ABSTRACT
Background. The COVID-19 pandemic continually challenges the scientific community to develop and evaluate viable treatments. In May 2020, remdesivir became the first medication to receive emergency use authorization for the treatment of COVID-19, while dexamethasone became standard of care for patients requiring supplementary oxygen in late 2020. Methods. This was a retrospective observational study of hospitalized adult patients with confirmed coronavirus disease 2019 (COVID-19) admitted in the first wave (3/2020-7/2020) and second wave (10/2020-1/2021) at Cook County Hospital. Variables on demographic, clinical data and outcomes were extracted from the EMR. The measured intervention was use of dexamethasone with remdesivir during the second wave;patients were matched by age and diabetic status to patients in the first wave who had received only remdesivir. The primary outcome was mortality;secondary outcomes were ICU admission and intubation. Conditional logistic regression was used to examine associations between use of dexamethasone and each outcome, controlling for glucose levels, use of remdesivir and severity of disease. Results. 621 patients were admitted in the first wave (3/2020-7/2020) versus 355 in the second wave (12/2020-1/2021). Median age was 55 years and 56 years, respectively. Most patients were Hispanic and Black. In the first wave, 296 patients (48%) were admitted with severe COVID-19 (defined as oxygen saturation on room air at or below 94%) versus 163 patients (46%) in the second wave. Logistic regression showed no association between use of dexamethasone and ICU admission, mortality or intubation. Use of remdesivir showed no association with any of the outcomes. Glucose and severe/critical disease were strongly associated with ICU admission (p=0.01 and p=0.003) and mortality (p=0.06 for both). Conclusion. Despite promising medications, in this study the mortality and disease severity of COVID-19 was very similar to that seen in the first wave. This could be due to patients presenting with more advanced disease and undiagnosed or poorlycontrolled comorbidities that may offset the potential benefit of these treatments. Enhancing access to care and decreasing health inequalities may be more worthwhile than finding a 'miracle drug'.
ABSTRACT
Background: In the U.S/Mexico border region, drug tourism (DT) has been linked to increased HIV risk among people who inject drugs (sharing injection equipment) and paying for sex. Sex and DT from the U.S. to Mexico drive bidirectional cross-border mobility, and have consequently played an important role in HIV spread in the border region, but prior to the COVID19 pandemic, HIV incidence remained <2 per 100 person years (PY). We assessed HIV incidence and associated risk factors among PWID during the COVID-19 pandemic. Methods: Participants are from La Frontera, a longitudinal study of PWID aged ≥18 from 3 groups: PWID who injected drugs in Tijuana ≤24 months ago but live in San Diego (SD DTs), and non-drug tourist (NDT) PWID, who live in SD county or Tijuana (TJ) but have never used illicit drugs across the border. Beginning in Oct/2020, participants underwent surveys and provided samples for HIV and SARS-CoV-2 serology every 6 months, and an egocentric social network (SN) survey. HIV prevalence, bivariate incidence-density rates, incident rate-ratios (IRR), and exact 95% confidence intervals (CI) were calculated for independent variables between baseline and follow-up. Results: To date, among 611 participants at baseline, HIV prevalence was 7.6% (SD DT: 3.8%, SD NDT: 3.5%, TJ NDT: 15.8%). Of the HIV-PWID returning for their 6 months visit thus far (n=286;93% follow-up), eight HIV seroconversions occurred during 118 PY of follow-up (Incidence: 13.53/100PY;95% CI: 5.84-26.66). Although not significant, incidence was notably higher among TJ NDT (19.9/100PY vs 1.82/100 PY SD DT vs 0 SD NDT;IRR 10.94, 95% CI 0.35, 22.59 TJ NDT vs SD DT), those who shared syringes/works with a network member (30.34/100PY vs. 7.31/100PY;IRR 4.15, 95% CI 0.37,9.19) and non-heterosexual participants (29.31/100PY vs 5.38/100PY;IRR 4.67, 95% CI 0.39, 9.67). Conclusion: Preliminary HIV incidence rates among PWID in the U.S./Mexico border region during the pandemic are high, and suggest a new HIV outbreak among PWID residing in TJ. Mobile harm reduction services providing syringes and HIV testing, as well as coordination with the municipal HIV program to allow for ART initiation and PrEP are urgently needed to prevent a continuing outbreak.