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The COVID-19 pandemic has spread worldwide exponentially. Typically, for testing, a provincial main government hospital cum testing center collects patients' specimens from remote health centers in the minimum possible time, satisfying the 'false negativity' constraint of the first collected specimen. With infrastructural developments throughout the world, multiple paths are available for transportation between two cities. Currently, the 'green corridor' is used for the transportation of human organs to be implanted, travel of VIPs, etc., in the minimum possible time. Taking these facts in consideration, for the first time, a green corridor system is suggested to provide a transportation pathway from small hospitals and urban/rural health centers to the testing center with COVID-19 specimens such as blood, nasal and throat swabs, and viral RNA, within the first collected specimen's life period. As health centers are located in different places, appropriate routing plans are needed for visiting them in the minimum possible time. A problem arises if this routing time exceeds the 'false negativity' of the first collected specimen. Thus, multipath COVID-19 specimen collection problems (MPC-19SCPs) are mathematically formulated to be collected from all health centers, and optimum routing plans are obtained using fixed and variable length genetic algorithms (VLGAs) developed for this purpose. For the first time, green corridor systems are suggested to incorporate the centers. The objectives of the models are, subject to the 'false-negative" constraint, minimization of the system time (Model A) and the green corridor time without or with mutual cooperation among the minimum number of centers for the transfer of specimens (Models B and C, respectively). The developed algorithms are based on variable length chromosomes, probabilistic selection, comparison crossover and generation-dependent mutation. Some benchmark instances from TSPLIB are solved by VLGA and GA. The competitiveness of VLGA is established through ANOVA. The models are numerically demonstrated, and some conclusions are derived.

Aims: It has been suggested that the COVID-19 restrictions may have negatively impacted physical activity (PA) levels, especially among adolescents, who often use organised sports to support their intrinsic motivation for staying active. This study aimed to investigate whether adolescents were less physically active after the COVID-19 restrictions compared with before and examine whether participation in organised sports has changed since the COVID-19 restrictions. Methods: This was a retrospective cohort study of Danish adolescents aged 15 to 19 years. Data was collected using a questionnaire in SurveyXact. The primary variable of interest was moderate or high-intensity PA frequency before and after COVID-19 restrictions (from March 11, 2020, to September 10, 2021). Secondary variables of interest included whether the PA was self-organised (e.g. running, hiking, going to a gym or cycling) or part of an organised sport delivered by a club or other association, before versus after the restrictions. Results: A total of 324 participants responded to the questionnaire. The relative risk of not performing PA at least twice per week after COVID-19 restrictions compared with before was significantly larger (1.44; 95%CI: 1.19 to 1.85, p = 0.005). Before the lockdowns, 190 (59%) were engaged in organised sports compared with 152 (47%) after the restrictions (relative risk: 1.51, 95%CI: 1.19 to 1.92, p < 0.001). Conclusions: Compared with activity levels before the pandemic, adolescents became significantly less physically active following the COVID-19 restrictions, beyond what is typically observed during adolescence. These results emphasise a need for strategies to increase PA levels among adolescents to minimise the long-term negative effects of physical inactivity during adolescence.

AIM: Efforts to control the COVID-19 pandemic might reduce accessibility for diagnostics and treatment of colorectal cancer. A universal public healthcare system may modify the availability of healthcare services. The aim of this study was to investigate changes in the quality of care for patients with colorectal cancer during the COVID-19 pandemic.METHOD: Nationwide data from the Danish Colorectal Cancer database and Statistics Denmark on the number of new diagnoses, disease and health behaviour measures, socioeconomic measures, clinical quality measures and time to adjuvant chemotherapy were retrieved. Measures during the COVID-19 pandemic in 2020 and the different pandemic periods were compared to the pre-pandemic period.RESULT: In 2020, 4035 patients were diagnosed with colorectal cancer, compared with 4346 in 2019 and 4496 in 2018. During the pandemic, patients were more likely to have UICC stage I disease (25.0% vs 23.4%; PR=1.07(95% confidence interval: 1.00;1.15)), belonging to the highest income quintile (PR=1.06(0.98;1.14), receive surgery with a curative aim (PR=1.02(1.01;1.03)), and to be operated on by a specialist (PR=1.07(1.06;1.08)), and less likely to be 60-69 years of age (PR=0.93(0.86;1.00)), non-western immigrants (PR=0.93(0.86;1.00)), diagnosed by screening (PR=0.79(0.73;0.86)) and receiving an acute operation (PR=0.77(0.66;0.91)). Furthermore, during the pandemic, 11.4% fewer patients waited 28 days or longer for initiation of adjuvant oncological treatment.CONCLUSION: Based on nationwide data, we observed no major adverse effect on disease measures or clinical quality in a tax funded health care system. However, small changes in the socioeconomic composition of the patient population were observed.

ObjectiveIn a setting with an extensive SARS-CoV-2 test strategy and availability of effective vaccines, we aimed to investigate if patients with inflammatory rheumatic diseases (IRD) face greater risk of contracting SARS-CoV-2 and have a worse prognosis of increased risk of hospitalisation, assisted ventilation and death compared with the general population.MethodsThis was a nationwide, population-based register study that compared outcomes of SARS-CoV-2 infection in Danish patients with IRD (n=66 840) with matched population controls (n=668 400). The study period was from March 2020 to January 2023. Cox regression analyses were used to calculate incidence rate ratios (IRRs) for SARS-CoV-2-related outcomes.ResultsWe observed a difference in time to first and second positive SARS-CoV-2 test in patients with IRD compared with the general population (IRR 1.06, 95% CI 1.05 to 1.07) and (IRR 1.21, 95% CI 1.15 to 1.27). The risks of hospital contact with COVID-19 and severe COVID-19 were increased in patients with IRD compared with population controls (IRR 2.11, 95% CI 1.99 to 2.23) and (IRR 2.18, 95% CI 1.94 to 2.45). The risks of assisted ventilation (IRR 2.33, 95% CI 1.89 to 2.87) and COVID-19 leading to death were increased (IRR 1.98, 95% CI 1.69 to 2.33). Patients with IRD had more comorbidities compared with the general population. A third SARS-CoV-2 vaccination was associated with a reduced need for hospitalisation with COVID-19 and reduced the risk of death.ConclusionPatients with IRD have a risk of SARS-CoV-2, which nearly corresponds to the general population but had a substantial increased risk of hospitalisation with COVID-19, severe COVID-19, requiring assisted ventilation and COVID-19 leading to death, especially in patients with comorbidities.

Background In the INSPIRATION-S trial, atorvastatin versus placebo was associated with a nonsignificant 16% reduction in 30-day composite of venous/arterial thrombosis or death in intensive care unit (ICU) patients with COVID-19. Thrombo-inflammatory response in coronavirus disease 2019 (COVID-19) may last beyond the first 30 days. Methods This article reports the effects of atorvastatin 20 mg daily versus placebo on 90-day clinical and functional outcomes from INSPIRATION-S, a double-blind multicenter randomized trial of adult ICU patients with COVID-19. The main outcome for this prespecified study was a composite of adjudicated venous/arterial thrombosis, treatment with extracorporeal membrane oxygenation (ECMO), or all-cause mortality. Functional status was assessed with the Post-COVID-19 Functional Scale. Results In the primary analysis, 587 patients were included (age: 57 [Q1–Q3: 45–68] years; 44% women). By 90-day follow-up, the main outcome occurred in 96 (33.1%) patients assigned to atorvastatin and 113 (38.0%) assigned to placebo (hazard ratio [HR]: 0.80, 95% confidence interval [CI]: 0.60–1.05, p = 0.11). Atorvastatin in patients who presented within 7 days of symptom onset was associated with reduced 90-day hazard for the main outcome (HR: 0.60, 95% CI: 0.42–0.86, p interaction = 0.02). Atorvastatin use was associated with improved 90-day functional status, although the upper bound CI crossed 1.0 (ORordinal: 0.64, 95% CI: 0.41–1.01, p = 0.05). Conclusion Atorvastatin 20 mg compared with placebo did not significantly reduce the 90-day composite of death, treatment with ECMO, or venous/arterial thrombosis. However, the point estimates do not exclude a potential clinically meaningful treatment effect, especially among patients who presented within 7 days of symptom onset (NCT04486508).

The future of airports and aeromobilities looked much different before Covid-19.Being a global growth-sector with a problematic environmental impact, the sectorshowed little inclination to radically re-think its potential futures. However, theadvent of Covid-19 dramatically changed this. This paper is based on a researchproject related to Airport City Futures that was initiated before Covid-19. Thistiming, however, has enabled us to see a dramatic change in the assessment offuture scenarios. In the paper we present four basic future scenarios that includeboth utopian and dystopian elements (business as usual, fortress airports, Ecoports, and Smart airports). We explore these on the background of a theoretical framework containing three themes: aeromobilities, future scenarios as a methodology, and the epidemic society. The paper thus explores the future of aeromobilities and potential innovations in air space by ‘thinking with’ Covid-19. It presents critical reflections on how to democratize the future of aeromobilities in light of global disruption.

Abstract This chapter presents the case of a woman who complains of persistent pain in the four limbs that started after intensive care unit (ICU) discharge due to COVID-19 infection. She fulfills criteria for Guillain–Barré syndrome, but her clinical picture may have been worsened by ICU stay. This case shows that Guillain–Barré syndrome is possible after COVID-19 and may induce neuropathic pain. Other potential causes of pain after COVID-19 mainly include post-ICU neuromuscular disorders for severe cases and long COVID syndrome. These consist of a constellation of symptoms, including headache or widespread pain, fatigue, respiratory or cardiovascular problems, and sleep disorders. These symptoms, which share similarities with other post-infectious disorders, might result from residual damage from acute infection, persistent immune activation, psychological factors, or unmasking of prior comorbidities.

VEXAS (vakuoler, E1-enzym, genvariant på X-kromosomet, utoinflammation, somatisk)-syndrom er et autoinflammatorisk syndrom først beskrevet i 2020. VEXAS-syndrom skyldes en genvariation med dysfunktion i ubiquitin-like modifier activating enzyme 1-genet (UBA1) i hæmatopoietiske stamceller i knoglemarven, hvilket fører til systemisk inflammation. Sygdommen rammer primært midaldrende til ældre mænd, da UBA1 er lokaliseret på X-kromosomet. De hyppigste symptomer er hududslæt, feber, vægttab, øjenaffektion, kondritis, artralgier og venøse tromboembolier. I knoglemarvsaspiratet er der karakteristiske vakuoler i myeloide og erytroide stamceller, og det kan være ledsaget af regelret myelodysplasi (MDS), monokolonal gammopati af ukendt betydning eller myelomatose [1]. VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a newly discovered complicated autoinflammatory syndrome associated with haematological and rheumatological manifestations, recognized for the first time in 2020. In this case report, we describe the first case of VEXAS syndrome in the North Denmark Region. A 76-year-old male was briefly admitted with COVID-19 and a myriad of symptoms including jaw pain, arthralgia, skin rash, malaise, intermittent fever and weight loss. After a prolonged diagnostic evaluation, VEXAS syndrome was suspected and confirmed with the presence of a mutated ubiquitin-like modifier activating enzyme 1 (UBA1) gene.