ABSTRACT
Background: Social distancing measures introduced during the COVID-19 pandemic have reduced admission rates for a variety of respiratory tract infections. We hypothesized that rates of asthma exacerbations would decline following the national lockdown introduced on March 12, 2020, in Denmark. Aim(s): To determine weekly rates of in- and out of hospital asthma exacerbations prior to and during the national lockdown. Method(s): All persons >18 years with at least one outpatient hospital contact with asthma as the primary diagnosis from January 1, 2013, to December 31, 2017, were included. Weekly asthma exacerbation rates from January 1, 2018, to May 22, 2020, were assessed. An interrupted time-series (ITS model) with March 12, 2020, as the point of interruption was conducted. Result(s): A total of 38,225 patients with asthma were identified. The ITS model showed no immediate changes in exacerbation rates during the first week after March 12, 2020. However, there was a significant decrease in weekly exacerbation rates in the following 10 weeks (change in trend for exacerbations requiring hospitalisation: -0.75 [95% CI -1.39,-0.12], (p < 0.02) corresponding to a reduction of about 1 exacerbation per year per 100 patients in the cohort, and a change in trend for all asthma exacerbations: -12.2 [95% CI -19.1,-5.4], p<0.001 corresponding to a reduction of 16.5 exacerbations per year per 100 patients in the cohort). Conclusion(s): The introduction of the social distancing measures in Denmark on March 12, 2020, did not lead to an immediate reduction in asthma exacerbation rates, however a gradual decline in exacerbation rates during the following 10-weeks period was observed.
ABSTRACT
Background: Venous thromboembolia have been reported in patients with COVID-19. However, it remains unclear if COVID-19 patients who, for other indications, take anti-coagulant medication on a regular basis, are protected against thrombosis-mediated death. The aim of this study was to estimate the risk of all-cause mortality, hospital admission, and intensive care unit (ICU) admission for verified COVID-19 patients who did vs. did not use oral anticoagulant therapy (OAC). Method(s): Data was obtained by using national registries. Patients were followed for 90 days or until death or hospital admission. An adjusted Cox proportional hazard regression was used to estimate the risk of all-cause mortality, hospital admission and ICU admission. Result(s): A total of 243,039 confirmed COVID-19 patients were included in the study (mean age 35 years;123,448 [50.79%] male), among whom 4,482 were OAC users. We observed an increased risk of all-cause mortality (HR 1.12, 95% CI 1.011-1.24, p=0.015) and hospital admission (HR 1.22, 95% CI 1.13-1.31, p<0.0001) in OAC users. Among admitted patients, however, we observed a decreased risk of ICU admission (HR 0.78, 95% CI 0.63-0.96, p=0.02) in OAC users. Conclusion(s): OAC was not associated with a lower risk of death or hospital admission, but our data support that hospitalized patients without anticoagulant treatment, may be at increased risk of respiratory deterioration and need for intensive care admission.
ABSTRACT
Background: Patients with bronchiectasis are at high risk of community acquired pneumonia. It remains unclear if this risk is reduced by social distancing (SD) measures. Method(s): Nationwide registry study with data from patients with specialist verified bronchiectasis between 1 January 2019 and 20 May 2020. Pneumonia hospitalisation was the primary outcome. Patients with COVID-19 and age < 18 were excluded. The incidence of pneumonia hospitalisations in the SD period (12 March 2020 to 20 May 2020) was compared to the same period in 2019 (control period). Result(s): A total of 672 patients with bronchiectasis were followed in the SD period and the control period. Median age was 68, and 36% were males. During the SD intervention, 7 incidents of pneumonia hospitalisation were observed, compared to 31 during the control period (Fig. 1). The corresponding incidence rate ratio was 0.24 (95% confidence interval: 0.17 to 0.33, p < 0.001). 6/642 (0.9%) patients died during the SD period compared to 8/672 (1.2%) during control period (p = 0.9). Conclusion(s): The social distancing intervention was associated with a substantially lower incidence of pneumoniahospitalizations among patients with bronchiectasis. Hygienic measures as used during SD are important in preventing serious life-threatening infections like pneumonias that require hospitalisation.
ABSTRACT
Background: Large randomized controlled trials (RCT) have shown that COVID-19 vaccines are effective at preventing severe COVID-19. However, the RCT's are not powered to detect rare adverse events. It has been reported that the new mRNA based COVID-19 vaccines may increase the risk of thromboembolic and ischemic events. Likewise, thromboembolic and ischemic events are also known complications to infection with SARS-CoV-19. Currently, less is known about the risk-reward relationship of receiving an mRNA-based COVID-19 vaccine versus contracting COVID-19 infection with respect to thromboembolic and ischemic outcomes. Purpose: To compare the risk of thromboembolic and ischemic events following COVID-19 vaccination to the risk following infection with SARS-CoV-19. Methods: The study period was from March 2020 to August 2021. All individuals were >18 years old. The population was stratified into two different groups. The vaccinated group consisted of recipients of the first dose of either Moderna (mRNA-1273, n=488,220) or Pfizer-BioNTech (BNT162b2 mRNA, n=3,186,164) vaccines. Individuals who had previously tested positive for SARS-CoV-19 were excluded. The other group consisted of individuals who had tested positive for SARS-CoV-19 in the same period who had not yet received their first vaccination dose (n=233,926). The exposure period for both groups was set to 28 days following vaccination/testing positive for SARS-CoV-19 (Figure 1). Patient level data were obtained on all included individuals using nationwide registries. Primary outcomes were acute myocardial infarction (AMI), ischemic stroke, pulmonary embolism (PE), and deep venous thrombosis (DVT). Odds ratios were obtained from logistic regression models with the vaccinated group acting as reference. Multivariable models were adjusted for demographics and comorbidities. Results: In the vaccinated group, mean age was 53±19 years and 50.3% were female. In the group of participants testing positive for SARS-CoV-19, mean age was 42.1±17.4 years and 50.2% were female. In total, 773 suffered a stroke, 472 suffered a PE, 500 suffered an AMI, and 484 suffered a DVT during the 28-day exposure period. We observed an increased absolute risk of all outcomes for participants testing positive for SARS-CoV-19 as compared to participants being vaccinated (stroke: 0.049% vs 0.019%, p<0.001), (PE: 0.91% vs 0.0072%, p<0.001), (AMI: 0.021 vs 0.013, p=0.0004), and (DVT: 0.037% vs 0.011%, p<0.001). In multivariable models, participants testing positive for SARS-CoV-19 had a significantly increased risk of all outcomes compared to participants being vaccinated: (stroke: OR: 4.0, 95% CI: [2.9–5.6], p<0.001), (PE: OR: 38.6 95% CI: [30.3–48.5], p<0.001), (AMI: OR: 3.3, 95% CI: [2.1–5.00], p<0.001), and (DVT: OR: 5.3, 95% CI: [3.8–7.5], p<0.001) (Figure 2). Conclusion: The risks of thromboembolic and ischemic events were substantially higher after SARS-CoV-19 infection than after vaccination in the Danish population. Funding Acknowledgement: Type of funding sources: Public hospital(s). Main funding source(s): Gentofte University HospitalFigure 1Figure 2