immunogen-BNT162b2 and mRNA-1273 SARS-CoV-2RBD compared with 69 of 87 (79%) who icity at 12 weeks in patients who received vaccines, respectively. We measured SARS-received mRNA-1273 (p < 0.001). At BNT162b2, a third dose is recommended CoV-2 immunoglobulin G antibodies to the 12 weeks afer the second dose, anti-spike in patients undergoing dialysis as a prispike protein (anti-spike), receptor binding and anti-RBD levels were significantly mary series, similar to recommendations domain (anti-RBD) and nucleocapsid pro-lower in patients who received BNT162b2 for other vulnerable populations. Patients with end-stage kidney disease who are receiving with the general population, and a review of 35 studies involving maintenance hemodialysis (HD) are at increased risk for dialysis patients found that in the 1-month period afer 2-dose vacsevere COVID-19, with mortality rates ranging from 9% to cination, seroconversion rates ranged from 70% to 96%. 5 28%. 1,2 Highly effective vaccines have been developed against The BNT162b2 (Pfizer BioNTech) and mRNA-1273 (Moderna) SARS-CoV-2, with 94.1%-95% eficacy in reducing the risk of severe SARS-CoV-2 vaccines are both lipid nanoparticle-encapsulated, COVID-19 (D614G strain) as confirmed by 2 large randomized con-nucleoside-modified mRNA encoding for the full-length SARStrolled trials; however, these studies included limited numbers of CoV-2 spike protein stabilized in its prefusion conformation. The patients with kidney disease. 3,4 Humoral response to vaccination ...