The incidence rate and severity of COVID-19 infection in hospitalized vaccinated patients and outpatients who received remdesivir from March to September 2021 and outcome comparison between single and double vaccinated patients

The incidence rate and severity of COVID-19 infection in hospitalized vaccinated patients and outpatients who received remdesivir from March to September 2021 and outcome comparison between single and double vaccinated patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The incidence rate and severity of COVID-19 infection in hospitalized vaccinated patients and outpatients who received remdesivir from March to September 2021 and outcome comparison between single and double vaccinated patients Mina Khosravi, Ebrahim Babaee, Nahid Nafissi, Sima Shokri, Taghi Riahi, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3271039/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: This study assessed the impact of COVID-19 vaccination on infection rates and severity, the protective period after vaccination, risk factors for hospitalization, and adverse reactions. It involved PCR-confirmed COVID-19 patients managed as inpatients or outpatients at Rasool-e Akram Hospital, Tehran, Iran, from March 21 to September 21, 2021. Methods: A standard checklist was used to gather data through phone calls from 3701 PCR+ patients, including 989 inpatients and 2712 outpatients. Results: After the first dose, COVID-19 incidence rate was 70.98%, mostly occurring one to four weeks post-vaccination. Following the second dose, the incidence rate dropped to 31.82%, with infections occurring between one to two months post-vaccination. Among inpatients and outpatients, 23% and 21% respectively had been vaccinated. Notably, 95.46% of outpatients and 91.52% of inpatients received both doses. Double vaccinated patients showed better outcomes, with lower O2 saturation below 70% (4.78% vs. 14.53%), and less severe lung involvement (0.65% vs. 5.71%). Conclusion: The study revealed that the second sinopharm vaccine dose significantly reduces the incidence and severity of COVID-19 infection. While it offers protection against moderate to severe illness and reduces hospitalization, it may not prevent very severe cases or ICU admission. The most effective protection against infection occurs between one month after the first dose and one to two months after the second dose. Nonetheless, two doses do not provide long-term protection against infection. Further research is warranted to understand long-term vaccine efficacy. COVID-19 vaccination infection rate severity hospitalization lung involvement. Key points There were 3701 patients in this study, including 989 who were managed as inpatients and 2712 as outpatients. Infection rate after the first dose of COVID-19 vaccine was 70.98% in all the patients and 31.82% after the second dose, which perhaps suggests that the second dose of the vaccine can decrease the rate of COVID-19 infection. There was no significant difference in gender between the inpatient and outpatient groups, but the inpatient group had significantly older age than the outpatient group (P=0.000). A total of 820 out of 3701 patients were vaccinated, including 23% in the inpatient group and 21% in the outpatient group. There was a higher percentage of double vaccination in the outpatient group than the inpatient group. Therefore, the second dose of vaccination can decrease the probability of hospitalization and moderate to severe COVID-19 infection significantly (P=0.029). The duration between the first dose of vaccination and subsequent COVID-19 infection was less than one month in most of the cases, which implies that the maximum protective effect of vaccination is one month after the first dose (P=0.000). In most of the inpatient and outpatient cases, the duration between the second dose of the vaccine and subsequent COVID-19 infection was one to two months (P=0.022), which implies that the protective effect of vaccination may decrease two months after the second dose. Therefore, the best protective effect of COVID vaccination against infection is achieved in the period between one month post-first dose and one to two months post-second dose. This observation suggests that two doses of COVID vaccine likely do not lead to long-term protection against COVID infection. O2 saturation was reported under 70% in 14.53% of the single vaccinated patients and 4.78% of the double vaccinated group. Also, 19.51% of the single vaccinated group and 27.73% of the double vaccinated group had O2 saturation over 90% (P=0.031). The severity of lung involvement less than 15% in the chest CT scan was 17.14% in the single vaccinated patients and 10.68% in the double vaccinated group. The severity of lung involvement more than 80% in the chest CT scan was 5.71% in the single vaccinated patients and 0.65% in the double vaccinated patients (P=0.008). Therefore, the second dose of the vaccine can significantly decrease lung involvement in COVID-19 patients. Requiring medical care after COVID-19 recovery was 23.66% in the inpatient group and 13.18% in the outpatient group (P=0.000), which could have been due to the fact that the inpatient group had more severe disease and subsequently greater complications and longer COVID-19 symptoms than the outpatient group. The reasons for requiring medical care or readmission include the progression of COVID-19 symptoms, reinfection by SARS-CoV-2, cardiac complications, pulmonary edema, pulmonary fibrosis, gastrointestinal bleeding and urine incontinency. The majority of the cases received two doses of COVID-19 vaccine. Hospitalization rate reduced significantly after the second dose of the vaccine (P=0.029); however, ICU admission did not decrease significantly after the second dose. This finding may suggest that the second dose of COVID-19 vaccine can bring protection against moderate to severe COVID-19 and reduce hospitalization but cannot prevent very severe COVID-19 or reduce the rate of ICU admission. Aligned with other studies and meta-analyses, the second dose of COVID-19 vaccine leads to better outcomes than one dose vaccination. In comparison with other studies, our study reported that Sinopharm vaccine as an inactivated vaccine had a shorter protection period. Introduction SARS-CoV-2, the virus causing COVID-19, has spread rapidly across the world, resulting in various levels of illness. On March 11, 2020, SARS-CoV-2 was declared a worldwide pandemic. ( 1 ) Vaccines are one of the best interventions developed for eradicating COVID-19, saving millions of lives annually, and the best option for combatting this virus remains an effective and safe vaccine. ( 2 ) As of 2023, over twenty vaccines have been approved for this virus in different parts of the world, including adenoviral vector vaccines, mRNA vaccines, subunit vaccines, vaccines based on inactivated SARS-CoV‐2, and a DNA vaccine. ( 3 ) Vaccination serves as a two-edged sword, as it is the best tool for curbing this pandemic while also bringing ambiguity, uncertainty, and challenges that the world faces during its administration or unknown long-term effects that might emerge later in life. For instance, the data delivered from clinical trials on the safety profile, immunogenicity, and efficacy of vaccines in preventing symptomatic infection are limited to the context of these trials and cannot be applied to the larger public. ( 4 ) The goals of vaccination are to reduce the risk of infection and the severity of the disease. Though vaccines against COVID-19 have demonstrated effectiveness, infection is still a possibility despite vaccination. ( 5 ) The concerns about developing infection even after vaccination are mitigated by abundant evidence showing that the risk of severe COVID-19 (as proxied by hospitalization, ICU admission, and mortality) is lessened by vaccination. ( 6 ) In this study, we report new infections and the severity of these new infections after one or two doses of COVID-19 vaccine, the duration between vaccination and reinfection, and a comparison of outcomes between COVID-19 patients managed as inpatients and outpatients. Due to the large number of COVID-19 patients during this pandemic in Iran, hospital equipment had become scarce and the research participants were managed in two groups, including an inpatient and an outpatient group. The inpatient group consisted of COVID-19 patients who had more severe symptoms and needed hospitalization. Both groups received remdesivir for their treatment. Methods Setting This cross-sectional study was conducted on about 3700 patients infected by SARS-CoV-2 as inpatients or outpatients at Rasool-e Akram Hospital in Tehran, Iran, from March 21 to September 21, 2021. The study was carried out in accordance with the ethical principles of the Declaration of Helsinki and was approved by the Ethics Committee of Iran University of Medical Sciences (#IR.IUMS.REC.1401.650). Verbal informed consent was obtained from the participants in advance. A standard checklist was designed by a group of COVID-19 researchers and filled out by a trained interviewer through phone calls with the patients. The first part of the checklist included the patients’ demographic information. In the next part, the patients were inquired about their COVID-19 vaccination status (including the type of vaccine received) and post-vaccination COVID-19 infection history, severity of the disease and need for hospitalization due to COVID-19 after the first dose and second dose of the vaccine. Also, data regarding vaccine-related adverse reactions were collected. Inpatients and outpatients were compared separately in terms of clinical characteristics and the need for additional treatment measures and vaccination status. In the next step, the effect of the number of doses of COVID-19 vaccine received on the probability of future hospitalizations due to COVID-19 and the need for additional treatments was evaluated. Quantitative and categorical variables are reported as mean ± standard deviation (SD) and frequency (percentage), respectively. To assess the association between the categorical variables, Chi-square and Fisher's exact tests (if needed) were applied. All the statistical analyses were performed at a 95% significance level using Stata software version 17 (Stata Corp, College Station, TX, USA). Results This study recruited 3701 patients with a history of COVID-19 infection managed as inpatients or outpatients. Just above half of the patients (50.31%) were male. Most patients were in the age group of 40 to 49 years (22.99%). Among the evaluated patients, 22.16% (n = 820) had been vaccinated against COVID-19 and the majority of them had received two doses of the vaccine (94.38%, n = 774 out of 820). Sinopharm was the most frequently-injected vaccine (79.58%). The incidence of COVID-19 infection after the first dose of vaccination was 70.98% and the infection had occurred from one to four weeks after vaccination in 62% of the cases. The incidence rate of COVID-19 after the second dose of vaccination was 31.82% and the infection had occurred one to two months after vaccination in 39.18% of the cases. Only 16% of the vaccinated patients infected by SARS-CoV-2 required medical care after their recovery. The causes of requiring medical care or readmission included the progression of COVID-19 symptoms, reinfection by SARS-CoV-2, cardiac complications, pulmonary edema, pulmonary fibrosis due to COVID-19, gastrointestinal bleeding and urine incontinency. A total of 14.53% of the single dose vaccinated patients had O2 saturation under 70%, but in the double dose vaccinated group, the rate was 4.78%; also, 19.51% of the single dose vaccinated group and 27.73% of the double dose vaccinated group had O2 saturation over 90% (P = 0.031). The severity of lung involvement less than 15% in the chest CT scan was 17.14% in the single dose vaccinated patients and 10.68% in the double vaccinated patients. The severity of more than 80% lung involvement in the chest CT scan was 5.71% in the single vaccinated patients and 0.65% in the double vaccinated patients (P = 0.008). Out of 3701 patients, 989 were managed as inpatients and 2712 as outpatients. The outpatient group was at younger age than the inpatient group (P = 0.000). A total of 95.46% (n = 568 out of 595) of the outpatient group and 91.52% (n = 205 out of 224) of the inpatient group were vaccinated with two doses of COVID-19 vaccine (P = 0.029). None of the outpatient group and 4.93% (n = 11 out of 223) of the inpatient group were readmitted to the hospital because of COVID-19 complications (P = 0.309), and 23.66% (n = 53 out of 223) of the inpatient group and 13.18% (n = 78 out of 592) of the outpatient group required medical care after COVID-19 recovery (Table 1 ). Table 1 Comparison of the inpatient and outpatient groups Variable Inpatient Outpatient P-value Gender Female 483 48.84% 1356 50% 0.531 Male 506 51.16% 1356 50% Age Under 18 9 0.91% 15 0.55% 0.000 18–29 33 3.34% 209 7.45% 30–39 193 19.51% 633 23.34% 40–49 208 21.03% 643 23.71% 50–59 220 22.24% 618 22.79% 60–69 209 21.13% 437 16.11% 70–79 86 8.7% 128 4.72% 80 and older 31 3.13% 36 1.33% Vaccination status Vaccinated One dose 17 7.4% 25 4.3% .029 Two doses 212 92.6% 566 95.7% Not vaccinated 760 76.8% 2121 78.2% Type of vaccination Sinopharm 195 29.6% 462 70.3% 0.476 AstraZeneca 30 33.3% 60 66.6% Sputnik 19 35% 35 64.8% Others 6 30% 14 70% COVID-19 infection after first dose of vaccination Infected 176 76.8% 400 69.5% 0.569 Not infected 53 23.14% 175 30.43% COVID infection after second dose of vaccination Infected 66 31.1% 186 32.8% 0.922 Not infected 146 68.9% 380 67.2% The duration between the first dose of the vaccine and subsequent COVID-19 infection Less than 3 days 20 11.36% 36 9% 0.000 4 days to 1 week 30 17.045% 57 14.25% 1 week to 2 weeks 42 23.86% 95 23.75% 2 weeks to 1 month 62 35.2% 180 45% 1 month to 2 months 20 11.36% 26 6.5% More than 2 months 2 1.13% 6 1.5% The duration between the second dose of the vaccine and subsequent COVID-19 infection Less than 3 days 3 4.54% 28 15.05% 0.022 4 days to 1 week 5 7.57% 31 16.6% 1 week to 2 weeks 10 15.15% 27 14.5% 2 weeks to 1month 13 19.69% 45 24.19% 1 month to 2 months 35 53.03% 55 29.56% Reaction after first dose of vaccination With reaction 38 15.2% 74 12.92% 0.467 Without reaction 212 84.8% 499 87.08% Readmission after COVID-19 Yes 11 4.93% 0 0.309 No 212 95.07% 20 100% Medical care after COVID-19 recovery Yes 53 23.66% 78 13.18% 0.000 No 171 76.34% 514 86.82% Table 2 A comparison between the single dose vaccinated and double dose vaccinated groups of patients. Variable One dose of vaccination Two doses of vaccination P-value Gender Male 5.14%(22) 64.86%(406) 0.536 Female 6.14%(24) 93.86%(367) Age Under 18 0 0 0.1 18–29 0 100%(12) 30–39 11.29%(7) 88.71%(55) 40–49 2.94%(2) 97.06%(66) 50–59 7.83%(17) 92.17%(200) 60–69 5.43%(15) 94.57%(261) 70–79 2.17%(3) 97.83%(135) 80 and older 4.35%(2) 95.65%(44) Hospitalization after vaccination yes 41.3%(19) 26.52%(205) 0.029 no 58.7%(27) 73.48%(568) Hospitalization days Less than 10 days 89.47%(17) 87.32%(179) 0.827 10–20 days 10.53%(2) 10.73%(22) More than 20 days 0 1.95%(4) ICU hospitalization after vaccination Yes 2.17%(1) 2.46%(19) 0.903 No 97.83%(45) 97.54%(754) ICU hospitalization days Less than 5 days 100%(1) 36.84%(7) 0.454 5 to 10 days 0 52.63%(10) More than 10 days 0 10.53%(2) Readmission after COVID-19 infection Yes 10%(2) 4.05%(9) 0.221 No 90%(18) 95.95%(213) Require medical care after COVID-19 infection Yes 26.09%(12) 15.47%(119) 0.057 No 73.91%(34) 84.53%(650) O2 saturation 90% 19.51%(8) 27.73%(180) Chest CT scan severity 80% 5.71%(20) 0.65%(4) The comparison of the vaccinated patients and those who had not been vaccinated at all showed no significant differences in hospitalization and ICU admission. In the vaccinated group, 27.44% (n = 225 out of 820) were hospitalized due to COVID-19 and 2.44% required ICU admission; in the unvaccinated group, 26.52% (n = 764 out of 2881) were hospitalized and 2.74% required ICU admission (P = 0.6). Most of the patients were hospitalized less than ten days (87.56%) and required ICU care for less than five days (45.45%). Reactions after the first dose of vaccination: Out of 820 patients who received the first dose of the vaccine, 13.69% (n = 112) showed some reactions. A total of 84% of the patients (n = 94 out of 112) had fever, headache and myalgia after the first dose of vaccination. A total of 9.8% (n = 11 out of 112) had malaise and 5% showed other reactions, including neurological, dermatological and respiratory symptoms. Reactions after the second dose of vaccination: Out of 774 patients who received the second dose of the vaccine, 8.13% (n = 63) showed some reactions. A total of 92% (n = 58) had fever, headache and myalgia after injection and 8% had other reactions, including malaise, respiratory, dermatological and GI symptoms. Discussion This study examined 3701 COVID-19 patients treated in our hospital as inpatients and outpatients, depending on the severity of their infection, and compared the effects of vaccination on their outcomes. A total of 989 of them were inpatients and 2712 were outpatients and they were mainly treated with remdesivir. A meta-analysis on 22 randomized controlled trials with a total of 3,404,696 older adults reported that any dose of the vaccine is protective in older adults; however, administration of two doses is more effective than one dose. They also found that older adults who received COVID-19 vaccines experienced better outcomes. Likewise, we also reported that the second dose of COVID-19 vaccine can significantly decrease the probability of hospitalization and moderate to severe COVID-19 infection.( 7 ) In another meta-analysis on 18 studies representing nearly seven million individuals, the effect of vaccination against all SARS-CoV-2 infections declined from 83% in the first month after completion of the original vaccination series to 22% in five months or longer. Similarly, the effect of vaccination against symptomatic COVID-19 declined from 94% in the first month after vaccination to 64% by the fourth month. Our study showed that the duration between the first dose of vaccination and subsequent COVID-19 infection was less than one month in most cases, which implies that the maximum protective effect of vaccination is one month after the first dose. In most inpatient and outpatient cases, the duration between the second dose of the vaccine and subsequent COVID-19 infection was one to two months, which implies that the protective effect of vaccination may decrease two months after the second dose. An explanation for a shorter period of effective protection is that our study subjects mostly received Sinopharm vaccine, which is an inactivated vaccine type or the fact that our participants only received one or two doses of vaccine. These data can be used to inform public health decision-makers about the need for booster vaccination or question the effectiveness of Sinopharm vaccine.( 8 ) A meta-analysis published in 2022 revealed that the vaccinated group had a 29% lower risk of developing long COVID-19 compared with the unvaccinated group. Furthermore, two doses of vaccination showed better protective effects as compared with one dose of vaccination. In addition, vaccination was effective against long COVD-19 in patients either vaccinated before SARS-CoV-2 infection or vaccinated after SARS-CoV-2 infection. For long COVID-19 symptoms, vaccination reduced the risk of cognitive dysfunction symptoms, kidney diseases, myalgia, and sleeping disorders. In our study, requiring medical care after COVID-19 recovery was 19.1%. Compared with one dose vaccinated patients, long COVID-19 or requiring medical care for COVID-19 related reasons decreased from 35.2–18% after the second dose of vaccine. The reasons for requiring medical care or readmission include the progression of COVID-19 symptoms, reinfection by SARS-CoV-2, cardiac complications, pulmonary edema, pulmonary fibrosis, gastrointestinal bleeding, urinary incontinency and other long COVID-19 symptoms. However, as a limitation in our study, we did not have the data to compare vaccinated and unvaccinated patients. Therefore, the vaccination rate should be improved as soon as possible, especially for a complete vaccination course. There should be more studies to explore the basic mechanisms of the protective effect of COVID-19 vaccines on long COVID in the future.( 9 ) In this study, we compared inpatient and outpatient cases who received remdesivir, non-hospitalized remdesivir treatment was not so common worldwide but due to the overwhelmed health care system, it was one way to help more patients. There are few studies evaluating non-hospitalized patients receiving remdesivir. For instance, in a randomized, double-blind, placebo-controlled study, unvaccinated patients 12 years or older with at least one risk factor for severe COVID-19 or those older than 60 years regardless of risk factor(s) were enrolled at 64 sites worldwide. Of these, 562 patients underwent 1:1 randomization to receive either remdesivir or placebo infusions. The remdesivir group received a three-day course of infusion at 200 mg on day one and then 100 mg on days two and three. Patients who received remdesivir had an 87% lower risk of COVID-19 related medical visits or all-cause deaths. Notably, the effectiveness of remdesivir in non-hospitalized patients with COVID-19 was comparable to monoclonal antibody treatment, which has less widespread availability. Study limitations include a low number of patients with liver or kidney diseases, and the exclusion of vaccinated patients. In our study, there was a higher percentage of double vaccination in the outpatient group than that in the inpatient group. Therefore, the second dose of vaccination can decrease the need of hospitalization and severe COVID-19 infection.( 10 ) Another study evaluated the differences in the clinical characteristics and severity of lung impairment, assessed by quantitative lung CT scan, between vaccinated and non-vaccinated hospitalized patients with COVID-19 including 684 consecutive patients [580 (84.8%) vaccinated, and 104 (15.2%) non-vaccinated]. The results showed that hospitalized vaccinated patients with COVID-19 presented a similar impairment in gas exchange and lung CT scan compared to non-vaccinated patients, but were at a lower risk of mortality. However, we reported in our study the severity of lung involvement less than 15% in the chest CT scan as 17.14% in the single vaccinated patients versus 10.68% in the double vaccinated group. The severity of lung involvement more than 80% in the chest CT scan was 5.71% in the single vaccinated patients and 0.65% in the double vaccinated patients. Therefore, the second dose of the vaccine can significantly decrease lung involvement in COVID-19 patients. We did not compare vaccinated with unvaccinated patients, but in comparison between one dose vaccinated and two dose vaccinated, lung impairment and CT scan severity is less in double dose vaccinated patients. Although this study revealed that the maximum protective effect of vaccination is achieved one to two months later and that it is necessary to get a booster dose after this period, these findings mainly pertain to Sinopharm, since it was the most frequently-injected vaccine injected in Iran during the COVID-19 pandemic. The burden of COVID-19 is higher in developing countries, probably reflecting the limited access of people in these countries to appropriate health care and antiviral treatments and the great burden on already-overwhelmed health care systems. ( 11 ) The lack of adequate equipment, the overload of COVID-19 patients and healthcare workers’ burnout during the pandemic led to the need for managing some COVID-19 patients on an outpatient basis, which could alleviate the burden of COVID-19 and prevent hospitalization that has been highlighted since the beginning of the pandemic. ( 12 ) Conclusion This study showed that the incidence and severity of COVID-19 infection decrease after receiving the second dose of COVID-19 vaccine. The second dose of the vaccine can bring protection against moderate to severe disease and reduce hospitalization but cannot prevent very severe COVID-19 or reduce the incidence of ICU admission. The second dose of the vaccine can significantly decrease lung involvement in COVID-19 patients, as well. The best protective effect of COVID-19 vaccination against infection is between one month post-first dose and one to two months post-second dose. Two doses of COVID-19 vaccine do not yield long-term protection against infection. Requiring medical care after COVID-19 recovery was 23.66% in the inpatient group and 13.18% in the outpatient group, which may have been caused by the fact that the inpatient group had more severe disease and consequently greater complications and longer duration of symptoms than the outpatient group. The causes for requiring medical care or readmission included the progression of COVID-19 symptoms, reinfection by SARS-Cov-2, cardiac complications, pulmonary edema, pulmonary fibrosis due to COVID-19, gastrointestinal bleeding and urine incontinency. Declarations a. Funding: This manuscript had no funding. b. Conflict of interest: there was no conflict of interests. c. Availability of data and material: the data of this study are available by contacting the corresponding author upon reasonable request. d. Code availability: not applicable. e. Ethics approval: The study was approved by the Ethics Committee of Iran University of Medical Sciences (#IR.IUMS.REC.1401.650) f. Author’s contributions: MK and AZ selected questions for the interview and make other decisions also drafted and approved manuscript. EB and MJ performed data analysis. NN, SS, TR, MF, SK supervised the work. SM approved final version of the manuscript. g. Consent to participate: Verbal informed consent was obtained from the participants in advance. h. Consent for publication: all authors consent to publish. References Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Vol. 55, International Journal of Antimicrobial Agents. 2020. Saeed BQ, Al-Shahrabi R, Alhaj SS, Alkokhardi ZM, Adrees AO. Side effects and perceptions following Sinopharm COVID-19 vaccination. Int J Infect Dis. 2021;111. Mohamed K, Rzymski P, Islam MS, Makuku R, Mushtaq A, Khan A, et al. COVID-19 vaccinations: The unknowns, challenges, and hopes. Vol. 94, Journal of Medical Virology. 2022. Jeyanathan M, Afkhami S, Smaill F, Miller MS, Lichty BD, Xing Z. Immunological considerations for COVID-19 vaccine strategies. Vol. 20, Nature Reviews Immunology. 2020. Parameswaran A, Apsingi S, Eachempati KK, Dannana CS, Jagathkar G, Iyer M, et al. Incidence and severity of COVID-19 infection post-vaccination: a survey among Indian doctors. Infection. 2022;50(4). Taquet M, Dercon Q, Harrison PJ. Six-month sequelae of post-vaccination SARS-CoV-2 infection: A retrospective cohort study of 10,024 breakthrough infections. Brain Behav Immun. 2022;103. Toubasi AA, Al-Sayegh TN, Obaid YY, Al-Harasis SM, AlRyalat SAS. Efficacy and safety of COVID-19 vaccines: A network meta-analysis. J Evid Based Med. 2022 Sep;15(3):245–62. Ssentongo P, Ssentongo AE, Voleti N, Groff D, Sun A, Ba DM, et al. SARS-CoV-2 vaccine effectiveness against infection, symptomatic and severe COVID-19: a systematic review and meta-analysis. BMC Infect Dis. 2022 Dec 7;22(1):439. Gao P, Liu J, Liu M. Effect of COVID-19 Vaccines on Reducing the Risk of Long COVID in the Real World: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022 Sep 29;19(19). Gottlieb RL, Vaca CE, Paredes R, Mera J, Webb BJ, Perez G, et al. Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients. N Engl J Med. 2022 Jan 27;386(4):305–15. Usher AD. The global COVID-19 treatment divide. Lancet (London, England). 2022 Feb 26;399(10327):779–82. Rajme-López S, Martinez-Guerra BA, Zalapa-Soto J, Román-Montes CM, Tamez-Torres KM, González-Lara MF, et al. Early Outpatient Treatment With Remdesivir in Patients at High Risk for Additional Declarations No competing interests reported. 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Mozafarpoor","email":"","orcid":"","institution":"Isfahan University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Samaneh","middleName":"","lastName":"Mozafarpoor","suffix":""},{"id":227250915,"identity":"388d4c62-48cd-4424-81b1-d3360cbbc86d","order_by":9,"name":"Azadeh Goodarzi","email":"data:image/png;base64,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","orcid":"","institution":"Rasool-e-Akram Medical Complex Clinical Research Development Center (RCRDC), Iran University of Medical Sciences","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Azadeh","middleName":"","lastName":"Goodarzi","suffix":""}],"badges":[],"createdAt":"2023-08-17 06:44:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3271039/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3271039/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":42794364,"identity":"d170794f-45a4-4a9a-969a-245270d8e288","added_by":"auto","created_at":"2023-09-07 21:07:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":329577,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3271039/v1/c583c9fd-1e99-4acf-b24a-48228843bf5d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The incidence rate and severity of COVID-19 infection in hospitalized vaccinated patients and outpatients who received remdesivir from March to September 2021 and outcome comparison between single and double vaccinated patients","fulltext":[{"header":"Key points","content":"\u003cul\u003e\n \u003cli\u003eThere were 3701 patients in this study, including 989 who were managed as inpatients and 2712 as outpatients.\u003c/li\u003e\n \u003cli\u003eInfection rate after the first dose of COVID-19 vaccine was 70.98% in all the patients and 31.82% after the second dose, which perhaps suggests that the second dose of the vaccine can decrease the rate of COVID-19 infection.\u003c/li\u003e\n \u003cli\u003eThere was no significant difference in gender between the inpatient and outpatient groups, but the inpatient group had significantly older age than the outpatient group (P=0.000).\u003c/li\u003e\n \u003cli\u003eA total of 820 out of 3701 patients were vaccinated, including 23% in the inpatient group and 21% in the outpatient group. There was a higher percentage of double vaccination in the outpatient group than the inpatient group. Therefore, the second dose of vaccination can decrease the probability of hospitalization and moderate to\u0026nbsp;severe COVID-19 infection significantly (P=0.029).\u003c/li\u003e\n \u003cli\u003eThe duration between the first dose of vaccination and subsequent COVID-19 infection was less than one month in most of the cases, which implies that the maximum protective effect of vaccination is one month after the first dose (P=0.000).\u003c/li\u003e\n \u003cli\u003eIn most of the inpatient and outpatient cases, the duration between the second dose of the vaccine and subsequent COVID-19 infection was one to two months (P=0.022),\u0026nbsp;which implies that the protective effect of vaccination may decrease two months after the second dose.\u003c/li\u003e\n \u003cli\u003eTherefore, the best protective effect of COVID vaccination against infection is achieved in the period between one month post-first dose and one to two months post-second dose. This observation suggests that two doses of COVID vaccine likely do not lead to long-term protection against COVID infection.\u003c/li\u003e\n \u003cli\u003eO2 saturation was reported under 70% in 14.53% of the single vaccinated patients and 4.78% of the double vaccinated group. Also, 19.51% of the single vaccinated group and 27.73% of the double vaccinated group had O2 saturation over 90% (P=0.031). The severity of lung involvement less than 15% in the chest CT scan was 17.14% in the single vaccinated patients and 10.68% in the double vaccinated group. The severity of lung involvement more than 80% in the chest CT scan was 5.71% in the single vaccinated patients and 0.65% in the double vaccinated patients (P=0.008). Therefore, the second dose of the vaccine can significantly decrease lung involvement in COVID-19 patients.\u003c/li\u003e\n \u003cli\u003eRequiring medical care after COVID-19 recovery was 23.66% in the inpatient group and 13.18% in the outpatient group (P=0.000), which could have been due to the fact that the inpatient group had more severe disease and subsequently greater complications and longer COVID-19 symptoms than the outpatient group.\u003c/li\u003e\n \u003cli\u003eThe reasons for requiring medical care or readmission include the progression of COVID-19 symptoms, reinfection by SARS-CoV-2, cardiac complications, pulmonary edema, pulmonary fibrosis, gastrointestinal bleeding and urine incontinency.\u003c/li\u003e\n \u003cli\u003eThe majority of the cases received two doses of COVID-19 vaccine. Hospitalization rate reduced significantly after the second dose of the vaccine (P=0.029); however, ICU admission did not decrease significantly after the second dose. This finding may suggest that the second dose of COVID-19 vaccine can bring protection against moderate to severe COVID-19 and reduce hospitalization but cannot prevent very severe COVID-19 or reduce the rate of ICU admission.\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Aligned with other studies and meta-analyses, the second dose of COVID-19 vaccine leads to better outcomes than one dose vaccination. In comparison with other studies, our study reported that Sinopharm vaccine as an inactivated vaccine had a shorter protection period.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eSARS-CoV-2, the virus causing COVID-19, has spread rapidly across the world, resulting in various levels of illness. On March 11, 2020, SARS-CoV-2 was declared a worldwide pandemic. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Vaccines are one of the best interventions developed for eradicating COVID-19, saving millions of lives annually, and the best option for combatting this virus remains an effective and safe vaccine. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) As of 2023, over twenty vaccines have been approved for this virus in different parts of the world, including adenoviral vector vaccines, mRNA vaccines, subunit vaccines, vaccines based on inactivated SARS-CoV‐2, and a DNA vaccine. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eVaccination serves as a two-edged sword, as it is the best tool for curbing this pandemic while also bringing ambiguity, uncertainty, and challenges that the world faces during its administration or unknown long-term effects that might emerge later in life. For instance, the data delivered from clinical trials on the safety profile, immunogenicity, and efficacy of vaccines in preventing symptomatic infection are limited to the context of these trials and cannot be applied to the larger public. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe goals of vaccination are to reduce the risk of infection and the severity of the disease. Though vaccines against COVID-19 have demonstrated effectiveness, infection is still a possibility despite vaccination. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) The concerns about developing infection even after vaccination are mitigated by abundant evidence showing that the risk of severe COVID-19 (as proxied by hospitalization, ICU admission, and mortality) is lessened by vaccination. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn this study, we report new infections and the severity of these new infections after one or two doses of COVID-19 vaccine, the duration between vaccination and reinfection, and a comparison of outcomes between COVID-19 patients managed as inpatients and outpatients. Due to the large number of COVID-19 patients during this pandemic in Iran, hospital equipment had become scarce and the research participants were managed in two groups, including an inpatient and an outpatient group. The inpatient group consisted of COVID-19 patients who had more severe symptoms and needed hospitalization. Both groups received remdesivir for their treatment.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSetting\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was conducted on about 3700 patients infected by SARS-CoV-2 as inpatients or outpatients at Rasool-e Akram Hospital in Tehran, Iran, from March 21 to September 21, 2021.\u003c/p\u003e \u003cp\u003e The study was carried out in accordance with the ethical principles of the Declaration of Helsinki and was approved by the Ethics Committee of Iran University of Medical Sciences (#IR.IUMS.REC.1401.650). Verbal informed consent was obtained from the participants in advance. A standard checklist was designed by a group of COVID-19 researchers and filled out by a trained interviewer through phone calls with the patients. The first part of the checklist included the patients\u0026rsquo; demographic information. In the next part, the patients were inquired about their COVID-19 vaccination status (including the type of vaccine received) and post-vaccination COVID-19 infection history, severity of the disease and need for hospitalization due to COVID-19 after the first dose and second dose of the vaccine. Also, data regarding vaccine-related adverse reactions were collected. Inpatients and outpatients were compared separately in terms of clinical characteristics and the need for additional treatment measures and vaccination status. In the next step, the effect of the number of doses of COVID-19 vaccine received on the probability of future hospitalizations due to COVID-19 and the need for additional treatments was evaluated. Quantitative and categorical variables are reported as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) and frequency (percentage), respectively. To assess the association between the categorical variables, Chi-square and Fisher's exact tests (if needed) were applied. All the statistical analyses were performed at a 95% significance level using Stata software version 17 (Stata Corp, College Station, TX, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThis study recruited 3701 patients with a history of COVID-19 infection managed as inpatients or outpatients. Just above half of the patients (50.31%) were male. Most patients were in the age group of 40 to 49 years (22.99%). Among the evaluated patients, 22.16% (n\u0026thinsp;=\u0026thinsp;820) had been vaccinated against COVID-19 and the majority of them had received two doses of the vaccine (94.38%, n\u0026thinsp;=\u0026thinsp;774 out of 820). Sinopharm was the most frequently-injected vaccine (79.58%). The incidence of COVID-19 infection after the first dose of vaccination was 70.98% and the infection had occurred from one to four weeks after vaccination in 62% of the cases. The incidence rate of COVID-19 after the second dose of vaccination was 31.82% and the infection had occurred one to two months after vaccination in 39.18% of the cases. Only 16% of the vaccinated patients infected by SARS-CoV-2 required medical care after their recovery. The causes of requiring medical care or readmission included the progression of COVID-19 symptoms, reinfection by SARS-CoV-2, cardiac complications, pulmonary edema, pulmonary fibrosis due to COVID-19, gastrointestinal bleeding and urine incontinency. A total of 14.53% of the single dose vaccinated patients had O2 saturation under 70%, but in the double dose vaccinated group, the rate was 4.78%; also, 19.51% of the single dose vaccinated group and 27.73% of the double dose vaccinated group had O2 saturation over 90% (P\u0026thinsp;=\u0026thinsp;0.031). The severity of lung involvement less than 15% in the chest CT scan was 17.14% in the single dose vaccinated patients and 10.68% in the double vaccinated patients. The severity of more than 80% lung involvement in the chest CT scan was 5.71% in the single vaccinated patients and 0.65% in the double vaccinated patients (P\u0026thinsp;=\u0026thinsp;0.008).\u003c/p\u003e \u003cp\u003eOut of 3701 patients, 989 were managed as inpatients and 2712 as outpatients. The outpatient group was at younger age than the inpatient group (P\u0026thinsp;=\u0026thinsp;0.000). A total of 95.46% (n\u0026thinsp;=\u0026thinsp;568 out of 595) of the outpatient group and 91.52% (n\u0026thinsp;=\u0026thinsp;205 out of 224) of the inpatient group were vaccinated with two doses of COVID-19 vaccine (P\u0026thinsp;=\u0026thinsp;0.029). None of the outpatient group and 4.93% (n\u0026thinsp;=\u0026thinsp;11 out of 223) of the inpatient group were readmitted to the hospital because of COVID-19 complications (P\u0026thinsp;=\u0026thinsp;0.309), and 23.66% (n\u0026thinsp;=\u0026thinsp;53 out of 223) of the inpatient group and 13.18% (n\u0026thinsp;=\u0026thinsp;78 out of 592) of the outpatient group required medical care after COVID-19 recovery (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the inpatient and outpatient groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInpatient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOutpatient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e483\u003c/p\u003e \u003cp\u003e48.84%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1356\u003c/p\u003e \u003cp\u003e50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.531\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e506\u003c/p\u003e \u003cp\u003e51.16%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1356\u003c/p\u003e \u003cp\u003e50%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnder 18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003cp\u003e0.91%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003cp\u003e0.55%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e18\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003cp\u003e3.34%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e209\u003c/p\u003e \u003cp\u003e7.45%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e193\u003c/p\u003e \u003cp\u003e19.51%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e633\u003c/p\u003e \u003cp\u003e23.34%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e208\u003c/p\u003e \u003cp\u003e21.03%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e643\u003c/p\u003e \u003cp\u003e23.71%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e220\u003c/p\u003e \u003cp\u003e22.24%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e618\u003c/p\u003e \u003cp\u003e22.79%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e60\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e209\u003c/p\u003e \u003cp\u003e21.13%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e437\u003c/p\u003e \u003cp\u003e16.11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e70\u0026ndash;79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86\u003c/p\u003e \u003cp\u003e8.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e128\u003c/p\u003e \u003cp\u003e4.72%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e80 and older\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31\u003c/p\u003e \u003cp\u003e3.13%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003cp\u003e1.33%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eVaccination status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVaccinated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOne dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003cp\u003e7.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003cp\u003e4.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.029\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTwo doses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e212\u003c/p\u003e \u003cp\u003e92.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e566\u003c/p\u003e \u003cp\u003e95.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNot vaccinated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e760\u003c/p\u003e \u003cp\u003e76.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2121\u003c/p\u003e \u003cp\u003e78.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eType of vaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSinopharm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e195\u003c/p\u003e \u003cp\u003e29.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e462\u003c/p\u003e \u003cp\u003e70.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.476\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAstraZeneca\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e60\u003c/p\u003e \u003cp\u003e66.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSputnik\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e35%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35\u003c/p\u003e \u003cp\u003e64.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003cp\u003e70%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOVID-19 infection after first dose of vaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eInfected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e176\u003c/p\u003e \u003cp\u003e76.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e400\u003c/p\u003e \u003cp\u003e69.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.569\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNot infected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53\u003c/p\u003e \u003cp\u003e23.14%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e175\u003c/p\u003e \u003cp\u003e30.43%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOVID infection after second dose of vaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eInfected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66\u003c/p\u003e \u003cp\u003e31.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e186\u003c/p\u003e \u003cp\u003e32.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.922\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNot infected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e146\u003c/p\u003e \u003cp\u003e68.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e380\u003c/p\u003e \u003cp\u003e67.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eThe duration between the first dose of the vaccine and subsequent COVID-19 infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eLess than 3 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003cp\u003e11.36%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4 days to 1 week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003cp\u003e17.045%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57\u003c/p\u003e \u003cp\u003e14.25%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1 week to 2 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003cp\u003e23.86%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95\u003c/p\u003e \u003cp\u003e23.75%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2 weeks to 1 month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62\u003c/p\u003e \u003cp\u003e35.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e180\u003c/p\u003e \u003cp\u003e45%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1 month to 2 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003cp\u003e11.36%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26\u003c/p\u003e \u003cp\u003e6.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMore than 2 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e1.13%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e1.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eThe duration between the second dose of the vaccine and subsequent COVID-19 infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eLess than 3 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e4.54%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28\u003c/p\u003e \u003cp\u003e15.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4 days to 1 week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003cp\u003e7.57%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31\u003c/p\u003e \u003cp\u003e16.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1 week to 2 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003cp\u003e15.15%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27\u003c/p\u003e \u003cp\u003e14.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2 weeks to 1month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003cp\u003e19.69%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45\u003c/p\u003e \u003cp\u003e24.19%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1 month to 2 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35\u003c/p\u003e \u003cp\u003e53.03%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55\u003c/p\u003e \u003cp\u003e29.56%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eReaction after first dose of vaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eWith reaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003cp\u003e15.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74\u003c/p\u003e \u003cp\u003e12.92%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.467\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eWithout reaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e212\u003c/p\u003e \u003cp\u003e84.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e499\u003c/p\u003e \u003cp\u003e87.08%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eReadmission after COVID-19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003cp\u003e4.93%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.309\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e212\u003c/p\u003e \u003cp\u003e95.07%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMedical care after COVID-19 recovery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53\u003c/p\u003e \u003cp\u003e23.66%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78\u003c/p\u003e \u003cp\u003e13.18%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e171\u003c/p\u003e \u003cp\u003e76.34%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e514\u003c/p\u003e \u003cp\u003e86.82%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eA comparison between the single dose vaccinated and double dose vaccinated groups of patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOne dose of vaccination\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTwo doses of vaccination\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.14%(22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.86%(406)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.536\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.14%(24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93.86%(367)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnder 18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%(12)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.29%(7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88.71%(55)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.94%(2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97.06%(66)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.83%(17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.17%(200)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.43%(15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94.57%(261)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70\u0026ndash;79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.17%(3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97.83%(135)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 and older\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.35%(2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95.65%(44)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHospitalization after vaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.3%(19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.52%(205)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.7%(27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73.48%(568)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHospitalization days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than 10 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89.47%(17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87.32%(179)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.827\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026ndash;20 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.53%(2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.73%(22)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore than 20 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.95%(4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eICU hospitalization after vaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.17%(1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.46%(19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.903\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.83%(45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97.54%(754)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eICU hospitalization days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than 5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%(1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.84%(7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.454\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 to 10 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.63%(10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore than 10 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%(2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eReadmission after COVID-19 infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10%(2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.05%(9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90%(18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95.95%(213)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRequire medical care after COVID-19 infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.09%(12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.47%(119)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.91%(34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84.53%(650)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eO2 saturation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.63%(6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.78%(31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70\u0026ndash;80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.51%(8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.64%(95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81\u0026ndash;90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.34%(19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.85%(343)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.51%(8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.73%(180)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eChest CT scan severity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;15%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.14%(6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.68%(66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.57%(10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.95%(284)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u0026ndash;50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.57%(10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.13%(180)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51\u0026ndash;80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20%(7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.59%(84)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.71%(20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.65%(4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe comparison of the vaccinated patients and those who had not been vaccinated at all showed no significant differences in hospitalization and ICU admission. In the vaccinated group, 27.44% (n\u0026thinsp;=\u0026thinsp;225 out of 820) were hospitalized due to COVID-19 and 2.44% required ICU admission; in the unvaccinated group, 26.52% (n\u0026thinsp;=\u0026thinsp;764 out of 2881) were hospitalized and 2.74% required ICU admission (P\u0026thinsp;=\u0026thinsp;0.6). Most of the patients were hospitalized less than ten days (87.56%) and required ICU care for less than five days (45.45%).\u003c/p\u003e \u003cp\u003eReactions after the first dose of vaccination: Out of 820 patients who received the first dose of the vaccine, 13.69% (n\u0026thinsp;=\u0026thinsp;112) showed some reactions. A total of 84% of the patients (n\u0026thinsp;=\u0026thinsp;94 out of 112) had fever, headache and myalgia after the first dose of vaccination. A total of 9.8% (n\u0026thinsp;=\u0026thinsp;11 out of 112) had malaise and 5% showed other reactions, including neurological, dermatological and respiratory symptoms.\u003c/p\u003e \u003cp\u003eReactions after the second dose of vaccination: Out of 774 patients who received the second dose of the vaccine, 8.13% (n\u0026thinsp;=\u0026thinsp;63) showed some reactions. A total of 92% (n\u0026thinsp;=\u0026thinsp;58) had fever, headache and myalgia after injection and 8% had other reactions, including malaise, respiratory, dermatological and GI symptoms.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined 3701 COVID-19 patients treated in our hospital as inpatients and outpatients, depending on the severity of their infection, and compared the effects of vaccination on their outcomes. A total of 989 of them were inpatients and 2712 were outpatients and they were mainly treated with remdesivir.\u003c/p\u003e \u003cp\u003eA meta-analysis on 22 randomized controlled trials with a total of 3,404,696 older adults reported that any dose of the vaccine is protective in older adults; however, administration of two doses is more effective than one dose. They also found that older adults who received COVID-19 vaccines experienced better outcomes. Likewise, we also reported that the second dose of COVID-19 vaccine can significantly decrease the probability of hospitalization and moderate to severe COVID-19 infection.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn another meta-analysis on 18 studies representing nearly seven million individuals, the effect of vaccination against all SARS-CoV-2 infections declined from 83% in the first month after completion of the original vaccination series to 22% in five months or longer. Similarly, the effect of vaccination against symptomatic COVID-19 declined from 94% in the first month after vaccination to 64% by the fourth month. Our study showed that the duration between the first dose of vaccination and subsequent COVID-19 infection was less than one month in most cases, which implies that the maximum protective effect of vaccination is one month after the first dose. In most inpatient and outpatient cases, the duration between the second dose of the vaccine and subsequent COVID-19 infection was one to two months, which implies that the protective effect of vaccination may decrease two months after the second dose. An explanation for a shorter period of effective protection is that our study subjects mostly received Sinopharm vaccine, which is an inactivated vaccine type or the fact that our participants only received one or two doses of vaccine. These data can be used to inform public health decision-makers about the need for booster vaccination or question the effectiveness of Sinopharm vaccine.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eA meta-analysis published in 2022 revealed that the vaccinated group had a 29% lower risk of developing long COVID-19 compared with the unvaccinated group. Furthermore, two doses of vaccination showed better protective effects as compared with one dose of vaccination. In addition, vaccination was effective against long COVD-19 in patients either vaccinated before SARS-CoV-2 infection or vaccinated after SARS-CoV-2 infection. For long COVID-19 symptoms, vaccination reduced the risk of cognitive dysfunction symptoms, kidney diseases, myalgia, and sleeping disorders. In our study, requiring medical care after COVID-19 recovery was 19.1%. Compared with one dose vaccinated patients, long COVID-19 or requiring medical care for COVID-19 related reasons decreased from 35.2\u0026ndash;18% after the second dose of vaccine. The reasons for requiring medical care or readmission include the progression of COVID-19 symptoms, reinfection by SARS-CoV-2, cardiac complications, pulmonary edema, pulmonary fibrosis, gastrointestinal bleeding, urinary incontinency and other long COVID-19 symptoms. However, as a limitation in our study, we did not have the data to compare vaccinated and unvaccinated patients. Therefore, the vaccination rate should be improved as soon as possible, especially for a complete vaccination course. There should be more studies to explore the basic mechanisms of the protective effect of COVID-19 vaccines on long COVID in the future.(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn this study, we compared inpatient and outpatient cases who received remdesivir, non-hospitalized remdesivir treatment was not so common worldwide but due to the overwhelmed health care system, it was one way to help more patients. There are few studies evaluating non-hospitalized patients receiving remdesivir. For instance, in a randomized, double-blind, placebo-controlled study, unvaccinated patients 12 years or older with at least one risk factor for severe COVID-19 or those older than 60 years regardless of risk factor(s) were enrolled at 64 sites worldwide. Of these, 562 patients underwent 1:1 randomization to receive either remdesivir or placebo infusions. The remdesivir group received a three-day course of infusion at 200 mg on day one and then 100 mg on days two and three. Patients who received remdesivir had an 87% lower risk of COVID-19 related medical visits or all-cause deaths. Notably, the effectiveness of remdesivir in non-hospitalized patients with COVID-19 was comparable to monoclonal antibody treatment, which has less widespread availability. Study limitations include a low number of patients with liver or kidney diseases, and the exclusion of vaccinated patients. In our study, there was a higher percentage of double vaccination in the outpatient group than that in the inpatient group. Therefore, the second dose of vaccination can decrease the need of hospitalization and severe COVID-19 infection.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAnother study evaluated the differences in the clinical characteristics and severity of lung impairment, assessed by quantitative lung CT scan, between vaccinated and non-vaccinated hospitalized patients with COVID-19 including 684 consecutive patients [580 (84.8%) vaccinated, and 104 (15.2%) non-vaccinated]. The results showed that hospitalized vaccinated patients with COVID-19 presented a similar impairment in gas exchange and lung CT scan compared to non-vaccinated patients, but were at a lower risk of mortality. However, we reported in our study the severity of lung involvement less than 15% in the chest CT scan as 17.14% in the single vaccinated patients versus 10.68% in the double vaccinated group. The severity of lung involvement more than 80% in the chest CT scan was 5.71% in the single vaccinated patients and 0.65% in the double vaccinated patients. Therefore, the second dose of the vaccine can significantly decrease lung involvement in COVID-19 patients. We did not compare vaccinated with unvaccinated patients, but in comparison between one dose vaccinated and two dose vaccinated, lung impairment and CT scan severity is less in double dose vaccinated patients.\u003c/p\u003e \u003cp\u003eAlthough this study revealed that the maximum protective effect of vaccination is achieved one to two months later and that it is necessary to get a booster dose after this period, these findings mainly pertain to Sinopharm, since it was the most frequently-injected vaccine injected in Iran during the COVID-19 pandemic. The burden of COVID-19 is higher in developing countries, probably reflecting the limited access of people in these countries to appropriate health care and antiviral treatments and the great burden on already-overwhelmed health care systems. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) The lack of adequate equipment, the overload of COVID-19 patients and healthcare workers\u0026rsquo; burnout during the pandemic led to the need for managing some COVID-19 patients on an outpatient basis, which could alleviate the burden of COVID-19 and prevent hospitalization that has been highlighted since the beginning of the pandemic. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study showed that the incidence and severity of COVID-19 infection decrease after receiving the second dose of COVID-19 vaccine. The second dose of the vaccine can bring protection against moderate to severe disease and reduce hospitalization but cannot prevent very severe COVID-19 or reduce the incidence of ICU admission. The second dose of the vaccine can significantly decrease lung involvement in COVID-19 patients, as well. The best protective effect of COVID-19 vaccination against infection is between one month post-first dose and one to two months post-second dose. Two doses of COVID-19 vaccine do not yield long-term protection against infection. Requiring medical care after COVID-19 recovery was 23.66% in the inpatient group and 13.18% in the outpatient group, which may have been caused by the fact that the inpatient group had more severe disease and consequently greater complications and longer duration of symptoms than the outpatient group. The causes for requiring medical care or readmission included the progression of COVID-19 symptoms, reinfection by SARS-Cov-2, cardiac complications, pulmonary edema, pulmonary fibrosis due to COVID-19, gastrointestinal bleeding and urine incontinency.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003ea. Funding:\u0026nbsp;\u003c/strong\u003eThis manuscript had no funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb. Conflict of interest:\u0026nbsp;\u003c/strong\u003ethere was no conflict of interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ec. Availability of data and material:\u0026nbsp;\u003c/strong\u003ethe data of this study are available by contacting the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ed. Code availability:\u0026nbsp;\u003c/strong\u003enot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ee. Ethics approval:\u0026nbsp;\u003c/strong\u003eThe study\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ewas approved by the Ethics Committee of Iran University of Medical Sciences (#IR.IUMS.REC.1401.650)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ef. Author\u0026rsquo;s contributions:\u0026nbsp;\u003c/strong\u003eMK and AZ selected questions for the interview and make other decisions also drafted and approved manuscript. EB and MJ performed data analysis. NN, SS, TR, MF, SK supervised the work. SM approved final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eg. Consent to participate:\u0026nbsp;\u003c/strong\u003eVerbal informed consent was obtained from the participants in advance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eh. Consent for publication:\u0026nbsp;\u003c/strong\u003eall authors consent to publish.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Vol. 55, International Journal of Antimicrobial Agents. 2020. \u003c/li\u003e\n\u003cli\u003eSaeed BQ, Al-Shahrabi R, Alhaj SS, Alkokhardi ZM, Adrees AO. Side effects and perceptions following Sinopharm COVID-19 vaccination. Int J Infect Dis. 2021;111. \u003c/li\u003e\n\u003cli\u003eMohamed K, Rzymski P, Islam MS, Makuku R, Mushtaq A, Khan A, et al. COVID-19 vaccinations: The unknowns, challenges, and hopes. Vol. 94, Journal of Medical Virology. 2022. \u003c/li\u003e\n\u003cli\u003eJeyanathan M, Afkhami S, Smaill F, Miller MS, Lichty BD, Xing Z. Immunological considerations for COVID-19 vaccine strategies. Vol. 20, Nature Reviews Immunology. 2020. \u003c/li\u003e\n\u003cli\u003eParameswaran A, Apsingi S, Eachempati KK, Dannana CS, Jagathkar G, Iyer M, et al. Incidence and severity of COVID-19 infection post-vaccination: a survey among Indian doctors. Infection. 2022;50(4). \u003c/li\u003e\n\u003cli\u003eTaquet M, Dercon Q, Harrison PJ. Six-month sequelae of post-vaccination SARS-CoV-2 infection: A retrospective cohort study of 10,024 breakthrough infections. Brain Behav Immun. 2022;103. \u003c/li\u003e\n\u003cli\u003eToubasi AA, Al-Sayegh TN, Obaid YY, Al-Harasis SM, AlRyalat SAS. Efficacy and safety of COVID-19 vaccines: A network meta-analysis. J Evid Based Med. 2022 Sep;15(3):245\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003eSsentongo P, Ssentongo AE, Voleti N, Groff D, Sun A, Ba DM, et al. SARS-CoV-2 vaccine effectiveness against infection, symptomatic and severe COVID-19: a systematic review and meta-analysis. BMC Infect Dis. 2022 Dec 7;22(1):439. \u003c/li\u003e\n\u003cli\u003eGao P, Liu J, Liu M. Effect of COVID-19 Vaccines on Reducing the Risk of Long COVID in the Real World: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022 Sep 29;19(19). \u003c/li\u003e\n\u003cli\u003eGottlieb RL, Vaca CE, Paredes R, Mera J, Webb BJ, Perez G, et al. Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients. N Engl J Med. 2022 Jan 27;386(4):305\u0026ndash;15. \u003c/li\u003e\n\u003cli\u003eUsher AD. The global COVID-19 treatment divide. Lancet (London, England). 2022 Feb 26;399(10327):779\u0026ndash;82. \u003c/li\u003e\n\u003cli\u003eRajme-L\u0026oacute;pez S, Martinez-Guerra BA, Zalapa-Soto J, Rom\u0026aacute;n-Montes CM, Tamez-Torres KM, Gonz\u0026aacute;lez-Lara MF, et al. Early Outpatient Treatment With Remdesivir in Patients at High Risk for \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, vaccination, infection rate, severity, hospitalization, lung involvement.","lastPublishedDoi":"10.21203/rs.3.rs-3271039/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3271039/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e This study assessed the impact of COVID-19 vaccination on infection rates and severity, the protective period after vaccination, risk factors for hospitalization, and adverse reactions. It involved PCR-confirmed COVID-19 patients managed as inpatients or outpatients at Rasool-e Akram Hospital, Tehran, Iran, from March 21 to September 21, 2021.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA standard checklist was used to gather data through phone calls from 3701 PCR+ patients, including 989 inpatients and 2712 outpatients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e After the first dose, COVID-19 incidence rate was 70.98%, mostly occurring one to four weeks post-vaccination. Following the second dose, the incidence rate dropped to 31.82%, with infections occurring between one to two months post-vaccination. Among inpatients and outpatients, 23% and 21% respectively had been vaccinated. Notably, 95.46% of outpatients and 91.52% of inpatients received both doses. Double vaccinated patients showed better outcomes, with lower O2 saturation below 70% (4.78% vs. 14.53%), and less severe lung involvement (0.65% vs. 5.71%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The study revealed that the second sinopharm vaccine dose significantly reduces the incidence and severity of COVID-19 infection. While it offers protection against moderate to severe illness and reduces hospitalization, it may not prevent very severe cases or ICU admission. The most effective protection against infection occurs between one month after the first dose and one to two months after the second dose. Nonetheless, two doses do not provide long-term protection against infection. Further research is warranted to understand long-term vaccine efficacy.\u003c/p\u003e","manuscriptTitle":"The incidence rate and severity of COVID-19 infection in hospitalized vaccinated patients and outpatients who received remdesivir from March to September 2021 and outcome comparison between single and double vaccinated patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-08-23 10:55:10","doi":"10.21203/rs.3.rs-3271039/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8d25b49d-d422-4ccd-96c8-8bdad1cdd73b","owner":[],"postedDate":"August 23rd, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-09-07T20:59:18+00:00","versionOfRecord":[],"versionCreatedAt":"2023-08-23 10:55:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3271039","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3271039","identity":"rs-3271039","version":["v1"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}