ABSTRACT
Background: As the COVID-19 pandemic continues, there are questions about whether patients with celiac disease (CD) are at increased risk for severe outcomes. Prior studies have shown that patients with CD have a higher risk of developing zoster and complications from influenza and pneumococcal pneumonia, risks that persist after adoption of the gluten free diet. To study the outcomes of COVID-19 in patients with celiac disease, we created a secure, online, de-identified adult and pediatric reporting registry. Methods: The SECURECeliac registry (www.covidceliac.org) was established on March 31, 2020 and promoted via physician email lists, national societies, and word-of-mouth. Clinicians worldwide are encouraged to report all cases of COVID-19 in patients with celiac disease, regardless of severity. (Only confirmed cases of COVID-19, either through viral PCR swab or serology testing, are eligible to be reported in the registry.) Clinicians were counseled to report confirmed cases only after a minimum of 7 days and sufficient time had passed to observe the disease course through resolution of acute illness or death. A choropleth map to illustrate geographic differences in reported cases of COVID-19 in those with CD was created using QGIS and an interactive online website was created using ARCGIS to visualize current data by time, country, age, sex, hospitalizations, and deaths. Results: Between March 31, 2020 and November 20, 2020, there have been 84 cases of COVID-19 reported in patients with celiac disease. Countries across five continents are represented in the registry: Asia, Australia, Europe, North America and South America (Figure 1). 86% of patients (N = 72) did not require hospitalization for COVID-19 while 14% did (N = 12). 1% of patients (N = 1) required ICU-level care while 1% of patients (N = 1) died from COVID-19. Patients who were hospitalized tended to be older (45.8y vs 39.4y, p= 0.2) and have at least one comorbidity (50.0% vs 31.9%, p= 0.3). Patients who were hospitalized were also less likely to adhere to a strict gluten-free diet (41.7% vs 65.3%, p=0.2). Patients with gastrointestinal symptoms were more likely to be hospitalized (66.7% vs 31.9%, p = 0.03). An online dashboard with interactive map displaying the current global distribution of patients with CD and COVID-19 is found here: www.covidceliac.org/map Conclusions: Preliminary data from the SECURECeliac registry does not suggest increased risk of severe outcomes in patients with celiac disease who contract COVID-19. Gastrointestinal symptoms were associated with hospitalization for COVID-19. The registry remains open for clinicians to contribute to this reporting system so as to better define the impact of COVID-19 on patients with celiac disease and how factors such as age, comorbidities, and treatments impact COVID-19 outcomes.(Image Presented)(Table Presented)
ABSTRACT
Background: Cases of Coronavirus disease 2019 (COVID-19) have emerged in discrete waves across different regions in the world. We explored temporal trends in the reporting of COVID-19 in patients with inflammatory bowel disease (IBD), in a large global database. Methods: The Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) is an international registry to study the character-istics and outcomes of patients with IBD diagnosed with COVID-19. Joinpoint regression models calculated the average percent change (APC) with 95% confidence intervals (CI) in weekly reported cases of COVID-19 in patients in the registry stratified by geographic regions (Asia, Europe, Latin America, and North America) during two time periods: March 22 to September 12 and September 13 to November 14, 2020. We also determined the APC in US regions (Midwest, Northeast, South and West) during the two time periods. Results: Across 63 countries and dependencies, 3,195 cases of COVID-19 in people with IBD were reported over an 8-month period. Overall, COVID-19 reporting steadily decreased throughout the world by 4.5% per week (95% CI: −5.7, −3.2) from March 22 to September 12, 2020 but then steadily climbed by 12.4% per week (95% CI: 6.8, 18.3) from September 13 to November 14, 2020. After stratification by geographic region, weekly reporting declined before September 13 in North America (APC = −2.0%;95% CI: −3.7, −0.4), Asia (APC =− 4.4%;95% CI: −7.8, −0.9), and Europe (APC = −8.6%;95% CI: −10.6, −6.6), but escalated in Latin America (APC = 3.4%;95% CI: 0.7, 6.1) (Figure 1). After September 12, the rate of weekly cases decreased in Latin America (APC = −19.0%;95% CI: −33.3, −1.7) and Asia (APC = −19.3%;95% CI: −34.6, −0.5), while increased in North America (APC = 10.7%;95% CI: 4.3, 17.4) and Europe (APC = 28.0%;95% CI: 17.3, 39.6) (Figure 1). Within the US, temporal trends differed by region: Midwest (stable APC: −0.8%;95% CI: −3.5, 1.9 then increase APC: 27.3%;95%: 16.1, 39.6), Northeast (decrease APC: −9.1%;95% CI:− 11.8, −6.2 then stable APC: 2.4%;95% CI: −9.9, 16.5), South (increase APC: 5.3%;95%CI: 2.5, 8.3 then decrease APC: −12.0;95% CI: −18.4, −5.0), and West (stable APC: 0.2%;95% CI: −3.0, 3.5 then stable APC: 9.0%;95% CI: −13.8, 37.9) (Figure 2). Conclusion: COVID-19 reporting to SECURE-IBD declined steadily during the first wave of the pandemic throughout the world except Latin America. Starting in September, reports to SECURE-IBD rose in both Europe and North America, consistent with the second wave of the pandemic in these countries.(Figure presented)Figure 1. Global regional temporal trends in reporting of COVID-19 in patients with IBD from the SECURE-IBD registry: A. Asia, B. Europe, C. Latin America, and D. North America: March 22–28 to September 6-12 and September 13-19 to November 8–14, 2020(Figure presented)Figure 2. United States regional temporal trends in reporting of COVID-19 in patients with IBD from the SECURE-IBD registry: A. Midwest, B. Northeast, C. South, and D. West: March 22–28 to September 6-12 and September 13-19 to November 8–14, 2020
ABSTRACT
Simplified topological maps can preserve the topology of regions within an area and provide a variety of ways to display geographic variables while granting equal weight to all regions. Canada's topology lends itself well to displaying information with topological maps. The first COVID-19 cases in Canada were identified in January 2020;the virus spread through much of the country in March, with a peak from April to May and a lull or trough in June-August, followed by a larger peak from October to November. Although Canada's most populous provinces saw the most cases per 100,000 persons, nearly every province experienced peaks from COVID-19. Atlantic Canada and the northern territories experienced the shortest and smallest peaks, with the highest being a November outbreak in Nunavut. Cases in central Canada remained moderate to high for much of the year, while western Canada experienced high peaks near the end of the year.