To What Extent do Social Determinants of Health Modulate Presentation, ITU Admission and Outcomes among Patients with SARS-COV-2 Infection? An Exploration of Household Overcrowding, Air Pollution, Housing Quality, Ethnicity, Comorbidities and Frailty.

Background: Internationally, researchers have called for evidence to support tackling health inequalities during the severe acute respiratory syndrome coronavirus 2 (COVID19) pandemic. Despite the 2020 Marmot review highlighting growing health gaps between wealthy and deprived areas, studies have not explored social determinants of health (ethnicity, frailty, comorbidities, household overcrowding, housing quality, air pollution) as modulators of presentation, intensive care unit (ITU) admissions and outcomes among COVID19 patients. There is an urgent need for studies examining social determinants of health including socioenvironmental risk factors in urban areas to inform the national and international landscape. Methods: An in-depth retrospective cohort study of 408 hospitalized COVID19 patients admitted to the Queen Elizabeth Hospital, Birmingham was conducted. Quantitative data analyses including a two-step cluster analysis were applied to explore the role of social determinants of health as modulators of presentation, ITU admission and outcomes. Results: Patients admitted from highest Living Environment deprivation indices were at increased risk of presenting with multi-lobar pneumonia and, in turn, ITU admission whilst patients admitted from highest Barriers to Housing and Services (BHS) deprivation Indies were at increased risk of ITU admission. Black, Asian and Minority Ethnic (BAME) patients were more likely, than Caucasians, to be admitted from regions of highest Living Environment and BHS deprivation, present with multi-lobar pneumonia and require ITU admission. Conclusion: Household overcrowding deprivation and presentation with multi-lobar pneumonia are potential modulators of ITU admission. Air pollution and housing quality deprivation are potential modulators of presentation with multi-lobar pneumonia. BAME patients are demographically at increased risk of exposure to household overcrowding, air pollution and housing quality deprivation, are more likely to present with multi-lobar pneumonia and require ITU admission. Irrespective of deprivation, consideration of the Charlson Comorbidity Score and the Clinical Frailty Score supports clinicians in stratifying high risk patients.

Dysfunctional neutrophil response in COVID-19 infection vary by subtype

S94 Figure 1Comparison of neutrophil effector functions between COVID-19 variants (alpha n=33, delta n=13, omicron n-14). A.% change in phagocytosis significantly increased between alpha and delta patients (p=0.0162). B. Fold change in cells migrated through a transwell pore to IL8 compared to vehicle control significantly reduced in omicron patients compared alpha and delta (vs alpha p=0.0018, vs delta p=0.0370). C. Neutrophil extracellular trap production after stimulation with PMA compared to vehicle control significantly reduced in omicron patients compared to alpha (p=0.0396)[Figure omitted. See PDF]DiscussionOur results showing changes in neutrophil „function and phenotype differ between variants of COVID-19 infection, potentially reflect viral evolution. This change in neutrophil function may contribute to the evolving clinical phenotype observed in patients. Our population of ward-based COVID-19 patients represents the majority of inpatient hospital burden where early intervention may prevent clinical deterioration. Targeting neutrophil function may be an effective way of improving infection outcome in the future.ReferenceBelchamber K, et al. Altered neutrophil phenotype and function in non-ICU hospitalised COVID-19 patients correlated with disease severity. medRxiv, 2021: p. 2021.06.08.21258535.

Association between vitamin D deficiency and extended duration of COVID-19 symptoms

Introduction and ObjectivesVitamin D (VD) is involved in immunity and inflammation through mechanisms such as renin inhibition and inflammatory cytokine reduction. There is already evidence to suggest that VDD may increase COVID-19 infection susceptibility, however research assessing the impact of VDD on COVID-19 symptom duration is limited. The aim of this research was to determine whether VDD is a significant independent risk factor for extended durations of COVID-19 symptoms.MethodsThe study included 392 healthcare workers who isolated due to COVID-19 symptoms during the first wave of the pandemic (12th to 22nd May 2020) as part of the convalescent immunity (COCO) study. Data on 8 symptom types and duration of symptoms were collected, including patients’ demographics and co-morbidities. Anti-SARS-Cov-2 antibodies were measured using a combined IgG, IgA and IgM ELISA (The Binding Site). Vitamin D status was determined by measurement of serum 25(OH)D3 using the AB SCIEX Triple Quad 4500 mass spectrometry system. VDD was defined as serum 25(OH)D3 <30 nmol/L.ResultsThrough univariate analysis of VDD and non-VDD staff, we initially showed VDD to be significantly associated with longer durations of body aches (median 7 days, IQR 5–14 vs. median 5 days, IQR 3–7.5;p=0.0075) and fatigue (median 12 days, IQR 7–14 vs. median 7 days, IQR 4–14;p=0.0127). VDD did not influence the duration of the other 6 symptoms analysed, such as cough and fever. Using binary logistic regression models, we confirm that VDD is a significant independent risk factor for extended durations of fatigue (OR 2.089, 95% CI 1.087–4.011;p=0.027) and body aches (OR 3.069, 95% CI 1.538–6.124;p=0.001). Additionally, VDD staff experienced a significantly greater quantity of symptoms compared to non-VDD staff (median 5, IQR 4–7 versus median 4, IQR 3–6;p=0.0030).ConclusionsThis is one of the first studies to investigate the influence of VDD on COVID-19 symptom duration. Our results indicate that VDD is a significant independent risk factor for a longer duration of body aches and fatigue. Larger studies are required to confirm these results and determine if VD supplementation could shorten symptoms.

Increased mortality of hospitalised community acquired pneumonia in winter 2020/21 compared to 2019/20

IntroductionCommunity acquired pneumonia is a leading cause of admission to hospital during the winter months. In the winter of 2020–21 the United Kingdom remained under social distancing measures to limit transmission of COVID-19. These measures should also limit transmission of other respiratory pathogens and therefore reduce admission to hospital. Work to date has demonstrated reduced hospital attendances. We aimed to investigate whether hospitalised cases of non-COVID-19 community acquired pneumonia differed between winter 2019–20 and winter 2020–21.MethodsCommunity acquired pneumonia hospital admissions were compared between 01/09/2019–31/01/2020 and 01/09/2020–31/01/2021 using Pioneer the Health Data Research Hub in Acute Care. Data were collected to compare demographics, severity, complications, and outcomes. Cases were identified using ICD coding. For the winter 20–21 cohort, all cases had a negative COVID PCR on admission to hospital.ResultsAdmissions fell by 16% in the 20/21 time period with 2073 admissions in 19/20 and 1757 in 20/21. The median age of cases was similar across both timepoints (74 in 19/20 and 72 in 20/21). Length of stay was similar between the two timepoints. However, mortality significantly increased from 13.5% in 19/20 to 21.6% in 20/21 (p<0.001). Admission to ICU did not change significantly during the time periods (21.2 vs. 24.6%).ConclusionWe demonstrate that changes in social distancing guidance impacts non COVID CAP in keeping with other studies. The increased mortality seen in winter 20/21 is likely multi-factorial but may be related to perceived reduced access to healthcare by patients resulting in delayed treatment. Additionally, we show that intensive care admission was unchanged despite the increased mortality and therefore severity of cases, suggesting that accessing critical care may have been more challenging in the winter of 20/21 than previous years. Further analyses to characterise the difference in cases and understand increase in mortality are underway.