COVID-19 Disease Severity among People with HIV Infection or Solid Organ Transplant in the United States: A Nationally-representative, Multicenter, Observational Cohort Study (preprint)

Background Individuals with immune dysfunction, including people with HIV (PWH) or solid organ transplant recipients (SOT), might have worse outcomes from COVID-19. We compared odds of COVID-19 outcomes between patients with and without immune dysfunction. Methods We evaluated data from the National COVID-19 Cohort Collaborative (N3C), a multicenter retrospective cohort of electronic medical record (EMR) data from across the United States, on. 1,446,913 adult patients with laboratory-confirmed SARS-CoV-2 infection. HIV, SOT, comorbidity, and HIV markers were identified from EMR data prior to SARS-CoV-2 infection. COVID-19 disease severity within 45 days of SARS-CoV-2 infection was classified into 5 categories: asymptomatic/mild disease with outpatient care; mild disease with emergency department (ED) visit; moderate disease requiring hospitalization; severe disease requiring ventilation or extracorporeal membrane oxygenation (ECMO); and death. We used multivariable, multinomial logistic regression models to compare odds of COVID-19 outcomes between patients with and without immune dysfunction. Findings Compared to patients without immune dysfunction, PWH and SOT had a greater likelihood of having ED visits (adjusted odds ratio [aOR]: 1.28, 95% confidence interval [CI] 1.27-1.29; aOR: 2.61, CI: 2.58-2.65, respectively), requiring ventilation or ECMO (aOR: 1.43, CI: 1.43-1.43; aOR: 4.82, CI: 4.78-4.86, respectively), and death (aOR: 1.20, CI: 1.19-1.20; aOR: 3.38, CI: 3.35-3.41, respectively). Associations were independent of sociodemographic and comorbidity burden. Compared to PWH with CD4>500 cells/mm3, PWH with CD4<350 cells/mm3 were independently at 4.4-, 5.4-, and 7.6-times higher odds for hospitalization, requiring ventilation, and death, respectively. Increased COVID-19 severity was associated with higher levels of HIV viremia. Interpretation Individuals with immune dysfunction have greater risk for severe COVID-19 outcomes. More advanced HIV disease (greater immunosuppression and HIV viremia) was associated with higher odds of severe COVID-19 outcomes. Appropriate prevention and treatment strategies should be investigated to reduce the higher morbidity and mortality associated with COVID-19 among PWH and SOT.

The incubation period of 2019-nCoV from publicly reported confirmed cases: estimation and application (preprint)

A novel human coronavirus (2019-nCoV) was identified in China in December, 2019. There is limited support for many of its key epidemiologic features, including the incubation period, which has important implications for surveillance and control activities. Here, we use data from public reports of 101 confirmed cases in 38 provinces, regions, and countries outside of Wuhan (Hubei province, China) with identifiable exposure windows and known dates of symptom onset to estimate the incubation period of 2019-nCoV. We estimate the median incubation period of 2019-nCoV to be 5.2 days (95% CI 4.4-6.0), and 97.5% of those who develop symptoms will do so within 10.5 days (95% CI: 7.3, 15.3) of infection. These estimates imply that, under conservative assumptions, 64 out of every 10,000 cases will develop symptoms after 14 days of active monitoring or quarantine. Whether this risk is acceptable depends on the underlying risk of infection and consequences of missed cases. The estimates presented here can be used to inform policy in multiple contexts based on these judgments.