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Calderaro A, Buttrini M, Montecchini S, Piccolo G, Martinelli M, Dell’Anna ML, Di Maio A, Arcangeletti MC, Maccari C, De Conto F, Chezzi C. Detection of SARS-CoV-2 and Other Infectious Agents in Lower Respiratory Tract Samples Belonging to Patients Admitted to Intensive Care Units of a Tertiary-Care Hospital, Located in an Epidemic Area, during the Italian Lockdown. Microorganisms 2021; 9:185. [PMID: 33467079 PMCID: PMC7830127 DOI: 10.3390/microorganisms9010185] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was the detection of infectious agents from lower respiratory tract (LRT) samples in order to describe their distribution in patients with severe acute respiratory failure and hospitalized in intensive care units (ICU) in an Italian tertiary-care hospital. LRT samples from 154 patients admitted to ICU from 27 February to 10 May 2020 were prospectively examined for respiratory viruses, including SARS-CoV-2, bacteria and/or fungi. SARS-CoV-2 was revealed in 90 patients (58.4%, 72 males, mean age 65 years). No significant difference was observed between SARS-CoV-2 positives and SARS-CoV-2 negatives with regard to sex, age and bacterial and/or fungal infections. Nonetheless, fungi were more frequently detected among SARS-CoV-2 positives (44/54, 81.4%, p = 0.0053). Candida albicans was the overall most frequently isolated agent, followed by Enterococcus faecalis among SARS-CoV-2 positives and Staphylococcus aureus among SARS-CoV-2 negatives. Overall mortality rate was 40.4%, accounting for 53 deaths: 37 among SARS-CoV-2 positives (mean age 69 years) and 16 among SARS-CoV-2 negatives (mean age 63 years). This study highlights the different patterns of infectious agents between the two patient categories: fungi were prevalently involved among SARS-CoV-2-positive patients and bacteria among the SARS-CoV-2-negative patients. The different therapies and the length of the ICU stay could have influenced these different patterns of infectious agents.
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Affiliation(s)
- Adriana Calderaro
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy; (M.B.); (G.P.); (M.C.A.); (C.M.); (F.D.C.); (C.C.)
| | - Mirko Buttrini
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy; (M.B.); (G.P.); (M.C.A.); (C.M.); (F.D.C.); (C.C.)
| | - Sara Montecchini
- Unit of Clinical Virology, University Hospital of Parma, Viale A. Gramsci 14, 43126 Parma, Italy; (S.M.); (M.L.D.)
| | - Giovanna Piccolo
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy; (M.B.); (G.P.); (M.C.A.); (C.M.); (F.D.C.); (C.C.)
| | - Monica Martinelli
- Unit of Clinical Microbiology, University Hospital of Parma, Viale A. Gramsci 14, 43126 Parma, Italy; (M.M.); (A.D.M.)
| | - Maria Loretana Dell’Anna
- Unit of Clinical Virology, University Hospital of Parma, Viale A. Gramsci 14, 43126 Parma, Italy; (S.M.); (M.L.D.)
| | - Alan Di Maio
- Unit of Clinical Microbiology, University Hospital of Parma, Viale A. Gramsci 14, 43126 Parma, Italy; (M.M.); (A.D.M.)
| | - Maria Cristina Arcangeletti
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy; (M.B.); (G.P.); (M.C.A.); (C.M.); (F.D.C.); (C.C.)
| | - Clara Maccari
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy; (M.B.); (G.P.); (M.C.A.); (C.M.); (F.D.C.); (C.C.)
| | - Flora De Conto
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy; (M.B.); (G.P.); (M.C.A.); (C.M.); (F.D.C.); (C.C.)
| | - Carlo Chezzi
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy; (M.B.); (G.P.); (M.C.A.); (C.M.); (F.D.C.); (C.C.)
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302
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Weinstein B, da Silva AR, Kouzoukas DE, Bose T, Kim GJ, Correa PA, Pondugula S, Lee Y, Kim J, Carpenter DO. Precision Mapping of COVID-19 Vulnerable Locales by Epidemiological and Socioeconomic Risk Factors, Developed Using South Korean Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020604. [PMID: 33445701 PMCID: PMC7828122 DOI: 10.3390/ijerph18020604] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 12/11/2022]
Abstract
COVID-19 has severely impacted socioeconomically disadvantaged populations. To support pandemic control strategies, geographically weighted negative binomial regression (GWNBR) mapped COVID-19 risk related to epidemiological and socioeconomic risk factors using South Korean incidence data (20 January 2020 to 1 July 2020). We constructed COVID-19-specific socioeconomic and epidemiological themes using established social theoretical frameworks and created composite indexes through principal component analysis. The risk of COVID-19 increased with higher area morbidity, risky health behaviours, crowding, and population mobility, and with lower social distancing, healthcare access, and education. Falling COVID-19 risks and spatial shifts over three consecutive time periods reflected effective public health interventions. This study provides a globally replicable methodological framework and precision mapping for COVID-19 and future pandemics.
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Affiliation(s)
- Bayarmagnai Weinstein
- Department of Environmental Health Sciences, School of Public Health, University at Albany, Rensselaer, New York, NY 12144, USA;
- Principles and Practice of Clinical Research Program, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Alan R. da Silva
- Department of Statistics, University of Brasília, Brasília 70910-900, Brazil;
| | - Dimitrios E. Kouzoukas
- Research Service, Edward Hines Jr. VA Hospital, Hines, IL 60141, USA;
- Department of Molecular Neuroscience and Pharmacology, Loyola University Chicago, Maywood, IL 60153, USA
| | - Tanima Bose
- Institute for Clinical Neuroimmunology, Ludwig-Maximilian University of Munich, Planegg-Martinsried, 82152 Munich, Germany;
| | - Gwang Jin Kim
- Institute of Experimental and Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany;
| | | | - Santhi Pondugula
- Department of Pharmacology & Therapeutics, University of Florida, Gainesville, FL 32610, USA;
| | - YoonJung Lee
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA;
| | - Jihoo Kim
- Department of Computer Science, Hanyang University, Seongdong-gu, Seoul 04763, Korea;
| | - David O. Carpenter
- Department of Environmental Health Sciences, School of Public Health, University at Albany, Rensselaer, New York, NY 12144, USA;
- Institute for Health and the Environment, University at Albany, Rensselaer, NY 12144, USA
- Correspondence: ; Tel.: +1-518-252-2660
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303
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Salmon RL, Monaghan SP. Who is dying from COVID-19 in the United Kingdom? A review of cremation authorisations from a single South Wales' crematorium. Epidemiol Infect 2021; 149:e13. [PMID: 33413718 PMCID: PMC7844172 DOI: 10.1017/s0950268821000054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/14/2020] [Accepted: 12/10/2020] [Indexed: 12/15/2022] Open
Abstract
Only studies in the UK on individuals dying from coronavirus disease 2019 (COVID-19) in hospital have been published, to date. Cremation law requires collection of clinical information that can improve understanding of deaths in both hospital and community settings. Age, sex, date and place of death, occupation, comorbidities and where infection acquired was recorded for all deaths from COVID-19, between 6 April and 30 May, for whom an application was made for cremation at a South Wales' crematorium. Of 752 cremations, 215 (28.6%) were COVID-19 (115 (53.5%) male and 100 (46.5%) female). Median age was 82 years (youngest patient 47 and the oldest 103 years). Over half the deaths (121/215: 56.3%) were over 80 years. Males' odds of dying in hospital, rather than the community were 1.96 times that of females (95% confidence intervals (CI) 1.03-3.74, P = 0.054) despite being of similar age and having a similar number of comorbidities. Only 21 (9.8%) of 215 patients had no comorbidities recorded. Patients dying in care homes were significantly older than those dying in hospital (median 88 years (interquartile (IQ) range 82-93 years) vs. 80 years (IQ range 71-87 years): P < 0.0001). Patients dying in hospital had significantly more comorbidities than those dying in care homes (median 2: IQ range 1-3 vs. 1: IQ range 1-2: P < 0.001). Sixty three (29.3%) of infections were hospital acquired and a further 55 (25.6%) acquired in care homes. In a series, of hospital and community deaths, persons over 80 with an average two comorbidities predominated. Men were more likely to die in hospital. Half the infections were acquired in hospitals or care homes with implications for management of the pandemic.
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Affiliation(s)
- R. L. Salmon
- Cardiff Thornhill Crematorium, Thornhill, CardiffCF14 9UA, UK
| | - S. P. Monaghan
- Cardiff Thornhill Crematorium, Thornhill, CardiffCF14 9UA, UK
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304
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Cippà PE, Cugnata F, Ferrari P, Brombin C, Ruinelli L, Bianchi G, Beria N, Schulz L, Bernasconi E, Merlani P, Ceschi A, Di Serio C. A data-driven approach to identify risk profiles and protective drugs in COVID-19. Proc Natl Acad Sci U S A 2021; 118:e2016877118. [PMID: 33303654 PMCID: PMC7817222 DOI: 10.1073/pnas.2016877118] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/12/2020] [Indexed: 01/08/2023] Open
Abstract
As the COVID-19 pandemic is spreading around the world, increasing evidence highlights the role of cardiometabolic risk factors in determining the susceptibility to the disease. The fragmented data collected during the initial emergency limited the possibility of investigating the effect of highly correlated covariates and of modeling the interplay between risk factors and medication. The present study is based on comprehensive monitoring of 576 COVID-19 patients. Different statistical approaches were applied to gain a comprehensive insight in terms of both the identification of risk factors and the analysis of dependency structure among clinical and demographic characteristics. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus enters host cells by binding to the angiotensin-converting enzyme 2 (ACE2), but whether or not renin-angiotensin-aldosterone system inhibitors (RAASi) would be beneficial to COVID-19 cases remains controversial. The survival tree approach was applied to define a multilayer risk stratification and better profile patient survival with respect to drug regimens, showing a significant protective effect of RAASi with a reduced risk of in-hospital death. Bayesian networks were estimated, to uncover complex interrelationships and confounding effects. The results confirmed the role of RAASi in reducing the risk of death in COVID-19 patients. De novo treatment with RAASi in patients hospitalized with COVID-19 should be prospectively investigated in a randomized controlled trial to ascertain the extent of risk reduction for in-hospital death in COVID-19.
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Affiliation(s)
- Pietro E Cippà
- Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
| | - Federica Cugnata
- University Centre of Statistics in the Biomedical Sciences, "Vita-Salute San Raffaele" University, 20132 Milan, Italy
| | - Paolo Ferrari
- Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Biomedical Faculty, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- Clinical School, University of New South Wales, Sydney, NSW 2052, Australia
| | - Chiara Brombin
- University Centre of Statistics in the Biomedical Sciences, "Vita-Salute San Raffaele" University, 20132 Milan, Italy
| | - Lorenzo Ruinelli
- ICT (Informatica e Tecnologia della Comunicazione), Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
| | - Giorgia Bianchi
- Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
| | - Nicola Beria
- Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
| | - Lukas Schulz
- Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
| | - Enos Bernasconi
- Biomedical Faculty, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- Department of Medicine, Division of Infectious Diseases, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Paolo Merlani
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
- Department of Critical Care Medicine, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
| | - Alessandro Ceschi
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
- Biomedical Faculty, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- Institute of Pharmacology and Toxicology, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Clelia Di Serio
- University Centre of Statistics in the Biomedical Sciences, "Vita-Salute San Raffaele" University, 20132 Milan, Italy;
- Biomedical Faculty, Università della Svizzera Italiana, 6900 Lugano, Switzerland
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305
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Indseth T, Grøsland M, Arnesen T, Skyrud K, Kløvstad H, Lamprini V, Telle K, Kjøllesdal M. COVID-19 among immigrants in Norway, notified infections, related hospitalizations and associated mortality: A register-based study. Scand J Public Health 2021; 49:48-56. [PMID: 33406993 PMCID: PMC7859570 DOI: 10.1177/1403494820984026] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Aim: Research concerning COVID-19 among immigrants is limited. We present epidemiological data for all notified cases of COVID-19 among the 17 largest immigrant groups in Norway, and related hospitalizations and mortality. Methods: We used data on all notified COVID-19 cases in Norway up to 18 October 2020, and associated hospitalizations and mortality, from the emergency preparedness register (including Norwegian Surveillance System for Communicable Diseases) set up by The Norwegian Institute of Public Health to handle the pandemic. We report numbers and rates per 100,000 people for notified COVID-19 cases, and related hospitalizations and mortality in the 17 largest immigrant groups in Norway, crude and with age adjustment. Results: The notification, hospitalization and mortality rates per 100,000 were 251, 21 and five, respectively, for non-immigrants; 567, 62 and four among immigrants; 408, 27 and two, respectively, for immigrants from Europe, North-America and Oceania; and 773, 106 and six, respectively for immigrants from Africa, Asia and South America. The notification rate was highest among immigrants from Somalia (2057), Pakistan (1868) and Iraq (1616). Differences between immigrants and non-immigrants increased when adjusting for age, especially for mortality. Immigrants had a high number of hospitalizations relative to notified cases compared to non-immigrants. Although the overall COVID-19 notification rate was higher in Oslo than outside of Oslo, the notification rate among immigrants compared to non-immigrants was not higher in Oslo than outside. Conclusions: We observed a higher COVID-19 notification rate in immigrants compared to non-immigrants and much higher hospitalization rate, with major differences between different immigrant groups. Somali-, Pakistani- and Iraqi-born immigrants had especially high rates.
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Affiliation(s)
- Thor Indseth
- Norwegian Institute of Public Health, Health Services Research, Oslo, Norway
| | - Mari Grøsland
- Norwegian Institute of Public Health, Health Services Research, Oslo, Norway
| | - Trude Arnesen
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Katrine Skyrud
- Norwegian Institute of Public Health, Health Services Research, Oslo, Norway
| | - Hilde Kløvstad
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Veneti Lamprini
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Kjetil Telle
- Norwegian Institute of Public Health, Health Services Research, Oslo, Norway
| | - Marte Kjøllesdal
- Norwegian Institute of Public Health, Health Services Research, Oslo, Norway
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306
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Sundararaman T, Muraleedharan VR, Ranjan A. Pandemic resilience and health systems preparedness: lessons from COVID-19 for the twenty-first century. JOURNAL OF SOCIAL AND ECONOMIC DEVELOPMENT 2021; 23:290-300. [PMID: 34720480 PMCID: PMC7786882 DOI: 10.1007/s40847-020-00133-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 05/09/2023]
Abstract
The pandemic of COVID-19 disease has acted like a stress test on every aspect of life, but particularly exposed weaknesses of health systems design and capacity. There have been similar pandemics in the past, and the threat of more frequent future pandemics in the twenty-first century is real. It is therefore important to learn the right lessons with regard to health systems preparedness and resilience. The five design features that this paper discusses are related to the organization of primary care services, planned surge capacity in secondary and tertiary care, a robust disease surveillance system that is integrated with the health management information system, adequate domestic capacity in being able to innovate and scale up production and logistics of much needed medical products and a governance approach that recognizes the importance of the health systems being able to continuously learn and adapt to meet changing needs. In addition to this, the organizational capacity of the system to deliver required services would need more investment in financial resources, and a suitable health human resource policy.
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Affiliation(s)
- T. Sundararaman
- Department of Humanities and Social Sciences, Centre for Technology and Policy, Indian Institute of Technology-Madras, Chennai, India
| | - V. R. Muraleedharan
- Department of Humanities and Social Sciences, Centre for Technology and Policy, Indian Institute of Technology-Madras, Chennai, India
| | - Alok Ranjan
- Department of Humanities and Social Sciences, Indian Institute of Technology-Madras, Chennai, India
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307
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Eastern Cape Healthcare Workers Acquisition of SARS-CoV-2 (ECHAS): Cross-Sectional (Nested Cohort) Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18010323. [PMID: 33466227 PMCID: PMC7795312 DOI: 10.3390/ijerph18010323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/24/2020] [Accepted: 12/25/2020] [Indexed: 12/15/2022]
Abstract
Healthcare workers (HCWs) are at increased risk of infection by the virulent severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Though data exist on the positivity rate of the SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) test as well as COVID-19-related deaths amongst HCWs in South Africa, the overall infection rate remains underestimated by these indicators. It is also unclear whether the humoral immune response after SARS-CoV-2 infection offers durable protection against reinfection. This study will assess the SARS-CoV-2 seroprevalence amongst HCWs in the Eastern Cape (EC) and examine the longitudinal changes (rate of decay) in the antibody levels after infection in this cohort. Using a multi-stage cluster sampling of healthcare workers in selected health facilities in the EC, a cross-sectional study of 2250 participants will be recruited. In order to assess the community infection rate, 750 antenatal women in the same settings will be recruited. Relevant demographic and clinical characteristics will be obtained by a self-administered questionnaire. A chemiluminescent microparticle immunoassay (CMIA) will be used for the qualitative detection of IgG antibodies against SARS-CoV-2 nucleocapsid protein. A nested cohort study will be conducted by performing eight-weekly antibody assays (X2) from 201 participants who tested positive for both SARS-CoV-2 RT-PCR and serology. Logistic regression models will be fitted to identify the independent risk factors for SARS-CoV-2 infection. The cumulative SARS-CoV-2 infection rate and infection fatality rate among the frontline HCWs will be estimated. In addition, the study will highlight the overall effectiveness of infection prevention and control measures (IPC) per exposure sites/wards at the selected health facilities. Findings will inform the South African Department of Health’s policies on how to protect HCWs better as the country prepares for the second wave of the SARS-CoV pandemic.
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308
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Correia W, Dorta-Guerra R, Sanches M, Almeida Semedo CDJB, Valladares B, de Pina-Araújo IIM, Carmelo E. Study of the Etiology of Acute Respiratory Infections in Children Under 5 Years at the Dr. Agostinho Neto Hospital, Praia, Santiago Island, Cabo Verde. Front Pediatr 2021; 9:716351. [PMID: 34650939 PMCID: PMC8505963 DOI: 10.3389/fped.2021.716351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/01/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Acute respiratory infections are one of the major causes of morbidity and mortality in children under 5 years in developing countries and are a challenge for the health system of these countries. In Cabo Verde, despite the lack of recent studies, data indicate that it affects thousands of children, being the fourth leading cause of infant mortality in 2013. The aim of this study was to identify and describe the etiological agents associated with acute respiratory tract infections in children under 5 years old, and their associated risk factors, such as clinical symptoms or socio-demographic characteristics. Methods: Naso-pharyngeal samples were collected from children under 5 years attending at Dr. Agostinho Neto Hospital (Praia, Santiago Island, Cabo Verde) with suspected ARI at different time-points during 2019. Samples were analyzed using FilmArray® Respiratory Panel v. 2.0 Plus to identify etiological agents of ARI. A questionnaire with socio-demographic information was also collected for each participant. Data analyses were carried out using the IBM SPSS version 25 (IBM Corporation, Armonk, NY) and R 3.5.1 statistical software. Results: A total of 129 naso-pharyngeal samples were included in the study. Seventeen different etiologic agents of respiratory infections were identified. HRV/EV was the most frequent agent detected, followed by FluA H3 and RSV. Coinfection with two or more pathogens was detected in up to 20% of positive samples. The results were analyzed in terms of age-group, sex, period of the year and other social and demographic factors. Conclusion: Viruses are the main causative agents of ARI in children <5 years attending at the pediatrics service at the Dr. Agostinho Neto Hospital in Praia city, Santiago Island, Cabo Verde. Some factors are described in this study as statistically associated with the presence of an infectious agent, such as having one or more children sharing the bedroom with an adult and the presence of some clinical symptoms. The data addresses the need for studies on respiratory tract infections in Cabo Verde.
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Affiliation(s)
- Wilson Correia
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, La Laguna, Spain
| | - Roberto Dorta-Guerra
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, La Laguna, Spain.,Departamento de Matemáticas, Estadística e Investigación Operativa, Facultad de Ciencias, Universidad de La Laguna, La Laguna, Spain
| | - Mitza Sanches
- Hospital Dr. Agostinho Neto, Ministry of Health and Social Security of Cabo Verde, Praia, Cabo Verde
| | | | - Basilio Valladares
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, La Laguna, Spain.,Departamento de Obstetricia y Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna, La Laguna, Spain
| | | | - Emma Carmelo
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, La Laguna, Spain.,Departamento de Obstetricia y Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna, La Laguna, Spain.,Red de Investigación Colaborativa en Enfermedades Tropicales (RICET), Madrid, Spain
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309
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Abstract
The COVID-19 pandemic poses many direct and indirect consequences for children's health and associated research. Direct consequences include participation of children in COVID-19 research trials, pausing other research in children and the potential implications of a global economic downturn on future research funding. Collaborative and networked research together with streamlined research processes and use of remote technology have been central to efforts by clinicians and scientists around the world and have proved essential for reducing COVID-19 morbidity and mortality. IMPACT: Maintain streamlined and efficient approaches to research governance and data sharing to facilitate high-quality collaborative research. Ensure early inclusion of children in trials of therapies for diseases that affect all age groups. Paediatric Research Societies should co-ordinate effective processes to define key research questions and develop multinational clinical trials for diagnostics, therapeutics and preventative strategies for infants, children and young people.
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310
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Halpin DMG, Criner GJ, Papi A, Singh D, Anzueto A, Martinez FJ, Agusti AA. Global Initiative for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. The 2020 GOLD Science Committee Report on COVID-19 and Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2021; 203:24-36. [PMID: 33146552 PMCID: PMC7781116 DOI: 10.1164/rccm.202009-3533so] [Citation(s) in RCA: 373] [Impact Index Per Article: 124.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/04/2020] [Indexed: 02/07/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has raised many questions about the management of patients with chronic obstructive pulmonary disease (COPD) and whether modifications of their therapy are required. It has raised questions about recognizing and differentiating coronavirus disease (COVID-19) from COPD given the similarity of the symptoms. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Science Committee used established methods for literature review to present an overview of the management of patients with COPD during the COVID-19 pandemic. It is unclear whether patients with COPD are at increased risk of becoming infected with SARS-CoV-2. During periods of high community prevalence of COVID-19, spirometry should only be used when it is essential for COPD diagnosis and/or to assess lung function status for interventional procedures or surgery. Patients with COPD should follow basic infection control measures, including social distancing, hand washing, and wearing a mask or face covering. Patients should remain up to date with appropriate vaccinations, particularly annual influenza vaccination. Although data are limited, inhaled corticosteroids, long-acting bronchodilators, roflumilast, or chronic macrolides should continue to be used as indicated for stable COPD management. Systemic steroids and antibiotics should be used in COPD exacerbations according to the usual indications. Differentiating symptoms of COVID-19 infection from chronic underlying symptoms or those of an acute COPD exacerbation may be challenging. If there is suspicion for COVID-19, testing for SARS-CoV-2 should be considered. Patients who developed moderate-to-severe COVID-19, including hospitalization and pneumonia, should be treated with evolving pharmacotherapeutic approaches as appropriate, including remdesivir, dexamethasone, and anticoagulation. Managing acute respiratory failure should include appropriate oxygen supplementation, prone positioning, noninvasive ventilation, and protective lung strategy in patients with COPD and severe acute respiratory distress syndrome. Patients who developed asymptomatic or mild COVID-19 should be followed with the usual COPD protocols. Patients who developed moderate or worse COVID-19 should be monitored more frequently and accurately than the usual patients with COPD, with particular attention to the need for oxygen therapy.
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Affiliation(s)
- David M. G. Halpin
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Gerard J. Criner
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Alberto Papi
- Department of Medical Sciences, Cardiorespiratory and Internal Medicine Unit, University of Ferrara, Ferrara, Italy
| | - Dave Singh
- Manchester University NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Antonio Anzueto
- Division of Pulmonary/Critical Care Medicine, South Texas Veterans Health Care System, University of Texas Health, University of Texas, San Antonio, Texas
| | - Fernando J. Martinez
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York
| | - Alvar A. Agusti
- Hospital Clinic, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain; and
| | - on behalf of the GOLD Science Committee
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Department of Medical Sciences, Cardiorespiratory and Internal Medicine Unit, University of Ferrara, Ferrara, Italy
- Manchester University NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
- Division of Pulmonary/Critical Care Medicine, South Texas Veterans Health Care System, University of Texas Health, University of Texas, San Antonio, Texas
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York
- Hospital Clinic, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain; and
- Department of Medicine, Pulmonary, and Critical Care Medicine, the German Center for Lung Research, University Medical Center Giessen and Marburg, Philipps-University Marburg, Marburg, Germany
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311
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Wang G, Foney DM, DiBari J, Hong X, Showell N, Kim KS, Ji H, Pearson C, Mirolli G, Rusk S, Sharfstein J, Cheng TL, Zuckerman B, Wang X. A prospective cohort study on the intersectionality of obesity, chronic disease, social factors, and incident risk of COVID-19 in US low-income minority middle-age mothers. Int J Obes (Lond) 2021; 45:2577-2584. [PMID: 34413468 PMCID: PMC8374030 DOI: 10.1038/s41366-021-00943-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/25/2021] [Accepted: 08/11/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) has disproportionally affected communities of color. We aimed to determine what factors are associated with COVID-19 testing and test positivity in an underrepresented, understudied, and underreported (U3) population of mothers. METHODS This study included 2996 middle-aged mothers of the Boston Birth Cohort (a sample of predominantly urban, low-income, Black and Hispanic mothers) who were enrolled shortly after they gave birth and followed onward at the Boston Medical Center. COVID-19 testing and test positivity were defined by the SARS-CoV-2 nucleic acid test. Two-probit Heckman selection models were performed to identify factors associated with test positivity while accounting for potential selection associated with COVID testing. RESULTS The mean (SD) age of study mothers was 41.9 (±7.7) years. In the sample, 1741 (58.1%) and 667 (22.3%) mothers were self-identified as Black and Hispanic, respectively. A total of 396 mothers had COVID-19 testing and of those, 95 mothers tested positive from March 2020 to February 2021. Among a multitude of factors examined, factors associated with the probability of being tested were obesity (RR = 1.27; 95% confidence interval (CI): 1.08-1.49); and presence of preexisting chronic medical conditions including hypertension, asthma, stroke, and other comorbidities (coronary heart disease, chronic kidney disease, and sickle cell disease) with a corresponding RR = 1.40 (95% CI: 1.23-1.60); 1.29 (95% CI: 1.11-1.50); 1.44 (95% CI: 1.23-1.68); and 1.37 (95% CI: 1.12-1.67), respectively. Factors associated with higher incident risk of a positive COVID-19 test were body mass index, birthplace outside of the USA, and being without a college-level education. CONCLUSIONS This study demonstrated the intersectionality of obesity and social factors in modulating incident risk of COVID-19 in this sample of US Black and Hispanic middle-aged mothers. Methodologically, our findings underscore the importance of accounting for potential selection bias in COVID-19 testing in order to obtain unbiased estimates of COVID-19 infection.
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Affiliation(s)
- Guoying Wang
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
| | - Dana M. Foney
- grid.454842.b0000 0004 0405 7557Division of Research, Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD USA
| | - Jessica DiBari
- grid.454842.b0000 0004 0405 7557Division of Research, Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD USA
| | - Xiumei Hong
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
| | - Nakiya Showell
- grid.21107.350000 0001 2171 9311Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Kwang Sik Kim
- grid.21107.350000 0001 2171 9311Department of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Hongkai Ji
- grid.21107.350000 0001 2171 9311Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
| | - Colleen Pearson
- grid.189504.10000 0004 1936 7558Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, MA USA
| | - Gabrielle Mirolli
- grid.189504.10000 0004 1936 7558Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, MA USA
| | - Serena Rusk
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
| | - Josh Sharfstein
- grid.21107.350000 0001 2171 9311Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
| | - Tina L. Cheng
- grid.239573.90000 0000 9025 8099Department of Pediatrics, Cincinnati Children’s Hospital and University of Cincinnati, Cincinnati, OH USA
| | - Barry Zuckerman
- grid.189504.10000 0004 1936 7558Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, MA USA
| | - Xiaobin Wang
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA ,grid.21107.350000 0001 2171 9311Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD USA
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312
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Obesity and Risk of COVID-19 Infection and Severity: Available Evidence and Mechanisms. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1321:97-107. [PMID: 33656716 DOI: 10.1007/978-3-030-59261-5_8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has resulted in worldwide research efforts to recognize people at greatest risk of developing critical illness and dying. Growing numbers of reports have connected obesity to more severe COVID-19 illness and death. Although the exact mechanism by which obesity may lead to severe COVID-19 outcomes has not yet been determined, the mechanisms appear to be multifactorial. These include mechanical changes of the airways and lung parenchyma, systemic and airway inflammation, and general metabolic dysfunction that adversely affect pulmonary function and/or response to treatment. As COVID-19 continues to spread worldwide, clinicians should carefully monitor and manage obese patients for prompt and targeted treatment.
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313
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Zhou J, Liu C, Sun Y, Huang W, Ye K. Cognitive disorders associated with hospitalization of COVID-19: Results from an observational cohort study. Brain Behav Immun 2021; 91:383-392. [PMID: 33148439 PMCID: PMC7584518 DOI: 10.1016/j.bbi.2020.10.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/30/2020] [Accepted: 10/19/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Our understanding of risk factors for COVID‑19, including pre-existing medical conditions and genetic variations, is limited. To what extent the pre-existing clinical condition and genetic background have implications for COVID-19 still needs to be explored. METHODS Our study included 389,620 participants of European descent from the UK Biobank, of whom 3,884 received the COVID-19 test and 1,091 were tested positive for COVID-19. We examined the association of COVID-19 status with an extensive list of 974 medical conditions and 30 blood biomarkers. Additionally, we tested the association of genetic variants in two key genes related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2), with COVID-19 or any other phenotypes. RESULTS The most significant risk factors for COVID-19 include Alzheimer's disease (OR = 2.29, 95% CI: 1.25-4.16), dementia (OR = 2.16, 95% CI: 1.36-3.42), and the overall category of delirium, dementia, amnestic and other cognitive disorders (OR = 1.90, 95% CI: 1.24-2.90). Evidence suggesting associations of genetic variants in SARS-CoV-2 infection-related genes with COVID-19 (rs7282236, OR = 1.33, 95% CI: 1.14-1.54, p = 2.31 × 10-4) and other phenotypes, such as an immune deficiency (p = 5.65 × 10-5) and prostate cancer (p = 1.1 × 10-5), was obtained. CONCLUSIONS Our unbiased and extensive search identified pre-existing Alzheimer's disease and dementia as top risk factors for hospital admission due to COVID-19, highlighting the importance of providing special protective care for patients with cognitive disorders during this pandemic. We also obtained evidence suggesting a direct association of genetic variants with COVID-19.
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Affiliation(s)
- Jingqi Zhou
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, USA,School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Chang Liu
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, USA,College of Life Sciences, Wuhan University, Wuhan, PR China
| | - Yitang Sun
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, USA
| | - Weishan Huang
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA,Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Kaixiong Ye
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, USA; Institute of Bioinformatics, University of Georgia, Athens, GA, USA.
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314
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Ho JSY, Fernando DI, Chan MY, Sia CH. Obesity in COVID-19: A Systematic Review and Meta-analysis. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2020; 49:996-1008. [DOI: 10.47102/annals-acadmedsg.2020299] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Abstract
Objective: Obesity has been shown to be associated with adverse outcomes in viral
infections such as influenza, but previous studies on coronavirus disease 2019
(COVID-19) had mixed results. The aim of this systematic review is to investigate the
relationship between COVID-19 and obesity.
Methods: We performed a systematic review and meta-analysis. A literature search of
MEDLINE, EMBASE, Scopus, Web of Science, CENTRAL, OpenGrey and preprint
servers medRxiv and bioRxiv was performed, with no restriction on language or date of
publication. Primary outcomes of this study were intensive care unit (ICU) admission
or critical disease, severe disease and mortality. Secondary outcome was a positive
COVID-19 test. Meta-analysis was performed using OpenMeta-Analyst software, and
heterogeneity was tested using Cochran’s Q test and I2 statistic. The study protocol was
registered on PROSPERO (CRD42020184953).
Results: A total of 1,493 articles were identified and 61 studies on 270,241 patients
were included. The pooled prevalence of obesity was 27.6% (95% confidence interval
[CI] 22.0–33.2) in hospitalised patients. Obesity was not significantly associated with
increased ICU admission or critical illness (odds ratio [OR] 1.25, 95% CI 0.99–1.58,
P=0.062, I2=31.0) but was significantly associated with more severe disease (OR 3.13,
95% CI 1.41–6.92, P=0.005, I2=82.6), mortality (OR 1.36, 95% CI 1.09–1.69, P=0.006,
I2=88.5) and a positive COVID-19 test (OR 1.50, 95% CI 1.25–1.81, P<0.001).
Conclusion: Obesity increased the risk of severe disease, mortality and infection with
COVID-19. Higher body mass index was associated with ICU admission and critical
disease. Patients who are obese may be more susceptible to severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) infection, and infected patients should be
monitored closely for adverse outcomes.
Keywords: Body mass index, coronavirus, intensive care, mortality, prognosis
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315
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Green I, Ashkenazi S, Merzon E, Vinker S, Golan-Cohen A. The association of previous influenza vaccination and coronavirus disease-2019. Hum Vaccin Immunother 2020; 17:2169-2175. [PMID: 33377817 DOI: 10.1080/21645515.2020.1852010] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Studies have shown similarities in the structure of influenza and coronaviruses, in their binding receptors and in patterns of immune responses; and that influenza vaccine can induce cross-immunity. We examined the association of previous influenza vaccination and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, resulting in coronavirus disease-2019 (COVID-19), among 715,164 members of a health maintenance organization. In a multivariate regression model, the odds ratios for SARS-CoV-2 infection among individuals vaccinated for influenza in 2018-2019, 2019-2020, and in both seasons, compared to non-vaccinated individuals, were 0.82 (95% CI 0.68-0.99, p = .048), 0.79 (95% CI 0.67-0.98, p = .005), and 0.76 (95% CI 0.61-0.97, p = .004), respectively. Based on our findings, administration of influenza vaccine before the influenza season is highly recommended to reduce the burden of influenza, which is critical in scenarios of outbreaks of both influenza and SARS-CoV-2 infections, and also regarding its association with reduced rate of COVID-19.
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Affiliation(s)
- Ilan Green
- Leumit Health Services, Medical Division, Tel-Aviv, Israel
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Eugene Merzon
- Leumit Health Services, Medical Division, Tel-Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Vinker
- Leumit Health Services, Medical Division, Tel-Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avivit Golan-Cohen
- Leumit Health Services, Medical Division, Tel-Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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316
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Monteiro AC, Suri R, Emeruwa IO, Stretch RJ, Cortes-Lopez RY, Sherman A, Lindsay CC, Fulcher JA, Goodman-Meza D, Sapru A, Buhr RG, Chang SY, Wang T, Qadir N. Obesity and smoking as risk factors for invasive mechanical ventilation in COVID-19: A retrospective, observational cohort study. PLoS One 2020; 15:e0238552. [PMID: 33351817 PMCID: PMC7755188 DOI: 10.1371/journal.pone.0238552] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/07/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To describe the trajectory of respiratory failure in COVID-19 and explore factors associated with risk of invasive mechanical ventilation (IMV). MATERIALS AND METHODS A retrospective, observational cohort study of 112 inpatient adults diagnosed with COVID-19 between March 12 and April 16, 2020. Data were manually extracted from electronic medical records. Multivariable and Univariable regression were used to evaluate association between baseline characteristics, initial serum markers and the outcome of IMV. RESULTS Our cohort had median age of 61 (IQR 45-74) and was 66% male. In-hospital mortality was 6% (7/112). ICU mortality was 12.8% (6/47), and 18% (5/28) for those requiring IMV. Obesity (OR 5.82, CI 1.74-19.48), former (OR 8.06, CI 1.51-43.06) and current smoking status (OR 10.33, CI 1.43-74.67) were associated with IMV after adjusting for age, sex, and high prevalence comorbidities by multivariable analysis. Initial absolute lymphocyte count (OR 0.33, CI 0.11-0.96), procalcitonin (OR 1.27, CI 1.02-1.57), IL-6 (OR 1.17, CI 1.03-1.33), ferritin (OR 1.05, CI 1.005-1.11), LDH (OR 1.57, 95% CI 1.13-2.17) and CRP (OR 1.13, CI 1.06-1.21), were associated with IMV by univariate analysis. CONCLUSIONS Obesity, smoking history, and elevated inflammatory markers were associated with increased need for IMV in patients with COVID-19.
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Affiliation(s)
- Ana C. Monteiro
- Division of Pulmonary and Critical Care, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Rajat Suri
- Division of Pulmonary and Critical Care, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Iheanacho O. Emeruwa
- Division of Pulmonary and Critical Care, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Robert J. Stretch
- Division of Pulmonary and Critical Care, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Roxana Y. Cortes-Lopez
- Division of Pulmonary and Critical Care, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Alexander Sherman
- Division of Pulmonary and Critical Care, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Catherine C. Lindsay
- Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Jennifer A. Fulcher
- Division of Infectious Disease, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - David Goodman-Meza
- Division of Infectious Disease, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Anil Sapru
- Division of Critical Care, Department of Pediatrics, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Russell G. Buhr
- Division of Pulmonary and Critical Care, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Steven Y. Chang
- Division of Pulmonary and Critical Care, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Tisha Wang
- Division of Pulmonary and Critical Care, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Nida Qadir
- Division of Pulmonary and Critical Care, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
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317
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Yang J, Ma Z, Lei Y. A meta-analysis of the association between obesity and COVID-19. Epidemiol Infect 2020; 149:e11. [PMID: 33349290 PMCID: PMC7844214 DOI: 10.1017/s0950268820003027] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/26/2020] [Accepted: 12/11/2020] [Indexed: 02/07/2023] Open
Abstract
Owing to limited data, we conducted a meta-analysis to re-evaluate the relationship between obesity and coronavirus-2019 (COVID-19). Literature published between 1 January 2020 and 22 August 2020 was comprehensively analysed, and RevMan3.5 was used for data analysis. A total of 50 studies, including data on 18 260 378 patients, were available. Obesity was associated with a higher risk of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2) infection (odds ratio (OR): 1.39, 95% confidence interval (CI) 1.25-1.54; P < 0.00001) and increased severity of COVID-19 (hospitalisation rate: OR: 2.45, 95% CI 1.78-3.39; P < 0.00001; severe cases: OR: 3.74, 95% CI 1.18-11.87; P: 0.02; need for intensive care unit admission: OR: 1.30, 95% CI 1.21-1.40; P < 0.00001; need for invasive mechanical ventilation: OR: 1.59, 95% CI 1.35-1.88; P < 0.00001 and mortality: OR: 1.65, 95% CI 1.21-2.25; P: 0.001). However, we found a non-linear association between BMI and the severity of COVID-19. In conclusion, we found that obesity could increase the risk of SARS-CoV2 infection and aggregate the severity of COVID-19. Further studies are needed to explore the possible mechanisms behind this association.
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Affiliation(s)
- Jiao Yang
- Department of Gastroenterology, Liuzhou People's Hospital, WenChang Road 8, LiuZhou545000, Guangxi Province, China
| | - ZhiYing Ma
- Department of Infectious Disease, Liuzhou People's Hospital, WenChang Road 8, LiuZhou545000, Guangxi Province, China
| | - YanChang Lei
- Department of Gastroenterology, Liuzhou People's Hospital, WenChang Road 8, LiuZhou545000, Guangxi Province, China
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318
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Elimian KO, Ochu CL, Ebhodaghe B, Myles P, Crawford EE, Igumbor E, Ukponu W, Olayinka A, Aruna O, Dan-Nwafor C, Olawepo OA, Ogunbode O, Atteh R, Nwachukwu W, Venkatesan S, Obagha C, Ngishe S, Suleiman K, Usman M, Yusuff HA, Nwadiuto I, Mohammed AA, Usman R, Mba N, Aderinola O, Ilori E, Oladejo J, Abubakar I, Ihekweazu C. Patient characteristics associated with COVID-19 positivity and fatality in Nigeria: retrospective cohort study. BMJ Open 2020; 10:e044079. [PMID: 33334842 PMCID: PMC7747485 DOI: 10.1136/bmjopen-2020-044079] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/05/2020] [Accepted: 11/10/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Despite the increasing disease burden, there is a dearth of context-specific evidence on the risk factors for COVID-19 positivity and subsequent death in Nigeria. Thus, the study objective was to identify context-specific factors associated with testing positive for COVID-19 and fatality in Nigeria. DESIGN Retrospective cohort study. SETTING COVID-19 surveillance and laboratory centres in 36 states and the Federal Capital Territory reporting data to the Nigeria Centre for Disease Control. PARTICIPANTS Individuals who were investigated for SARS-CoV-2 using real-time PCR testing during the study period 27 February-8 June 2020. METHODS COVID-19 positivity and subsequent mortality. Multivariable logistic regression analyses were performed to identify factors independently associated with both outcome variables, and findings are presented as adjusted ORs (aORs) and 95% CIs. RESULTS A total of 36 496 patients were tested for COVID-19, with 10 517 confirmed cases. Of 3215 confirmed cases with available clinical outcomes, 295 died. Factors independently associated with COVID-19 positivity were older age (p value for trend<0.0001), male sex (aOR 1.11, 95% CI 1.04 to 1.18) and the following presenting symptoms: cough (aOR 1.23, 95% CI 1.13 to 1.32), fever (aOR 1.45, 95% CI 1.45 to 1.71), loss of smell (aOR 7.78, 95% CI 5.19 to 11.66) and loss of taste (aOR 2.50, 95% CI 1.60 to 3.90). An increased risk of mortality following COVID-19 was observed in those aged ≥51 years, patients in farming occupation (aOR 7.56, 95% CI 1.70 to 33.53) and those presenting with cough (aOR 2.06, 95% CI 1.41 to 3.01), breathing difficulties (aOR 5.68, 95% CI 3.77 to 8.58) and vomiting (aOR 2.54, 95% CI 1.33 to 4.84). CONCLUSION The significant risk factors associated with COVID-19 positivity and subsequent mortality in the Nigerian population are similar to those reported in studies from other countries and should guide clinical decisions for COVID-19 testing and specialist care referrals.
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Affiliation(s)
- Kelly Osezele Elimian
- Prevention, Programme and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
- Department of Microbiology, Faculty of Life Sciences, University of Benin, Benin City, Nigeria
| | - Chinwe Lucia Ochu
- Prevention, Programme and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Blessing Ebhodaghe
- Prevention, Programme and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Puja Myles
- Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Emily E Crawford
- Prevention, Programme and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Ehimario Igumbor
- Prevention, Programme and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Winifred Ukponu
- Center for Global Health Practice and Impact, Georgetown University, Abuja, Nigeria
| | - Adobola Olayinka
- WHO, Abuja, Nigeria
- Ahmadu Bello University, Zaria, Kaduna, Nigeria
| | - Olusola Aruna
- IHR Strengthening Project, Global Public Health, Public Health England, London, UK
- Public Health England, British High Commission Nigeria, Abuja, Nigeria
| | - Chioma Dan-Nwafor
- Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, FCT, Nigeria
| | | | - Oladipo Ogunbode
- Prevention, Programme and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Rhoda Atteh
- Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, FCT, Nigeria
| | - William Nwachukwu
- Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, FCT, Nigeria
| | - Sudhir Venkatesan
- EMEA Data Science Hub, IQVIA, London, UK
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | | | | | - Rabi Usman
- Ministry of Health, Zamfara State, Zamfara, Nigeria
| | - Nwando Mba
- Public Health Laboratory Services, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Olaolu Aderinola
- Health Emergency Preparedness and Response, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Elsie Ilori
- Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, FCT, Nigeria
| | - John Oladejo
- Health Emergency Preparedness and Response, Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | - Chikwe Ihekweazu
- Office of the Director General, Nigeria Centre for Disease Control, Abuja, Nigeria
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319
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Abstract
COVID-19 has spread to all countries around the world after it was first discovered in Wuhan of China at the end of 2019. It is caused by a novel coronavirus called SARS-CoV-2 with much semblance to SARS-CoV including the sequence homology and disease symptoms. It is reported to be more infectious than SARS-CoV due to higher binding affinities between its spike protein and the ACE2 receptor on cell surface. Despite this, its case fatality rate is much lower compared with that of SARS-CoV although it varies in different countries. However, the case fatality rate increases steadily with age and it is reported to be the highest in aged COVID-19 male patients in almost all countries. Consistent with these, females have higher antiviral immune responses. Males and females are different in inflammatory response and aberrantly hyperactive cytokines are the main lethal causes of COVID-19. Interestingly, the gene encoding the ACE2 receptor protein and some genes encoding the immune regulatory proteins such as TLR7 are located on X chromosome which is subject to X chromosome inactivation and sex hormone regulation. These may account for some sex-dependent immune responses and lethality observed in COVID-19 patients. In general, children are less likely to be infected with SARS-CoV-2 and only less than 1% of pediatric COVID-19 patients may die of COVID-19. However, the most severe pediatric cases become multisystem inflammatory syndrome that is similar to Kawasiki disease with features of viral infection. Since most infected kids were boys in China, there may be sex-dependent immune response in pediatric COVID-19 cases as well.
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Affiliation(s)
- Albert Jiarui Li
- Edgemont High School, 200 White Oak Lane, Scarsdale, NY 10583, USA
| | - Xiajun Li
- School of Life Science and Technology, ShanghaiTech University, Shanghai 201210, China.
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Thomson RJ, Hunter J, Dutton J, Schneider J, Khosravi M, Casement A, Dhadwal K, Martin D. Clinical characteristics and outcomes of critically ill patients with COVID-19 admitted to an intensive care unit in London: A prospective observational cohort study. PLoS One 2020; 15:e0243710. [PMID: 33320904 PMCID: PMC7737956 DOI: 10.1371/journal.pone.0243710] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/29/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Cohorts of severely ill patients with COVID-19 have been described in several countries around the globe, but to date there have been few published reports from the United Kingdom (UK). Understanding the characteristics of the affected population admitted to intensive care units (ICUs) in the UK is crucial to inform clinical decision making, research and planning for future waves of infection. METHODS We conducted a prospective observational cohort study of all patients with COVID-19 admitted to a large UK ICU from March to May 2020 with follow-up to June 2020. Data were collected from health records using a standardised template. We used multivariable logistic regression to analyse the factors associated with ICU survival. RESULTS Of the 156 patients included, 112 (72%) were male, 89 (57%) were overweight or obese, 68 (44%) were from ethnic minorities, and 89 (57%) were aged over 60 years of age. 136 (87%) received mechanical ventilation, 77 (57% of those intubated) were placed in the prone position and 95 (70% of those intubated) received neuromuscular blockade. 154 (99%) patients required cardiovascular support and 44 (28%) required renal replacement therapy. Of the 130 patients with completed ICU episodes, 38 (29%) died and 92 (71%) were discharged alive from ICU. In multivariable models, age (OR 1.13 [95% CI 1.07-1.21]), obesity (OR 3.06 [95% CI 1.16-8.74]), lowest P/F ratio on the first day of admission (OR 0.82 [95% CI 0.67-0.98]) and PaCO2 (OR 1.52 [95% CI 1.01-2.39]) were independently associated with ICU death. CONCLUSIONS Age, obesity and severity of respiratory failure were key determinants of survival in this cohort. Multiorgan failure was prevalent. These findings are important for guiding future research and should be taken into consideration during future healthcare planning in the UK.
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Affiliation(s)
- Ross J. Thomson
- Department of Intensive Care Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
- William Harvey Research Institute, Queen Mary, University of London, London, United Kingdom
| | - Jennifer Hunter
- Department of Anaesthesia, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Jonathan Dutton
- Department of Anaesthesia, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - James Schneider
- Department of Anaesthesia, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Maryam Khosravi
- Department of Intensive Care Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
- Department of Nephrology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Alisha Casement
- Department of Intensive Care Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Kulwant Dhadwal
- Department of Intensive Care Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
- Department of Anaesthesia, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Daniel Martin
- Department of Intensive Care Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
- Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom
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321
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Zhang JT, Zhong WZ, Wu YL. Cancer treatment in the coronavirus disease pandemic. Lung Cancer 2020; 152:98-103. [PMID: 33373838 PMCID: PMC7832712 DOI: 10.1016/j.lungcan.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 12/04/2022]
Abstract
COVID-19 patients with cancer had increased risk of death and severe outcomes compared to those without cancer. There is no conclusive evidence indicating that antineoplastic treatment aggravates COVID-19 disease There was no significant difference in COVID-19 severity regardless of PD-1 blockade exposure.
Half a year after its emergence, severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) has resulted in a pandemic, with cases continuing to increase in nearly every country. Surges in coronavirus disease of 2019 (COVID-19) cases have clearly had profound effects on current cancer treatment paradigms. Considering the effect of antineoplastic treatment and the immunosuppressive properties of cancer itself, cancer patients are deemed to be more vulnerable to SARS-CoV-2. Hence, the specific risk of SARS-CoV-2 must be carefully weighed against the benefit of antineoplastic treatment for cancer patients in the COVID-19 era. In this review, we discuss the current evidence in this important field, and in particular, the effect of SARS-CoV-2 on antineoplastic treatment.
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Affiliation(s)
- Jia-Tao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, South China University of Technology & Guangdong Academy of Medical Sciences, Guangdong Key Laboratory of Lung Cancer Translational Medicine, Guangzhou, 510080, China
| | - Wen-Zhao Zhong
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, South China University of Technology & Guangdong Academy of Medical Sciences, Guangdong Key Laboratory of Lung Cancer Translational Medicine, Guangzhou, 510080, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, South China University of Technology & Guangdong Academy of Medical Sciences, Guangdong Key Laboratory of Lung Cancer Translational Medicine, Guangzhou, 510080, China.
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322
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Kantele A, Lääveri T, Kareinen L, Pakkanen SH, Blomgren K, Mero S, Patjas A, Virtanen J, Uusitalo R, Lappalainen M, Järvinen A, Kurkela S, Jääskeläinen AJ, Vapalahti O, Sironen T. SARS-CoV-2 infections among healthcare workers at Helsinki University Hospital, Finland, spring 2020: Serosurvey, symptoms and risk factors. Travel Med Infect Dis 2020; 39:101949. [PMID: 33321195 PMCID: PMC7833655 DOI: 10.1016/j.tmaid.2020.101949] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/29/2020] [Accepted: 12/06/2020] [Indexed: 12/12/2022]
Abstract
Background Exposure, risks and immunity of healthcare workers (HCWs), a vital resource during the SARS-CoV-2 pandemic, warrant special attention. Methods HCWs at Helsinki University Hospital, Finland, filled in questionnaires and provided serum samples for SARS-CoV-2-specific antibody screening by Euroimmun IgG assay in March–April 2020. Positive/equivocal findings were confirmed by Abbott and microneutralization tests. Positivity by two of the three assays or RT-PCR indicated a Covid-19 case (CoV+). Results The rate of CoV(+) was 3.3% (36/1095) and seropositivity 3.0% (33/1095). CoV(+) was associated with contact with a known Covid-19 case, and working on a Covid-19-dedicated ward or one with cases among staff. The rate in the Covid-19-dedicated ICU was negligible. Smoking and age <55 years were associated with decreased risk. CoV(+) was strongly associated with ageusia, anosmia, myalgia, fatigue, fever, and chest pressure. Seropositivity was recorded for 89.3% of those with prior documented RT-PCR-positivity and 2.4% of those RT-PCR-negative. The rate of previously unidentified cases was 0.7% (8/1067) and asymptomatic ones 0% (0/36). Conclusion Undiagnosed and asymptomatic cases among HCWs proved rare. An increased risk was associated with Covid-19-dedicated wards. Particularly high rates were seen for wards with liberal HCW-HCW contacts, highlighting the importance of social distancing also among HCWs.
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Affiliation(s)
- Anu Kantele
- Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Finland; Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Finland; Meilahti Vaccine Research Center, MeVac, Helsinki University Hospital and University of Helsinki, Finland.
| | - Tinja Lääveri
- Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Finland
| | - Lauri Kareinen
- Department of Virology, Medicum, Faculty of Medicine, University of Helsinki, Finland; Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 66, 00014 University of Helsinki, Finland
| | - Sari H Pakkanen
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Finland; Meilahti Vaccine Research Center, MeVac, Helsinki University Hospital and University of Helsinki, Finland
| | - Karin Blomgren
- Meilahti Vaccine Research Center, MeVac, Helsinki University Hospital and University of Helsinki, Finland
| | - Sointu Mero
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Finland
| | - Anu Patjas
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Finland; Meilahti Vaccine Research Center, MeVac, Helsinki University Hospital and University of Helsinki, Finland
| | - Jenni Virtanen
- Department of Virology, Medicum, Faculty of Medicine, University of Helsinki, Finland; Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 66, 00014 University of Helsinki, Finland
| | - Ruut Uusitalo
- Department of Virology, Medicum, Faculty of Medicine, University of Helsinki, Finland; Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 66, 00014 University of Helsinki, Finland; Department of Geosciences and Geography, Faculty of Science, University of Helsinki, Finland
| | - Maija Lappalainen
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Finland
| | - Asko Järvinen
- Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Finland
| | - Satu Kurkela
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Finland
| | - Anne J Jääskeläinen
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Finland
| | - Olli Vapalahti
- Department of Virology, Medicum, Faculty of Medicine, University of Helsinki, Finland; Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 66, 00014 University of Helsinki, Finland; HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Finland
| | - Tarja Sironen
- Department of Virology, Medicum, Faculty of Medicine, University of Helsinki, Finland; Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 66, 00014 University of Helsinki, Finland
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Hutter HP, Poteser M, Moshammer H, Lemmerer K, Mayer M, Weitensfelder L, Wallner P, Kundi M. Air Pollution Is Associated with COVID-19 Incidence and Mortality in Vienna, Austria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9275. [PMID: 33322456 PMCID: PMC7764269 DOI: 10.3390/ijerph17249275] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/01/2020] [Accepted: 12/09/2020] [Indexed: 12/23/2022]
Abstract
We determined the impact of air pollution on COVID-19-related mortality and reported-case incidence, analyzing the correlation of infection case numbers and outcomes with previous-year air pollution data from the populations of 23 Viennese districts. Time at risk started in a district when the first COVID-19 case was diagnosed. High exposure levels were defined as living in a district with an average (year 2019) concentration of nitrogen dioxide (NO2) and/or particulate matter (PM10) higher than the upper quartile (30 and 20 µg/m3, respectively) of all districts. The total population of the individual districts was followed until diagnosis of or death from COVID-19, or until 21 April 2020, whichever came first. Cox proportional hazard regression was performed after controlling for percentage of population aged 65 and more, percentage of foreigners and of persons with a university degree, unemployment rate, and population density. PM10 and NO2 were significantly and positively associated with the risk of a COVID-19 diagnosis (hazard ratio (HR) = 1.44 and 1.16, respectively). NO2 was also significantly associated with death from COVID-19 (HR = 1.72). Even within a single city, higher levels of air pollution are associated with an adverse impact on COVID-19 risk.
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Affiliation(s)
- Hans-Peter Hutter
- Center for Public Health, Department of Environmental Health, Medical University of Vienna, 1090 Vienna, Austria; (H.-P.H.); (H.M.); (K.L.); (L.W.); (P.W.); (M.K.)
| | - Michael Poteser
- Center for Public Health, Department of Environmental Health, Medical University of Vienna, 1090 Vienna, Austria; (H.-P.H.); (H.M.); (K.L.); (L.W.); (P.W.); (M.K.)
| | - Hanns Moshammer
- Center for Public Health, Department of Environmental Health, Medical University of Vienna, 1090 Vienna, Austria; (H.-P.H.); (H.M.); (K.L.); (L.W.); (P.W.); (M.K.)
- Department of Hygiene, Medical University of Karakalpakstan, Nukus 230100, Uzbekistan
| | - Kathrin Lemmerer
- Center for Public Health, Department of Environmental Health, Medical University of Vienna, 1090 Vienna, Austria; (H.-P.H.); (H.M.); (K.L.); (L.W.); (P.W.); (M.K.)
| | - Monika Mayer
- Institute of Meteorology and Climatology, University of Natural Resources and Life Sciences Vienna, 1180 Vienna, Austria;
| | - Lisbeth Weitensfelder
- Center for Public Health, Department of Environmental Health, Medical University of Vienna, 1090 Vienna, Austria; (H.-P.H.); (H.M.); (K.L.); (L.W.); (P.W.); (M.K.)
| | - Peter Wallner
- Center for Public Health, Department of Environmental Health, Medical University of Vienna, 1090 Vienna, Austria; (H.-P.H.); (H.M.); (K.L.); (L.W.); (P.W.); (M.K.)
| | - Michael Kundi
- Center for Public Health, Department of Environmental Health, Medical University of Vienna, 1090 Vienna, Austria; (H.-P.H.); (H.M.); (K.L.); (L.W.); (P.W.); (M.K.)
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324
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Nilles EJ, Siddiqui SM, Fischinger S, Bartsch YC, de Saint Aubin M, Zhou G, Gluck MJ, Berger S, Rhee J, Petersen E, Mormann B, Loesche M, Chen Z, Yu J, Gebre M, Atyeo C, Gorman MJ, Lee Zhu A, Burke J, Slein M, Hasdianda MA, Jambaulikar G, Boyer E, Sabeti P, Barouch DH, Julg BD, Kucharski AJ, Musk ER, Lauffenburger DA, Alter G, Menon AS. Epidemiological and immunological features of obesity and SARS-CoV-2. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.11.11.20229724. [PMID: 33200139 PMCID: PMC7668749 DOI: 10.1101/2020.11.11.20229724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Obesity is a key correlate of severe SARS-CoV-2 outcomes while the role of obesity on risk of SARS-CoV-2 infection, symptom phenotype, and immune response are poorly defined. We examined data from a prospective SARS-CoV-2 cohort study to address these questions. Serostatus, body mass index, demographics, comorbidities, and prior COVID-19 compatible symptoms were assessed at baseline and serostatus and symptoms monthly thereafter. SARS-CoV-2 immunoassays included an IgG ELISA targeting the spike RBD, multiarray Luminex targeting 20 viral antigens, pseudovirus neutralization, and T cell ELISPOT assays. Our results from a large prospective SARS-CoV-2 cohort study indicate symptom phenotype is strongly influenced by obesity among younger but not older age groups; we did not identify evidence to suggest obese individuals are at higher risk of SARS-CoV-2 infection; and, remarkably homogenous immune activity across BMI categories suggests natural- and vaccine-induced protection may be similar across these groups.
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Affiliation(s)
- Eric J Nilles
- Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Harvard Humanitarian Initiative, Boston, MA
- Massachusetts Consortium on Pathogen Readiness, Boston, MA
| | - Sameed M Siddiqui
- Computational and Systems Biology Program, Massachusetts Institute of Technology, Cambridge, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
| | | | | | | | - Guohai Zhou
- Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Matthew J Gluck
- Space Exploration Technologies Corp, Hawthorne, CA
- Icahn School of Medicine- Mount Sinai, New York, NY
| | | | - Justin Rhee
- Space Exploration Technologies Corp, Hawthorne, CA
| | | | - Benjamin Mormann
- Brigham and Women’s Hospital, Boston, MA
- Space Exploration Technologies Corp, Hawthorne, CA
| | - Michael Loesche
- Brigham and Women’s Hospital, Boston, MA
- Space Exploration Technologies Corp, Hawthorne, CA
| | - Zhilin Chen
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
| | - Jingyou Yu
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - Makda Gebre
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
- Harvard T.H. Chan School of Public Health, Boston, MA
| | | | | | - Alex Lee Zhu
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
| | - John Burke
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
| | - Matthew Slein
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
| | | | | | - Edward Boyer
- Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Pardis Sabeti
- Massachusetts Consortium on Pathogen Readiness, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
- Harvard T.H. Chan School of Public Health, Boston, MA
- Howard Hughes Medical Institute, Chevy Chase, MD
| | - Dan H Barouch
- Broad Institute of MIT and Harvard, Cambridge, MA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Boris D Julg
- Broad Institute of MIT and Harvard, Cambridge, MA
| | | | - Elon R Musk
- Space Exploration Technologies Corp, Hawthorne, CA
| | | | - Galit Alter
- Massachusetts Consortium on Pathogen Readiness, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Anil S Menon
- Space Exploration Technologies Corp, Hawthorne, CA
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325
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Vila-Córcoles A, Ochoa-Gondar O, Satué-Gracia EM, Torrente-Fraga C, Gomez-Bertomeu F, Vila-Rovira A, Hospital-Guardiola I, de Diego-Cabanes C, Bejarano-Romero F, Basora-Gallisà J. Influence of prior comorbidities and chronic medications use on the risk of COVID-19 in adults: a population-based cohort study in Tarragona, Spain. BMJ Open 2020; 10:e041577. [PMID: 33303459 PMCID: PMC7733229 DOI: 10.1136/bmjopen-2020-041577] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To investigate possible relationships between pre-existing medical conditions (including common comorbidities and chronic medications) and risk for suffering COVID-19 disease in middle-aged and older adults. DESIGN Population-based retrospective cohort study. SETTING Twelve primary care centres (PCCs) in Tarragona (Spain). PARTICIPANTS 79 083 people (77 676 community-dwelling and 1407 nursing-home residents), who were all individuals aged >50 years affiliated to the 12 participating PCCs. OUTCOMES Baseline cohort characteristics (age, sex, vaccinations, comorbidities and chronic medications) were established at study start (1st. March 2020) and primary outcome was time to COVID-19 confirmed by PCR among cohort members throughout the epidemic period (from 1st. March 2020 to 23rd. May 2020). Risk for suffering COVID-19 was evaluated by Cox regression, estimating multivariable HRs adjusted for age, sex, comorbidities and medications use. RESULTS During the study period, 2324 cohort members were PCR-tested, with 1944 negative and 380 positive results, which means an incidence of 480.5 PCR-confirmed COVID-19 cases per 100 000 persons-period. Assessing the total study cohort, only age (HR 1.02; 95% CI 1.01 to 1.03; p=0.002), nursing-home residence (HR 21.83; 95% CI 16.66 to 28.61; p<0.001) and receiving diuretics (HR 1.35; 95% CI 1.04 to 1.76; p=0.026) appeared independently associated with increased risk. Smoking (HR 0.62; 95% CI 0.41 to 0.93; p=0.022), ACE inhibitors (HR 0.68; 95% CI 0.47 to 0.99; p=0.046) and antihistamine (HR 0.47; 95% CI 0.22 to 1.01; p=0.052) were associated with a lower risk. Among community-dwelling individuals, cancer (HR 1.52; 95% CI 1.03 to 2.24; p=0.035), chronic respiratory disease (HR 1.82; 95% CI 1.08 to 3.07; p=0.025) and cardiac disease (HR 1.53; 95% CI 1.06 to 2.19; p=0.021) emerged to be also associated with an increased risk. Receiving ACE inhibitors (HR 0.66; 95% CI 0.44 to 0.99; p=0.046) and influenza vaccination (HR 0.63; 95% CI 0.44 to 0.91; p=0.012) was associated with decreased risk. CONCLUSION Age, nursing-home residence and multiple comorbidities appear predisposing for COVID-19. Conversely, receiving ACE inhibitors, antihistamine and influenza vaccination could be protective, which should be closely investigated in further studies specifically focused on these concerns.
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Affiliation(s)
- Angel Vila-Córcoles
- Primary Healthcare Service Camp de Tarragona, Institut Catala de la Salut (ICS), Tarragona, Catalunya, Spain
- Unitat de Suport a la recerca Camp de Tarragona-Reus, IDIAP Jordi Gol, Barcelona, Catalunya, Spain
| | - Olga Ochoa-Gondar
- Primary Healthcare Service Camp de Tarragona, Institut Catala de la Salut (ICS), Tarragona, Catalunya, Spain
- Unitat de Suport a la recerca Camp de Tarragona-Reus, IDIAP Jordi Gol, Barcelona, Catalunya, Spain
| | - Eva M Satué-Gracia
- Primary Healthcare Service Camp de Tarragona, Institut Catala de la Salut (ICS), Tarragona, Catalunya, Spain
- Unitat de Suport a la recerca Camp de Tarragona-Reus, IDIAP Jordi Gol, Barcelona, Catalunya, Spain
| | - Cristina Torrente-Fraga
- Information and Communication Technologies, Institut Catala de la Salut (ICS), Tarragona, Catalunya, Spain
| | - Frederic Gomez-Bertomeu
- Department of Microbiology, Hospital Universtari Joan XXIII, Institut Catala de la Salut (ICS), Tarragona, Catalunya, Spain
| | - Angel Vila-Rovira
- Unitat de Suport a la recerca Camp de Tarragona-Reus, IDIAP Jordi Gol, Barcelona, Catalunya, Spain
| | | | - Cinta de Diego-Cabanes
- Primary Healthcare Service Camp de Tarragona, Institut Catala de la Salut (ICS), Tarragona, Catalunya, Spain
| | - Ferran Bejarano-Romero
- Department of Pharmacology, Primary Healthcare Service Camp de Tarragona, Institut Catala de la Salut (ICS), Tarragona, Catalunya, Spain
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326
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Wang PY, Li Y, Wang Q. Sarcopenia: An underlying treatment target during the COVID-19 pandemic. Nutrition 2020; 84:111104. [PMID: 33421827 PMCID: PMC7833321 DOI: 10.1016/j.nut.2020.111104] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 12/29/2022]
Abstract
The role of skeletal muscle mass in modulating immune response and supporting metabolic stress has been increasingly confirmed. Patients with sarcopenia, characterized by reduced muscle mass and muscle strength, were reported to have poor immune response and metabolic stress when facing acute infection, major surgeries, and other attacks. Based on empirical data, patients with sarcopenia are speculated to have increased infection rates and dismal prognoses amid the current 2019 novel coronavirus disease (COVID-19) epidemic. COVID-19 infection also aggravates sarcopenia because of the increased muscle wasting caused by systematic inflammation and the reduced physical activity and inadequate nutrient intake caused by social isolation. Notably, the interventions targeting skeletal muscle are anticipated to break the vicious circle and benefit the treatment of both conditions. We recommend sarcopenia assessment for populations with advanced age, inactivity, chronic disease, cancers, and nutritional deficiency. Patients with sarcopenia and COVID-19 infection need intensive care and aggressive treatments. The provision of at-home physical activities together with protein supplementation is anticipated to reverse sarcopenia and promote the prevention and treatment of COVID-19. The recommended protocols on nutritional support and physical activities are provided in detail.
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Affiliation(s)
- Pei-Yu Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.
| | - Yin Li
- Department of Thoracic Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qin Wang
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, Henan China
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327
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Affiliation(s)
- D Thomas
- Institut de Cardiologie, Hôpital Pitié-Salpêtrière-Sorbonne Université, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - I Berlin
- Département de Pharmacologie, Hôpital Pitié-Salpêtrière-Sorbonne Université, 47-83 boulevard de l'Hôpital, 75013 Paris, France.,Centre Universitaire de Médecine Générale et Santé Publique, UNISANTE, Université de Lausanne Faculté de Biologie et Médecine, rue du Bugnon 44, 1011 Lausanne, Suisse
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328
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Sze S, Pan D, Nevill CR, Gray LJ, Martin CA, Nazareth J, Minhas JS, Divall P, Khunti K, Abrams KR, Nellums LB, Pareek M. Ethnicity and clinical outcomes in COVID-19: A systematic review and meta-analysis. EClinicalMedicine 2020; 29:100630. [PMID: 33200120 PMCID: PMC7658622 DOI: 10.1016/j.eclinm.2020.100630] [Citation(s) in RCA: 355] [Impact Index Per Article: 88.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Patients from ethnic minority groups are disproportionately affected by Coronavirus disease (COVID-19). We performed a systematic review and meta-analysis to explore the relationship between ethnicity and clinical outcomes in COVID-19. METHODS Databases (MEDLINE, EMBASE, PROSPERO, Cochrane library and MedRxiv) were searched up to 31st August 2020, for studies reporting COVID-19 data disaggregated by ethnicity. Outcomes were: risk of infection; intensive therapy unit (ITU) admission and death. PROSPERO ID: 180654. FINDINGS 18,728,893 patients from 50 studies were included; 26 were peer-reviewed; 42 were from the United States of America and 8 from the United Kingdom. Individuals from Black and Asian ethnicities had a higher risk of COVID-19 infection compared to White individuals. This was consistent in both the main analysis (pooled adjusted RR for Black: 2.02, 95% CI 1.67-2.44; pooled adjusted RR for Asian: 1.50, 95% CI 1.24-1.83) and sensitivity analyses examining peer-reviewed studies only (pooled adjusted RR for Black: 1.85, 95%CI: 1.46-2.35; pooled adjusted RR for Asian: 1.51, 95% CI 1.22-1.88). Individuals of Asian ethnicity may also be at higher risk of ITU admission (pooled adjusted RR 1.97 95% CI 1.34-2.89) (but no studies had yet been peer-reviewed) and death (pooled adjusted RR/HR 1.22 [0.99-1.50]). INTERPRETATION Individuals of Black and Asian ethnicity are at increased risk of COVID-19 infection compared to White individuals; Asians may be at higher risk of ITU admission and death. These findings are of critical public health importance in informing interventions to reduce morbidity and mortality amongst ethnic minority groups.
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Affiliation(s)
- Shirley Sze
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, United Kingdom
| | - Clareece R Nevill
- Department of Health Sciences, University of Leicester, United Kingdom
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, United Kingdom
| | - Christopher A Martin
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, United Kingdom
| | - Joshua Nazareth
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, United Kingdom
| | - Jatinder S Minhas
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
| | - Pip Divall
- University Hospitals of Leicester, Education Centre Library, Glenfield Hospital and Leicester Royal Infirmary, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, United Kingdom
| | - Keith R Abrams
- Department of Health Sciences, University of Leicester, United Kingdom
| | - Laura B Nellums
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, United Kingdom
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, United Kingdom
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329
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Aran D, Beachler DC, Lanes S, Overhage JM. Prior presumed coronavirus infection reduces COVID-19 risk: A cohort study. J Infect 2020; 81:923-930. [PMID: 33127456 PMCID: PMC7590640 DOI: 10.1016/j.jinf.2020.10.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 10/25/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Immunological cross-reactivity between common cold coronaviruses (CCC) and SARS-CoV-2 might account for the reduced incidence of COVID-19 in children. Evidence to support speculation includes in vitro evidence for humoral and cellular cross-reactivity with SARS-CoV-2 in specimens obtained before the pandemic started. METHOD We used retrospective health insurance enrollment records, claims, and laboratory results to assemble a cohort of 869,236 insured individuals who had a PCR test for SARS-CoV-2. We estimated the effects of having clinical encounters for various diagnostic categories in the year preceding the study period on the risk of a positive test result. FINDINGS After adjusting for age, gender and care seeking behavior, we identified that individuals with diagnoses for common cold symptoms, including acute sinusitis, bronchitis, or pharyngitis in the preceding year had a lower risk of testing positive for SARS-CoV-2 (OR=0.76, 95%CI=0.75, 0.77). No reduction in the odds of a positive test for SARS-CoV-2 was seen in individuals under 18 years. The reduction in odds in adults remained stable for four years but was strongest in those with recent common cold symptoms. INTERPRETATION While this study cannot attribute this association to cross-immunity resulting from a prior CCC infection, it is one potential explanation. Regardless of the cause, the reduction in the odds of being infected by SARS-CoV-2 among those with a recent diagnosis of common cold symptoms may have a role in shifting future COVD-19 infection patterns from endemic to episodic.
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Affiliation(s)
- Dvir Aran
- Faculty of Biology, Technion-Israel Institute of Technology, Haifa, Israel; Department of Computer Science, Technion-Israel Institute of Technology, Haifa, Israel; Lorry I. Lokey Interdisciplinary Center for Life Sciences & Engineering, Technion-Israel Institute of Technology, Haifa, Israel; Anthem AI, Anthem Inc. Palo Alto, USA.
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Alla F, Berlin I, Nguyen-Thanh V, Guignard R, Pasquereau A, Quelet S, Schwarzinger M, Arwidson P. Tobacco and COVID-19: a crisis within a crisis? CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2020; 111:995-999. [PMID: 33052586 PMCID: PMC7556572 DOI: 10.17269/s41997-020-00427-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023]
Abstract
During the pandemic, the world's media have publicized preliminary findings suggesting that tobacco use is protective against COVID-19. An ad hoc multidisciplinary group was created to address the major public health implications of this messaging. Key messages of this commentary are as follows: 1) The COVID-19 crisis may increase tobacco consumption and decrease access to healthcare. As a result, smoking-related morbidity and mortality could increase in the coming months and years; 2) Smoking and tobacco-related diseases are prognostic factors for severe COVID-19; and 3) In theory, smokers may be at lower risk of COVID-19 infection because of having fewer social contacts. In conclusion, tobacco control is a greater challenge than ever in the context of the COVID-19 pandemic. Public decision-makers must be vigilant in ensuring that public health practices are consistent and compliant with the principles of the WHO Framework Convention on Tobacco Control. In addition, researchers and the media have a responsibility to be cautious in communicating preliminary results that may promote non-evidence-based research, self-destructive individual behaviours, and commercial agendas.
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Affiliation(s)
- François Alla
- Bordeaux Population Health Research Center, UMR 1219, Inserm, Université de Bordeaux, 33000, Bordeaux, France.
| | - Ivan Berlin
- Département de pharmacologie, AP-HP, 75012, Paris, France
- Centre universitaire de médecine générale et de santé publique, 1011, Lausanne, Switzerland
| | - Viet Nguyen-Thanh
- Santé Publique France, The National Public Health Agency, Saint-Maurice, France
| | - Romain Guignard
- Santé Publique France, The National Public Health Agency, Saint-Maurice, France
| | - Anne Pasquereau
- Santé Publique France, The National Public Health Agency, Saint-Maurice, France
| | - Sylvie Quelet
- Santé Publique France, The National Public Health Agency, Saint-Maurice, France
| | - Michaël Schwarzinger
- Bordeaux Population Health Research Center, UMR 1219, Inserm, Université de Bordeaux, 33000, Bordeaux, France
| | - Pierre Arwidson
- Santé Publique France, The National Public Health Agency, Saint-Maurice, France
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331
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Huang Y, Lu Y, Huang YM, Wang M, Ling W, Sui Y, Zhao HL. Obesity in patients with COVID-19: a systematic review and meta-analysis. Metabolism 2020; 113:154378. [PMID: 33002478 PMCID: PMC7521361 DOI: 10.1016/j.metabol.2020.154378] [Citation(s) in RCA: 276] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/15/2020] [Accepted: 09/19/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obesity is common in patients with coronavirus disease 2019 (COVID-19). The effects of obesity on clinical outcomes of COVID-19 warrant systematical investigation. OBJECTIVE This study explores the effects of obesity with the risk of severe disease among patients with COVID-19. METHODS Body mass index (BMI) and degree of visceral adipose tissue (VAT) accumulation were used as indicators for obesity status. Publication databases including preprints were searched up to August 10, 2020. Clinical outcomes of severe COVID-19 included hospitalization, a requirement for treatment in an intensive care unit (ICU), invasive mechanical ventilation (IMV), and mortality. Risks for severe COVID-19 outcomes are presented as odds ratios (OR) and 95% confidence interval (95%CI) for cohort studies with BMI-defined obesity, and standardized mean difference (SMD) and 95%CI for controlled studies with VAT-defined excessive adiposity. RESULTS A total of 45, 650 participants from 30 studies with BMI-defined obesity and 3 controlled studies with VAT-defined adiposity were included for assessing the risk of severe COVID-19. Univariate analyses showed significantly higher ORs of severe COVID-19 with higher BMI: 1.76 (95%: 1.21, 2.56, P = 0.003) for hospitalization, 1.67 (95%CI: 1.26, 2.21, P<0.001) for ICU admission, 2.19 (95%CI: 1.56, 3.07, P<0.001) for IMV requirement, and 1.37 (95%CI: 1.06, 1.75, P = 0.014) for death, giving an overall OR for severe COVID-19 of 1.67 (95%CI: 1.43, 1.96; P<0.001). Multivariate analyses revealed increased ORs of severe COVID-19 associated with higher BMI: 2.36 (95%CI: 1.37, 4.07, P = 0.002) for hospitalization, 2.32 (95%CI: 1.38, 3.90, P = 0.001) for requiring ICU admission, 2.63 (95%CI: 1.32, 5.25, P = 0.006) for IMV support, and 1.49 (95%CI: 1.20, 1.85, P<0.001) for mortality, giving an overall OR for severe COVID-19 of 2.09 (95%CI: 1.67, 2.62; P<0.001). Compared to non-severe COVID-19 patients, severe COVID-19 cases showed significantly higher VAT accumulation with a SMD of 0.49 for hospitalization (95% CI: 0.11, 0.87; P = 0.011), 0.57 (95% CI: 0.33, 0.81; P<0.001) for requiring ICU admission and 0.37 (95% CI: 0.03, 0.71; P = 0.035) for IMV support. The overall SMD for severe COVID-19 was 0.50 (95% CI: 0.33, 0.68; P<0.001). CONCLUSIONS Obesity increases risk for hospitalization, ICU admission, IMV requirement and death among patients with COVID-19. Further, excessive visceral adiposity appears to be associated with severe COVID-19 outcomes. These findings emphasize the need for effective actions by individuals, the public and governments to increase awareness of the risks resulting from obesity and how these are heightened in the current global pandemic.
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Affiliation(s)
- Yi Huang
- Center for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin 541100, China; Department of Immunology, Guangxi Area of Excellence, Guilin Medical University, Guilin 541100, China; Institute of Basic Medical Sciences, Guilin Medical University, Guilin 541100, China
| | - Yao Lu
- Center for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin 541100, China; Department of Immunology, Guangxi Area of Excellence, Guilin Medical University, Guilin 541100, China; Institute of Basic Medical Sciences, Guilin Medical University, Guilin 541100, China
| | - Yan-Mei Huang
- Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Min Wang
- Institute of Basic Medical Sciences, Guilin Medical University, Guilin 541100, China
| | - Wei Ling
- Center for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin 541100, China; Department of Immunology, Guangxi Area of Excellence, Guilin Medical University, Guilin 541100, China; Institute of Basic Medical Sciences, Guilin Medical University, Guilin 541100, China; Department of Endocrinology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yi Sui
- Department of Clinical Nutrition, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hai-Lu Zhao
- Center for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin 541100, China; Department of Immunology, Guangxi Area of Excellence, Guilin Medical University, Guilin 541100, China; Institute of Basic Medical Sciences, Guilin Medical University, Guilin 541100, China.
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332
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Yang J, Tian C, Chen Y, Zhu C, Chi H, Li J. Obesity aggravates COVID-19: An updated systematic review and meta-analysis. J Med Virol 2020; 93:2662-2674. [PMID: 33200825 PMCID: PMC7753795 DOI: 10.1002/jmv.26677] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 12/13/2022]
Abstract
This review aimed to evaluate the impact of obesity on the onset, exacerbation, and mortality of coronavirus disease 2019 (COVID‐19); and compare the effects of different degrees of obesity. PubMed, EMBASE, and Web of Science were searched to find articles published between December 1, 2019, and July 27, 2020. Only observational studies with specific obesity definition were included. Literature screening and data extraction were conducted simultaneously by two researchers. A random‐effects model was used to merge the effect quantity. Sensitivity analysis, subgroup analysis, and meta‐regression analysis were used to deal with the heterogeneity among studies. Forty‐one studies with 219,543 subjects and 115,635 COVID‐19 patients were included. Subjects with obesity were more likely to have positive SARS‐CoV‐2 test results (OR = 1.50; 95% CI: 1.37–1.63, I2 = 69.2%); COVID‐19 patients with obesity had a higher incidence of hospitalization (OR = 1.54, 95% CI: 1.33–1.78, I2 = 60.9%); hospitalized COVID‐19 patients with obesity had a higher incidence of intensive care unit admission (OR = 1.48, 95% CI: 1.24–1.77, I2 = 67.5%), invasive mechanical ventilation (OR = 1.47, 95% CI: 1.31–1.65, I2 = 18.8%), and in‐hospital mortality (OR = 1.14, 95% CI: 1.04–1.26, I2 = 74.4%). A higher degree of obesity also indicated a higher risk of almost all of the above events. The region may be one of the causes of heterogeneity. Obesity could promote the occurrence of the whole course of COVID‐19. A higher degree of obesity may predict a higher risk. Further basic and clinical therapeutic research needs to be strengthened.
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Affiliation(s)
- Jun Yang
- Institute of Chinese Materia MedicaChina Academy of Chinese Medical SciencesBeijingChina
| | - Congmin Tian
- Institute of Chinese Materia MedicaChina Academy of Chinese Medical SciencesBeijingChina
- Institute of Clinical PharmacologyGuangzhou University of Chinese MedicineGuangzhouGuangdongChina
- Science and Technology Innovation CenterGuangzhou University of Chinese MedicineGuangzhouChina
| | - Ying Chen
- Department of Cardiovascular MedicineShanghai Putuo Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Chunyan Zhu
- Institute of Chinese Materia MedicaChina Academy of Chinese Medical SciencesBeijingChina
| | - Hongyu Chi
- Institute of Chinese Materia MedicaChina Academy of Chinese Medical SciencesBeijingChina
- International Institute for Translational Chinese MedicineGuangzhou University of Chinese MedicineGuangzhouGuangdongChina
| | - Jiahao Li
- Institute of Chinese Materia MedicaChina Academy of Chinese Medical SciencesBeijingChina
- College of PharmacyFujian University of Traditional Chinese MedicineFuzhouChina
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333
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Matei V, Pavel A, Giurgiuca A, Roșca A, Sofia A, Duțu I, Tudose C. Knowledge of Prevention Measures and Information About Coronavirus in Romanian Male Patients with Severe Mental Illness and Severe Alcohol Use Disorder. Neuropsychiatr Dis Treat 2020; 16:2857-2864. [PMID: 33273815 PMCID: PMC7705487 DOI: 10.2147/ndt.s278471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/31/2020] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Patients with severe mental illness (SMI) and alcohol use disorder (AUD) are at higher risk for contracting coronavirus-19 (COVID-19) and for poor outcomes of COVID-19 infection. One reason for this could be the lack of knowledge regarding preventive measures against COVID-19 and the inability of the psychiatric patients to discern misinformation from facts. PATIENTS AND METHODS The study design was cross-sectional. We applied one questionnaire that evaluated knowledge of prevention measures and information about COVID-19 (comprised of two sections, each with five questions). The first section evaluated knowledge regarding the official WHO prevention measures against COVID-19, and the second consisted of false information about COVID-19 which examined the ability to identify misinformation about COVID-19. These questionnaires were applied face-to-face to psychiatric male inpatients from a tertiary psychiatric hospital in Bucharest diagnosed with SMI or severe alcohol disorder (SAUD) and to male controls from the community, matched by age and education. Mean scores of patients and controls were compared using Mann-Whitney test. RESULTS There were 115 male psychiatric patients in total (65 SMI and 50 SAUD) and 57 controls included after the matching procedure. We found statistically significant lower (P<0.05) scores for psychiatric patients compared to controls regarding the prevention and general knowledge of COVID-19 (P<0.001), the WHO information about prevention measures (P=0.041), and the ability to identify misinformation about COVID-19 (P<0.001). The fact that psychiatric patients have less knowledge about prevention measures against COVID-19 and a reduced capacity to discern misinformation suggests that we need to identify new methods to convey correct information to these patients and also to better equip them to handle misinformation regarding COVID-19. CONCLUSION Patients with SMI and SAUD are less informed regarding COVID-19 infection and preventive measures compared to controls, while being prone to believing false information about COVID-19 as well.
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Affiliation(s)
- Valentin Matei
- Psychiatry Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- 2nd Clinical Ward, “Prof. Dr. Alexandru Obregia” Psychiatric Hospital, Bucharest, Romania
| | - Alexandru Pavel
- Psychiatry Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- 2nd Clinical Ward, “Prof. Dr. Alexandru Obregia” Psychiatric Hospital, Bucharest, Romania
| | - Ana Giurgiuca
- Psychiatry Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- 2nd Clinical Ward, “Prof. Dr. Alexandru Obregia” Psychiatric Hospital, Bucharest, Romania
| | - Alina Roșca
- Psychiatry Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- 2nd Clinical Ward, “Prof. Dr. Alexandru Obregia” Psychiatric Hospital, Bucharest, Romania
| | - Arina Sofia
- Psychiatry Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- 2nd Clinical Ward, “Prof. Dr. Alexandru Obregia” Psychiatric Hospital, Bucharest, Romania
| | - Irina Duțu
- Psychiatry Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- 2nd Clinical Ward, “Prof. Dr. Alexandru Obregia” Psychiatric Hospital, Bucharest, Romania
| | - Cătălina Tudose
- Psychiatry Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- 2nd Clinical Ward, “Prof. Dr. Alexandru Obregia” Psychiatric Hospital, Bucharest, Romania
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334
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Excess mortality in the first COVID pandemic peak: cross-sectional analyses of the impact of age, sex, ethnicity, household size, and long-term conditions in people of known SARS-CoV-2 status in England. Br J Gen Pract 2020; 70:e890-e898. [PMID: 33077508 PMCID: PMC7575407 DOI: 10.3399/bjgp20x713393] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/20/2020] [Indexed: 12/23/2022] Open
Abstract
Background The SARS-CoV-2 pandemic has passed its first peak in Europe. Aim To describe the mortality in England and its association with SARS-CoV-2 status and other demographic and risk factors. Design and setting Cross-sectional analyses of people with known SARS-CoV-2 status in the Oxford RCGP Research and Surveillance Centre (RSC) sentinel network. Method Pseudonymised, coded clinical data were uploaded from volunteer general practice members of this nationally representative network (n = 4 413 734). All-cause mortality was compared with national rates for 2019, using a relative survival model, reporting relative hazard ratios (RHR), and 95% confidence intervals (CI). A multivariable adjusted odds ratios (OR) analysis was conducted for those with known SARS-CoV-2 status (n = 56 628, 1.3%) including multiple imputation and inverse probability analysis, and a complete cases sensitivity analysis. Results Mortality peaked in week 16. People living in households of ≥9 had a fivefold increase in relative mortality (RHR = 5.1, 95% CI = 4.87 to 5.31, P<0.0001). The ORs of mortality were 8.9 (95% CI = 6.7 to 11.8, P<0.0001) and 9.7 (95% CI = 7.1 to 13.2, P<0.0001) for virologically and clinically diagnosed cases respectively, using people with negative tests as reference. The adjusted mortality for the virologically confirmed group was 18.1% (95% CI = 17.6 to 18.7). Male sex, population density, black ethnicity (compared to white), and people with long-term conditions, including learning disability (OR = 1.96, 95% CI = 1.22 to 3.18, P = 0.0056) had higher odds of mortality. Conclusion The first SARS-CoV-2 peak in England has been associated with excess mortality. Planning for subsequent peaks needs to better manage risk in males, those of black ethnicity, older people, people with learning disabilities, and people who live in multi-occupancy dwellings.
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335
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de Lusignan S, Sherlock J, Akinyemi O, Pebody R, Elliot A, Byford R, Yonova I, Zambon M, Joy M. Household presentation of influenza and acute respiratory illnesses to a primary care sentinel network: retrospective database studies (2013-2018). BMC Public Health 2020; 20:1748. [PMID: 33218318 PMCID: PMC7677442 DOI: 10.1186/s12889-020-09790-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 10/29/2020] [Indexed: 12/12/2022] Open
Abstract
Background Direct observation of the household spread of influenza and respiratory infections is limited; much of our understanding comes from mathematical models. The study aims to determine household incidence of influenza-like illness (ILI), lower (LRTI) and upper (URTI) respiratory infections within a primary care routine data and identify factors associated with the diseases’ incidence. Methods We conducted two five-year retrospective analyses of influenza-like illness (ILI), lower (LRTI) and upper (URTI) respiratory infections using the England Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care sentinel network database; a cross-sectional study reporting incident rate ratio (IRR) from a negative binomial model and a retrospective cohort study, using a shared gamma frailty survival model, reporting hazard ratios (HR). We reported the following household characteristics: children < 5 years old, each extra household member, gender, ethnicity (reference white), chronic disease, pregnancy, and rurality. Results The IRR where there was a child < 5 years were 1·62 (1·38–1·89, p < 0·0001), 2·40 (2.04–2.83, p < 0·0001) and 4·46 (3.79–5.255, p < 0·0001) for ILI, LRTI and URTI respectively. IRR also increased with household size, rurality and presentations and by female gender, compared to male. Household incidence of URTI and LRTI changed little between years whereas influenza did and were greater in years with lower vaccine effectiveness. The HR where there was a child < 5 years were 2·34 (95%CI 1·88–2·90, p < 0·0001), 2·97 (95%CI 2·76–3·2, p < 0·0001) and 10·32 (95%CI 10.04–10.62, p < 0·0001) for ILI, LRTI and URTI respectively. HR were increased with female gender, rurality, and increasing household size. Conclusions Patterns of household incidence can be measured from routine data and may provide insights for the modelling of disease transmission and public health policy. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09790-3.
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Affiliation(s)
- Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK. .,Royal College of General Practitioners Research and Surveillance Centre, 30 Euston Square, London, NW1 2FB, UK. .,Department of Clinical & Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK.
| | - Julian Sherlock
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK.,Department of Clinical & Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK
| | - Oluwafunmi Akinyemi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK.,Department of Clinical & Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK
| | - Richard Pebody
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Alex Elliot
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK.,Department of Clinical & Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK
| | - Ivelina Yonova
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK.,Department of Clinical & Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK
| | - Maria Zambon
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK.,Department of Clinical & Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK
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336
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de Lusignan S, Liyanage H, McGagh D, Jani BD, Bauwens J, Byford R, Evans D, Fahey T, Greenhalgh T, Jones N, Mair FS, Okusi C, Parimalanathan V, Pell JP, Sherlock J, Tamburis O, Tripathy M, Ferreira F, Williams J, Hobbs FDR. COVID-19 Surveillance in a Primary Care Sentinel Network: In-Pandemic Development of an Application Ontology. JMIR Public Health Surveill 2020; 6:e21434. [PMID: 33112762 PMCID: PMC7674143 DOI: 10.2196/21434] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/02/2020] [Accepted: 10/02/2020] [Indexed: 02/06/2023] Open
Abstract
Background Creating an ontology for COVID-19 surveillance should help ensure transparency and consistency. Ontologies formalize conceptualizations at either the domain or application level. Application ontologies cross domains and are specified through testable use cases. Our use case was an extension of the role of the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) to monitor the current pandemic and become an in-pandemic research platform. Objective This study aimed to develop an application ontology for COVID-19 that can be deployed across the various use-case domains of the RCGP RSC research and surveillance activities. Methods We described our domain-specific use case. The actor was the RCGP RSC sentinel network, the system was the course of the COVID-19 pandemic, and the outcomes were the spread and effect of mitigation measures. We used our established 3-step method to develop the ontology, separating ontological concept development from code mapping and data extract validation. We developed a coding system–independent COVID-19 case identification algorithm. As there were no gold-standard pandemic surveillance ontologies, we conducted a rapid Delphi consensus exercise through the International Medical Informatics Association Primary Health Care Informatics working group and extended networks. Results Our use-case domains included primary care, public health, virology, clinical research, and clinical informatics. Our ontology supported (1) case identification, microbiological sampling, and health outcomes at an individual practice and at the national level; (2) feedback through a dashboard; (3) a national observatory; (4) regular updates for Public Health England; and (5) transformation of a sentinel network into a trial platform. We have identified a total of 19,115 people with a definite COVID-19 status, 5226 probable cases, and 74,293 people with possible COVID-19, within the RCGP RSC network (N=5,370,225). Conclusions The underpinning structure of our ontological approach has coped with multiple clinical coding challenges. At a time when there is uncertainty about international comparisons, clarity about the basis on which case definitions and outcomes are made from routine data is essential.
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Affiliation(s)
- Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Harshana Liyanage
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Dylan McGagh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Bhautesh Dinesh Jani
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Jorgen Bauwens
- University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Dai Evans
- PRIMIS, University of Nottingham, Nottingham, United Kingdom
| | - Tom Fahey
- Department of General Practice, Royal College of Surgeons, Ireland, Dublin, Ireland
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Nicholas Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Cecilia Okusi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Vaishnavi Parimalanathan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jill P Pell
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Julian Sherlock
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Oscar Tamburis
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, Naples, Italy
| | - Manasa Tripathy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Filipa Ferreira
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - John Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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337
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Martin CA, Patel P, Goss C, Jenkins DR, Price A, Barton L, Gupta P, Zaccardi F, Jerina H, Duraisingham S, Brunskill NJ, Khunti K, Pareek M. Demographic and occupational determinants of anti-SARS-CoV-2 IgG seropositivity in hospital staff. J Public Health (Oxf) 2020; 44:234-245. [PMID: 33200200 PMCID: PMC7717317 DOI: 10.1093/pubmed/fdaa199] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 12/26/2022] Open
Abstract
Background Although evidence suggests that demographic characteristics including minority ethnicity increase the risk of infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), it is unclear whether these characteristics, together with occupational factors, influence anti-SARS-CoV-2 IgG seroprevalence in hospital staff. Methods We conducted cross-sectional surveillance examining seroprevalence of anti-SARS-CoV-2 IgG amongst staff at University Hospitals of Leicester (UHL) NHS Trust. We quantified seroprevalence stratified by ethnicity, occupation and seniority of practitioner and used logistic regression to examine demographic and occupational factors associated with seropositivity. Results A total of 1148/10662 (10.8%) hospital staff members were seropositive. Compared to White staff (seroprevalence 9.1%), seroprevalence was higher in South Asian (12.3%) and Black (21.2%) staff. The occupations and department with the highest seroprevalence were nurses/healthcare assistants (13.7%) and the Emergency Department (ED)/Acute Medicine (17.5%), respectively. Seroprevalence decreased with seniority in medical/nursing practitioners. Minority ethnicity was associated with seropositivity on an adjusted analysis (South Asian: aOR 1.26; 95%CI: 1.07–1.49 and Black: 2.42; 1.90–3.09). Anaesthetics/ICU staff members were less likely to be seropositive than ED/Acute medicine staff (0.41; 0.27–0.61). Conclusions Ethnicity and occupational factors, including specialty and seniority, are associated with seropositivity for anti-SARS-Cov-2 IgG. These findings could be used to inform occupational risk assessments for front-line healthcare workers.
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Affiliation(s)
| | | | - Charles Goss
- Department of Occupational Health, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - David R Jenkins
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - Arthur Price
- Department of Immunology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - Linda Barton
- Department of Haematology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - Pankaj Gupta
- Department of Chemical Pathology and Metabolic Diseases, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Francesco Zaccardi
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK
| | - Helen Jerina
- Department of Chemical Pathology and Metabolic Diseases, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - Sai Duraisingham
- Department of Immunology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - Nigel J Brunskill
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK
- Department of Nephrology, Leicester General Hospital, Leicester LE5 4PW, UK
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de Lusignan S, Tsang RSM, Akinyemi O, Lopez Bernal J, Amirthalingam G, Sherlock J, Smith G, Zambon M, Howsam G, Joy M. Comparing the incidence of common adverse events of interest following influenza vaccination in the first season adjuvanted trivalent immunisation was introduced: English sentinel network annual report paper 2018/19 (Preprint). JMIR Public Health Surveill 2020; 8:e25803. [PMID: 35343907 PMCID: PMC9002594 DOI: 10.2196/25803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/18/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background Vaccination is the most effective form of prevention of seasonal influenza; the United Kingdom has a national influenza vaccination program to cover targeted population groups. Influenza vaccines are known to be associated with some common minor adverse events of interest (AEIs), but it is not known if the adjuvanted trivalent influenza vaccine (aTIV), first offered in the 2018/2019 season, would be associated with more AEIs than other types of vaccines. Objective We aim to compare the incidence of AEIs associated with different types of seasonal influenza vaccines offered in the 2018/2019 season. Methods We carried out a retrospective cohort study using computerized medical record data from the Royal College of General Practitioners Research and Surveillance Centre sentinel network database. We extracted data on vaccine exposure and consultations for European Medicines Agency–specified AEIs for the 2018/2019 influenza season. We used a self-controlled case series design; computed relative incidence (RI) of AEIs following vaccination; and compared the incidence of AEIs associated with aTIV, the quadrivalent influenza vaccine, and the live attenuated influenza vaccine. We also compared the incidence of AEIs for vaccinations that took place in a practice with those that took place elsewhere. Results A total of 1,024,160 individuals received a seasonal influenza vaccine, of which 165,723 individuals reported a total of 283,355 compatible symptoms in the 2018/2019 season. Most AEIs occurred within 7 days following vaccination, with a seasonal effect observed. Using aTIV as the reference group, the quadrivalent influenza vaccine was associated with a higher incidence of AEIs (RI 1.46, 95% CI 1.41-1.52), whereas the live attenuated influenza vaccine was associated with a lower incidence of AEIs (RI 0.79, 95% CI 0.73-0.83). No effect of vaccination setting on the incidence of AEIs was observed. Conclusions Routine sentinel network data offer an opportunity to make comparisons between safety profiles of different vaccines. Evidence that supports the safety of newer types of vaccines may be reassuring for patients and could help improve uptake in the future.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Gary Howsam
- Royal College of General Practitioners, London, United Kingdom
| | - Mark Joy
- University of Oxford, Oxford, United Kingdom
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339
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Holst J. [COVID-19: Special Challenges for Theoretical and Practical Public Health]. DAS GESUNDHEITSWESEN 2020; 82:829-835. [PMID: 33187002 DOI: 10.1055/a-1276-0847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The COVID 19 crisis offers unique opportunities and poses special challenges for practical and theoretical public health. Management of the pandemic was initially dominated by virologists, supported by epidemiologists who did not always exercise the necessary scientific rigour. Expertise in interdisciplinary health sciences and complex considerations from a broader public health perspective, however, did not have noticeable impact on the COVID 19 debate and even less on the strategies for containing the pandemic. Public health is universal and more than health security or health protection. As an explicitly political discipline, public health takes a far-reaching socio-political approach and must not be reduced to biomedical aspects. Medical and biotechnological solutions alone will not meet the challenges of the corona crisis. The analysis of the political, economic, social and ecological determinants that led to the crisis is indispensable for the sustainable management of the pandemic. In order to improve population health and reduce the risk of future outbreaks of dangerous infections, a comprehensive policy is needed that also addresses hegemonies and power relations.
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Affiliation(s)
- Jens Holst
- Fachbereich Pflege und Gesundheit, Hochschule Fulda, Fulda
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340
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Saffary T, Adegboye OA, Gayawan E, Elfaki F, Kuddus MA, Saffary R. Analysis of COVID-19 Cases' Spatial Dependence in US Counties Reveals Health Inequalities. Front Public Health 2020; 8:579190. [PMID: 33282812 PMCID: PMC7690561 DOI: 10.3389/fpubh.2020.579190] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/12/2020] [Indexed: 12/23/2022] Open
Abstract
On March 13, 2020, the World Health Organization (WHO) declared the 2019 coronavirus disease (COVID-19) caused by the novel coronavirus SARS-CoV2 a pandemic. Since then the virus has infected over 9.1 million individuals and resulted in over 470,000 deaths worldwide (as of June 24, 2020). Here, we discuss the spatial correlation between county population health rankings and the incidence of COVID-19 cases and COVID-19 related deaths in the United States. We analyzed the spread of the disease based on multiple variables at the county level, using publicly available data on the numbers of confirmed cases and deaths, intensive care unit beds and socio-demographic, and healthcare resources in the U.S. Our results indicate substantial geographical variations in the distribution of COVID-19 cases and deaths across the US counties. There was significant positive global spatial correlation between the percentage of Black Americans and cases of COVID-19 (Moran I = 0.174 and 0.264, p < 0.0001). A similar result was found for the global spatial correlation between the percentage of Black American and deaths due to COVID-19 at the county level in the U.S. (Moran I = 0.264, p < 0.0001). There was no significant spatial correlation between the Hispanic population and COVID-19 cases and deaths; however, a higher percentage of non-Hispanic white was significantly negatively spatially correlated with cases (Moran I = -0.203, p < 0.0001) and deaths (Moran I = -0.137, p < 0.0001) from the disease. This study showed significant but weak spatial autocorrelation between the number of intensive care unit beds and COVID-19 cases (Moran I = 0.08, p < 0.0001) and deaths (Moran I = 0.15, p < 0.0001), respectively. These findings provide more detail into the interplay between the infectious disease and healthcare-related characteristics of the population. Only by understanding these relationships will it be possible to mitigate the rate of spread and severity of the disease.
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Affiliation(s)
- T. Saffary
- Department of Mathematics, Engineering and Computer Science, Chemeketa Community College, Salem, OR, United States
| | - Oyelola A. Adegboye
- Evolution Equations Research Group, Ton Duc Thang University, Ho Chi Minh City, Vietnam
- Faculty of Mathematics and Statistics, Ton Duc Thang University, Ho Chi Minh City, Vietnam
| | - E. Gayawan
- Department of Statistics, Federal University of Technology, Akure, Nigeria
| | - F. Elfaki
- Department of Mathematics, Physics and Statistics, Qatar University, Doha, Qatar
| | - Md Abdul Kuddus
- Department of Mathematics, University of Rajshahi, Rajshahi, Bangladesh
| | - R. Saffary
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, United States
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341
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Greenhalgh T, Thompson P, Weiringa S, Neves AL, Husain L, Dunlop M, Rushforth A, Nunan D, de Lusignan S, Delaney B. What items should be included in an early warning score for remote assessment of suspected COVID-19? qualitative and Delphi study. BMJ Open 2020; 10:e042626. [PMID: 33184088 PMCID: PMC7662139 DOI: 10.1136/bmjopen-2020-042626] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To develop items for an early warning score (RECAP: REmote COVID-19 Assessment in Primary Care) for patients with suspected COVID-19 who need escalation to next level of care. METHODS The study was based in UK primary healthcare. The mixed-methods design included rapid review, Delphi panel, interviews, focus groups and software development. Participants were 112 primary care clinicians and 50 patients recovered from COVID-19, recruited through social media, patient groups and snowballing. Using rapid literature review, we identified signs and symptoms which are commoner in severe COVID-19. Building a preliminary set of items from these, we ran four rounds of an online Delphi panel with 72 clinicians, the last incorporating fictional vignettes, collating data on R software. We refined the items iteratively in response to quantitative and qualitative feedback. Items in the penultimate round were checked against narrative interviews with 50 COVID-19 patients. We required, for each item, at least 80% clinician agreement on relevance, wording and cut-off values, and that the item addressed issues and concerns raised by patients. In focus groups, 40 clinicians suggested further refinements and discussed workability of the instrument in relation to local resources and care pathways. This informed design of an electronic template for primary care systems. RESULTS The prevalidation RECAP-V0 comprises a red flag alert box and 10 assessment items: pulse, shortness of breath or respiratory rate, trajectory of breathlessness, pulse oximeter reading (with brief exercise test if appropriate) or symptoms suggestive of hypoxia, temperature or fever symptoms, duration of symptoms, muscle aches, new confusion, shielded list and known risk factors for poor outcome. It is not yet known how sensitive or specific it is. CONCLUSIONS Items on RECAP-V0 align strongly with published evidence, clinical judgement and patient experience. The validation phase of this study is ongoing. TRIAL REGISTRATION NUMBER NCT04435041.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Thompson
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Sietse Weiringa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ana Luisa Neves
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Laiba Husain
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Alexander Rushforth
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - David Nunan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Brendan Delaney
- Institute of Global Health Innovation, Imperial College London, London, UK
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342
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Griffith GJ, Morris TT, Tudball MJ, Herbert A, Mancano G, Pike L, Sharp GC, Sterne J, Palmer TM, Davey Smith G, Tilling K, Zuccolo L, Davies NM, Hemani G. Collider bias undermines our understanding of COVID-19 disease risk and severity. Nat Commun 2020; 11:5749. [PMID: 33184277 PMCID: PMC7665028 DOI: 10.1038/s41467-020-19478-2] [Citation(s) in RCA: 468] [Impact Index Per Article: 117.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/08/2020] [Indexed: 12/12/2022] Open
Abstract
Numerous observational studies have attempted to identify risk factors for infection with SARS-CoV-2 and COVID-19 disease outcomes. Studies have used datasets sampled from patients admitted to hospital, people tested for active infection, or people who volunteered to participate. Here, we highlight the challenge of interpreting observational evidence from such non-representative samples. Collider bias can induce associations between two or more variables which affect the likelihood of an individual being sampled, distorting associations between these variables in the sample. Analysing UK Biobank data, compared to the wider cohort the participants tested for COVID-19 were highly selected for a range of genetic, behavioural, cardiovascular, demographic, and anthropometric traits. We discuss the mechanisms inducing these problems, and approaches that could help mitigate them. While collider bias should be explored in existing studies, the optimal way to mitigate the problem is to use appropriate sampling strategies at the study design stage.
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Affiliation(s)
- Gareth J Griffith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Tim T Morris
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Matthew J Tudball
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Annie Herbert
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Giulia Mancano
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Lindsey Pike
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Gemma C Sharp
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Jonathan Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Tom M Palmer
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Kate Tilling
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Luisa Zuccolo
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Neil M Davies
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gibran Hemani
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
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343
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Rowland TAJ, Whitaker H, Jeffery-Smith A, Lang N, Sendall K, McLaren R, Brown KE, Ramsay M, Ladhani SN, Zambon M. Seropositivity and risk factors for SARS-CoV-2 infection in staff working in care homes during the COVID-19 pandemic. J Infect 2020; 82:84-123. [PMID: 33160012 PMCID: PMC7640892 DOI: 10.1016/j.jinf.2020.10.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 10/27/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Thomas A J Rowland
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Heather Whitaker
- Data and Analytical Sciences, National Infection Service, Public Health England, London, United Kingdom
| | - Anna Jeffery-Smith
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Nicola Lang
- Hammersmith and Fulham London Borough Council, London, United Kingdom
| | - Kate Sendall
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Rob McLaren
- Hammersmith and Fulham Partnership, London, United Kingdom
| | - Kevin E Brown
- Immunisations and Countermeasures Division, Public Health England, London, United Kingdom
| | - Mary Ramsay
- Immunisations and Countermeasures Division, Public Health England, London, United Kingdom
| | - Shamez N Ladhani
- Immunisations and Countermeasures Division, Public Health England, London, United Kingdom.
| | - Maria Zambon
- Virus Reference Department, Public Health England, London, United Kingdom
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344
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Affiliation(s)
- Ivan Berlin
- Department of Pharmacology, Hôpital Pitié-Salpêtrière-Sorbonne Université, Paris, France
- Centre Universitaire de Médecine Générale et Santé Publique, UNISANTE, Université de Lausanne Faculté de Biologie et Médecine, Lausanne, Switzerland
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345
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Moreno GK, Braun KM, Riemersma KK, Martin MA, Halfmann PJ, Crooks CM, Prall T, Baker D, Baczenas JJ, Heffron AS, Ramuta M, Khubbar M, Weiler AM, Accola MA, Rehrauer WM, O'Connor SL, Safdar N, Pepperell CS, Dasu T, Bhattacharyya S, Kawaoka Y, Koelle K, O'Connor DH, Friedrich TC. Revealing fine-scale spatiotemporal differences in SARS-CoV-2 introduction and spread. Nat Commun 2020; 11:5558. [PMID: 33144575 PMCID: PMC7609670 DOI: 10.1038/s41467-020-19346-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/06/2020] [Indexed: 12/25/2022] Open
Abstract
Evidence-based public health approaches that minimize the introduction and spread of new SARS-CoV-2 transmission clusters are urgently needed in the United States and other countries struggling with expanding epidemics. Here we analyze 247 full-genome SARS-CoV-2 sequences from two nearby communities in Wisconsin, USA, and find surprisingly distinct patterns of viral spread. Dane County had the 12th known introduction of SARS-CoV-2 in the United States, but this did not lead to descendant community spread. Instead, the Dane County outbreak was seeded by multiple later introductions, followed by limited community spread. In contrast, relatively few introductions in Milwaukee County led to extensive community spread. We present evidence for reduced viral spread in both counties following the statewide "Safer at Home" order, which went into effect 25 March 2020. Our results suggest patterns of SARS-CoV-2 transmission may vary substantially even in nearby communities. Understanding these local patterns will enable better targeting of public health interventions.
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Affiliation(s)
- Gage K Moreno
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Katarina M Braun
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Kasen K Riemersma
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael A Martin
- Population Biology, Ecology, and Evolution Graduate Program, Laney Graduate School, Emory University, Atlanta, GA, USA
- Department of Biology, Emory University, Atlanta, GA, USA
| | - Peter J Halfmann
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA
- Influenza Research Institute, School of Veterinary Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Chelsea M Crooks
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Trent Prall
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - David Baker
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - John J Baczenas
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Anna S Heffron
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Mitchell Ramuta
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Manjeet Khubbar
- City of Milwaukee Health Department Laboratory, Milwaukee, WI, USA
| | - Andrea M Weiler
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Molly A Accola
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- The William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - William M Rehrauer
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- The William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Shelby L O'Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Nasia Safdar
- Department of Medicine, Division of Infectious Diseases, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Caitlin S Pepperell
- Department of Medicine, Division of Infectious Diseases, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, WI, USA
| | - Trivikram Dasu
- City of Milwaukee Health Department Laboratory, Milwaukee, WI, USA
| | | | - Yoshihiro Kawaoka
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA
- Influenza Research Institute, School of Veterinary Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Katia Koelle
- Population Biology, Ecology, and Evolution Graduate Program, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - David H O'Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Thomas C Friedrich
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA.
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA.
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346
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de Lusignan S, Joy M, Oke J, McGagh D, Nicholson B, Sheppard J, Akinyemi O, Amirthalingam G, Brown K, Byford R, Dabrera G, Krajenbrink E, Liyanage H, LopezBernal J, Okusi C, Ramsay M, Sherlock J, Sinnathamby M, Tsang RSM, Tzortziou Brown V, Williams J, Zambon M, Ferreira F, Howsam G, Hobbs FDR. Disparities in the excess risk of mortality in the first wave of COVID-19: Cross sectional study of the English sentinel network. J Infect 2020; 81:785-792. [PMID: 32858068 PMCID: PMC7446615 DOI: 10.1016/j.jinf.2020.08.037] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 08/21/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Few studies report contributors to the excess mortality in England during the first wave of coronavirus disease 2019 (COVID-19) infection. We report the absolute excess risk (AER) of mortality and excess mortality rate (EMR) from a nationally representative COVID-19 sentinel surveillance network including known COVID-19 risk factors in people aged 45 years and above. METHODS Pseudonymised, coded clinical data were uploaded from contributing primary care providers (N = 1,970,314, ≥45years). We calculated the AER in mortality by comparing mortality for weeks 2 to 20 this year with mortality data from the Office for National Statistics (ONS) from 2018 for the same weeks. We conducted univariate and multivariate analysis including preselected variables. We report AER and EMR, with 95% confidence intervals (95% CI). RESULTS The AER of mortality was 197.8/10,000 person years (95%CI:194.30-201.40). The EMR for male gender, compared with female, was 1.4 (95%CI:1.35-1.44, p<0.00); for our oldest age band (≥75 years) 10.09 (95%CI:9.46-10.75, p<0.00) compared to 45-64 year olds; Black ethnicity's EMR was 1.17 (95%CI: 1.03-1.33, p<0.02), reference white; and for dwellings with ≥9 occupants 8.01 (95%CI: 9.46-10.75, p<0.00). Presence of all included comorbidities significantly increased EMR. Ranked from lowest to highest these were: hypertension, chronic kidney disease, chronic respiratory and heart disease, and cancer or immunocompromised. CONCLUSIONS The absolute excess mortality was approximately 2 deaths per 100 person years in the first wave of COVID-19. More personalised shielding advice for any second wave should include ethnicity, comorbidity and household size as predictors of risk.
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Affiliation(s)
- Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
| | - Jason Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
| | - Dylan McGagh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
| | - Brian Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
| | - James Sheppard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
| | - Oluwafunmi Akinyemi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
| | | | | | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
| | | | - Else Krajenbrink
- Royal College of General Practitioners, Euston Square, London NW1 2FB, UK.
| | - Harshana Liyanage
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
| | | | - Cecilia Okusi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
| | | | - Julian Sherlock
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
| | | | - Ruby S M Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
| | | | - John Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
| | | | - Filipa Ferreira
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
| | - Gary Howsam
- Royal College of General Practitioners, Euston Square, London NW1 2FB, UK.
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
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347
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Fisman DN, Greer AL, Hillmer M, Tuite R. Derivation and Validation of Clinical Prediction Rules for COVID-19 Mortality in Ontario, Canada. Open Forum Infect Dis 2020; 7:ofaa463. [PMID: 33204755 PMCID: PMC7650986 DOI: 10.1093/ofid/ofaa463] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/30/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently causing a high-mortality global pandemic. The clinical spectrum of disease caused by this virus is broad, ranging from asymptomatic infection to organ failure and death. Risk stratification of individuals with coronavirus disease 2019 (COVID-19) is desirable for management, and prioritization for trial enrollment. We developed a prediction rule for COVID-19 mortality in a population-based cohort in Ontario, Canada. METHODS Data from Ontario's provincial iPHIS system were extracted for the period from January 23 to May 15, 2020. Logistic regression-based prediction rules and a rule derived using a Cox proportional hazards model were developed and validated using split-halves validation. Sensitivity analyses were performed, with varying approaches to missing data. RESULTS Of 21 922 COVID-19 cases, 1734 with complete data were included in the derivation set; 1796 were included in the validation set. Age and comorbidities (notably diabetes, renal disease, and immune compromise) were strong predictors of mortality. Four point-based prediction rules were derived (base case, smoking excluded, long-term care excluded, and Cox model-based). All displayed excellent discrimination (area under the curve for all rules > 0.92) and calibration (P > .50 by Hosmer-Lemeshow test) in the derivation set. All performed well in the validation set and were robust to varying approaches to replacement of missing variables. CONCLUSIONS We used a public health case management data system to build and validate 4 accurate, well-calibrated, robust clinical prediction rules for COVID-19 mortality in Ontario, Canada. While these rules need external validation, they may be useful tools for management, risk stratification, and clinical trials.
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Affiliation(s)
- David N Fisman
- The Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Amy L Greer
- The Department of Population Medicine, University of Guelph, Ontario, Canada
| | - Michael Hillmer
- The Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- The Ontario Ministry of Health, Ontario, Canada
- The Dalla Lana School of Public Health, Ontario, Canada
| | - R Tuite
- The Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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348
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Zakeri R, Bendayan R, Ashworth M, Bean DM, Dodhia H, Durbaba S, O'Gallagher K, Palmer C, Curcin V, Aitken E, Bernal W, Barker RD, Norton S, Gulliford M, Teo JTH, Galloway J, Dobson RJB, Shah AM. A case-control and cohort study to determine the relationship between ethnic background and severe COVID-19. EClinicalMedicine 2020; 28:100574. [PMID: 33052324 PMCID: PMC7545271 DOI: 10.1016/j.eclinm.2020.100574] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND People of minority ethnic backgrounds may be disproportionately affected by severe COVID-19. Whether this relates to increased infection risk, more severe disease progression, or worse in-hospital survival is unknown. The contribution of comorbidities or socioeconomic deprivation to ethnic patterning of outcomes is also unclear. METHODS We conducted a case-control and a cohort study in an inner city primary and secondary care setting to examine whether ethnic background affects the risk of hospital admission with severe COVID-19 and/or in-hospital mortality. Inner city adult residents admitted to hospital with confirmed COVID-19 (n = 872 cases) were compared with 3,488 matched controls randomly sampled from a primary healthcare database comprising 344,083 people residing in the same region. For the cohort study, we studied 1827 adults consecutively admitted with COVID-19. The primary exposure variable was self-defined ethnicity. Analyses were adjusted for socio-demographic and clinical variables. FINDINGS The 872 cases comprised 48.1% Black, 33.7% White, 12.6% Mixed/Other and 5.6% Asian patients. In conditional logistic regression analyses, Black and Mixed/Other ethnicity were associated with higher admission risk than white (OR 3.12 [95% CI 2.63-3.71] and 2.97 [2.30-3.85] respectively). Adjustment for comorbidities and deprivation modestly attenuated the association (OR 2.24 [1.83-2.74] for Black, 2.70 [2.03-3.59] for Mixed/Other). Asian ethnicity was not associated with higher admission risk (adjusted OR 1.01 [0.70-1.46]). In the cohort study of 1827 patients, 455 (28.9%) died over a median (IQR) of 8 (4-16) days. Age and male sex, but not Black (adjusted HR 1.06 [0.82-1.37]) or Mixed/Other ethnicity (adjusted HR 0.72 [0.47-1.10]), were associated with in-hospital mortality. Asian ethnicity was associated with higher in-hospital mortality but with a large confidence interval (adjusted HR 1.71 [1.15-2.56]). INTERPRETATION Black and Mixed ethnicity are independently associated with greater admission risk with COVID-19 and may be risk factors for development of severe disease, but do not affect in-hospital mortality risk. Comorbidities and socioeconomic factors only partly account for this and additional ethnicity-related factors may play a large role. The impact of COVID-19 may be different in Asians. FUNDING British Heart Foundation; the National Institute for Health Research; Health Data Research UK.
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Affiliation(s)
- Rosita Zakeri
- School of Cardiovascular Medicine and Sciences, James Black Centre, King's College London British Heart Foundation Centre, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Rebecca Bendayan
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK
| | - Mark Ashworth
- School of Population Health and Environmental Sciences, King's College London, UK
| | - Daniel M Bean
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Hiten Dodhia
- School of Population Health and Environmental Sciences, King's College London, UK
| | - Stevo Durbaba
- School of Population Health and Environmental Sciences, King's College London, UK
| | - Kevin O'Gallagher
- School of Cardiovascular Medicine and Sciences, James Black Centre, King's College London British Heart Foundation Centre, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Claire Palmer
- King's College Hospital NHS Foundation Trust, London, UK
| | - Vasa Curcin
- School of Population Health and Environmental Sciences, King's College London, UK
| | | | - William Bernal
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - Sam Norton
- Centre for Rheumatic Disease, School of Immunology and Microbial Sciences, King's College London, UK
| | - Martin Gulliford
- School of Population Health and Environmental Sciences, King's College London, UK
| | - James T H Teo
- King's College Hospital NHS Foundation Trust, London, UK
| | - James Galloway
- Centre for Rheumatic Disease, School of Immunology and Microbial Sciences, King's College London, UK
| | - Richard J B Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Health Data Research UK London, Institute of Health Informatics, University College London, UK
| | - Ajay M Shah
- School of Cardiovascular Medicine and Sciences, James Black Centre, King's College London British Heart Foundation Centre, 125 Coldharbour Lane, London SE5 9NU, UK
- King's College Hospital NHS Foundation Trust, London, UK
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349
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Popkin BM, Du S, Green WD, Beck MA, Algaith T, Herbst CH, Alsukait RF, Alluhidan M, Alazemi N, Shekar M. Individuals with obesity and COVID-19: A global perspective on the epidemiology and biological relationships. Obes Rev 2020; 21:e13128. [PMID: 32845580 PMCID: PMC7461480 DOI: 10.1111/obr.13128] [Citation(s) in RCA: 670] [Impact Index Per Article: 167.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 12/11/2022]
Abstract
The linkage of individuals with obesity and COVID-19 is controversial and lacks systematic reviews. After a systematic search of the Chinese and English language literature on COVID-19, 75 studies were used to conduct a series of meta-analyses on the relationship of individuals with obesity-COVID-19 over the full spectrum from risk to mortality. A systematic review of the mechanistic pathways for COVID-19 and individuals with obesity is presented. Pooled analysis show individuals with obesity were more at risk for COVID-19 positive, >46.0% higher (OR = 1.46; 95% CI, 1.30-1.65; p < 0.0001); for hospitalization, 113% higher (OR = 2.13; 95% CI, 1.74-2.60; p < 0.0001); for ICU admission, 74% higher (OR = 1.74; 95% CI, 1.46-2.08); and for mortality, 48% increase in deaths (OR = 1.48; 95% CI, 1.22-1.80; p < 0.001). Mechanistic pathways for individuals with obesity are presented in depth for factors linked with COVID-19 risk, severity and their potential for diminished therapeutic and prophylactic treatments among these individuals. Individuals with obesity are linked with large significant increases in morbidity and mortality from COVID-19. There are many mechanisms that jointly explain this impact. A major concern is that vaccines will be less effective for the individuals with obesity.
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Affiliation(s)
- Barry M. Popkin
- Health, Nutrition and Population Global PracticeThe World BankWashington, D.C.USA
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Shufa Du
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - William D. Green
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Melinda A. Beck
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | | | | | - Reem F. Alsukait
- Health, Nutrition and Population Global PracticeThe World BankWashington, D.C.USA
- Community Health SciencesKing Saud UniversityRiyadhKingdom of Saudi Arabia
| | | | | | - Meera Shekar
- Health, Nutrition and Population Global PracticeThe World BankWashington, D.C.USA
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350
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Islam MZ, Riaz BK, Islam ANMS, Khanam F, Akhter J, Choudhury R, Farhana N, Jahan NA, Uddin MJ, Efa SS. Risk factors associated with morbidity and mortality outcomes of COVID-19 patients on the 28th day of the disease course: a retrospective cohort study in Bangladesh. Epidemiol Infect 2020. [PMID: 33115547 DOI: 10.1101/10.1101/2020.08.17.20176586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Diverse risk factors intercede the outcomes of coronavirus disease 2019 (COVID-19). We conducted this retrospective cohort study with a cohort of 1016 COVID-19 patients diagnosed in May 2020 to identify the risk factors associated with morbidity and mortality outcomes. Data were collected by telephone-interview and reviewing records using a questionnaire and checklist. The study identified morbidity and mortality risk factors on the 28th day of the disease course. The majority of the patients were male (64.1%) and belonged to the age group 25-39 years (39.4%). Urban patients were higher in proportion than rural (69.3% vs. 30.7%). Major comorbidities included 35.0% diabetes mellitus (DM), 28.4% hypertension (HTN), 16.6% chronic obstructive pulmonary disease (COPD), and 7.8% coronary heart disease (CHD). The morbidity rate (not-cured) was 6.0%, and the mortality rate (non-survivor) was 2.5%. Morbidity risk factors included elderly (AOR = 2.56, 95% CI = 1.31-4.99), having comorbidity (AOR = 1.43, 95% CI = 0.83-2.47), and smokeless tobacco use (AOR = 2.17, 95% CI = 0.84-5.61). The morbidity risk was higher with COPD (RR = 2.68), chronic kidney disease (CKD) (RR = 3.33) and chronic liver disease (CLD) (RR = 3.99). Mortality risk factors included elderly (AOR = 7.56, 95% CI = 3.19-17.92), having comorbidity (AOR = 5.27, 95% CI = 1.88-14.79) and SLT use (AOR = 1.93, 95% CI = 0.50-7.46). The mortality risk was higher with COPD (RR = 7.30), DM (RR = 2.63), CHD (RR = 4.65), HTN (RR = 3.38), CKD (RR = 9.03), CLD (RR = 10.52) and malignant diseases (RR = 9.73). We must espouse programme interventions considering the morbidity and mortality risk factors to condense the aggressive outcomes of COVID-19.
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Affiliation(s)
- M Z Islam
- Department of Community Medicine, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka1212, Bangladesh
| | - B K Riaz
- Department of Public Health and Hospital Administration, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka1212, Bangladesh
| | - A N M S Islam
- Department of Public Health and Hospital Administration, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka1212, Bangladesh
| | - F Khanam
- Department of Parasitology, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka1212, Bangladesh
| | - J Akhter
- Department of Microbiology and Mycology, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka1212, Bangladesh
| | - R Choudhury
- Department of Microbiology and Mycology, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka1212, Bangladesh
| | - N Farhana
- Department of Microbiology and Mycology, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka1212, Bangladesh
| | - N A Jahan
- Department of Nutrition and Biochemistry, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka1212, Bangladesh
| | - M J Uddin
- Department of Microbiology and Mycology, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka1212, Bangladesh
| | - S S Efa
- Department of Community Medicine, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka1212, Bangladesh
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