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1.
J Infect Dis ; 226(5): 757-765, 2022 09 13.
Article in English | MEDLINE | ID: covidwho-2029040

ABSTRACT

BACKGROUND: Down syndrome (DS) is associated with an increased risk of infections attributed to immune defects. Whether individuals with DS are at an increased risk of severe coronavirus disease 2019 (COVID-19) remains unclear. METHODS: In a matched cohort study, we evaluated the risk of COVID-19 infection and severe COVID-19 disease in individuals with DS and their matched counterparts in a pre-COVID-19 vaccination period at Kaiser Permanente Southern California. Multivariable Cox proportion hazard regression was used to investigate associations between DS and risk of COVID-19 infection and severe COVID-19 disease. RESULTS: Our cohort included 2541 individuals with DS and 10 164 without DS matched on age, sex, and race/ethnicity (51.6% female, 53.3% Hispanic, median age 25 years [interquartile range, 14-38]). Although the rate of COVID-19 infection in individuals with DS was 32% lower than their matched counterparts (adjusted hazard ratio [aHR], 0.68; 95% confidence interval [CI], .56-.83), the rate of severe COVID-19 disease was 6-fold higher (aHR, 6.14; 95% CI, 1.87-20.16). CONCLUSIONS: Although the risk of COVID-19 infection is lower, the risk of severe disease is higher in individuals with DS compared with their matched counterparts. Better infection monitoring, early treatment, and promotion of vaccine for COVID-19 are warranted for DS populations.


Subject(s)
COVID-19 , Delivery of Health Care, Integrated , Down Syndrome , Adult , COVID-19/epidemiology , COVID-19 Vaccines , Cohort Studies , Down Syndrome/complications , Down Syndrome/epidemiology , Female , Humans , Male
2.
Hosp Top ; : 1-8, 2022 Sep 10.
Article in English | MEDLINE | ID: covidwho-2017050

ABSTRACT

Background: Vaccination against SARS-CoV-2 is widely used and confers protection against morbidity and mortality in COVID-19. Little is known about disease severity and outcomes in fully vaccinated patients during hospitalization for COVID-19. Aim: To determine whether vaccination status and time from vaccination-to-hospitalization impacted disease severity in patients admitted with COVID-19. Methods: A multicenter retrospective cohort study was conducted on hospitalized adults with COVID-19 between January 1 and September 8, 2021, in Rhode Island, USA. Vaccination status and markers of disease severity, including C-reactive protein, D-Dimer values, and supplemental oxygen use during hospitalization, were obtained. Results: Two thousand three hundred forty-four patients were included. For every vaccinated patient, three unvaccinated patients were matched for a total of 424 patients in the analytic sample. Vaccinated patients had lower peak C-reactive protein (beta = -39.10, 95% CI [-79.10, -0. 65]) and supplemental oxygen requirements (beta = -38.14, 95% CI [-61.62, -9.91]) compared to unvaccinated patients. Patients who had a greater discrepancy between date of vaccination and admission had higher C-reactive protein (beta = 0.37, 95% CI [0.02, 0.71]) and supplemental oxygen requirements (beta = 0.44, 95% CI [0.15, 0.75]. Conclusion: Vaccination against SARS-CoV-2 was associated with a protective effect on disease severity during hospitalization for breakthrough COVID-19. Time elapsed since vaccination was associated with indicators of greater disease severity suggestive of waning protection over time.

3.
SSRN; 2022.
Preprint in English | SSRN | ID: ppcovidwho-341200

ABSTRACT

Background: The COVID-19 vaccines effectively reduce moderate or severe illness, including death. Despite this, more than 5% of vaccinated patients require hospitalization, resulting in a mortality ratio between 14⋅8% to 24%. This mortality ratio is very similar in non-vaccinated patients, which is used to argue against the efficacy of the COVID-19 vaccination. However, the differences in the clinical profile of the patients belonging to these two groups have not been acknowledged. We set to accurately estimate the vaccine protection in hospitalized patients with moderate or severe COVID-19 disease in a large multi-continental cohort of patients. Methods: A retrospective cohort study, with data from 148 hospitals in both Spain (111 hospitals) and Argentina (37 hospitals). We evaluated hospitalized patients for COVID-19 older than 18 years with oxygen requirements. Vaccine protection against death was assessed through a multivariable logistic regression model adjusting by potential confounders. The adjusted model was used to determine the Population Attributable Risk. We performed a propensity score matching and multiple imputations for missing data as a sensitivity analysis. Also, a Cox proportional-hazards regression model and Kaplan Maier curve were used to estimate vaccine effectiveness variation based on time since vaccination. Findings: Between January 2020 and May 2022, we evaluated 21,479 COVID-19 hospitalized patients with oxygen requirements. Of these 338 (1⋅5%) patients received a single dose of the COVID-19 vaccine and 379 (1⋅8%) were fully vaccinated. In vaccinated patients mortality was 20⋅9% (95%CI 17⋅9-24%), compared to 19⋅5% (95%CI 19-20%) in unvaccinated patients, resulting in a crude Odds Ratio (OR) of 1⋅07 (IC95% 0⋅89-1⋅29;p=0⋅41). However, after considering the multiple comorbidities in the vaccinated group the adjusted OR was 0⋅73 (IC95% 0⋅56-0⋅95;p=0⋅02) with a Population Attributable Risk reduction of 4⋅3% (95%CI 1%-5%). These observations were robust to both sensitivity analyses. In the Cox regression analysis, the adjusted HR was 0⋅49 (IC95% 0⋅28-0⋅88). Importantly, the vaccine protection waned after 200 days. Interpretation: COVID-19 vaccines significantly reduce the probability of death in patients suffering from a moderate disease (oxygen therapy). This subgroup of vaccinated patients (with a high burden of comorbidities) represents most infected individuals needing hospitalization in the current pandemic waves. Together with the observed waning of the protection after 200 days, our data strongly support booster doses for this subgroup of patients.

4.
Psychol Med ; : 1-10, 2022 May 19.
Article in English | MEDLINE | ID: covidwho-1852323

ABSTRACT

BACKGROUND: Pre-pandemic psychological distress is associated with increased susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but associations with the coronavirus disease 2019 (COVID-19) severity are not established. The authors examined the associations between distress prior to SARS-CoV-2 infection and subsequent risk of hospitalization. METHODS: Between April 2020 (baseline) and April 2021, we followed 54 781 participants from three ongoing cohorts: Nurses' Health Study II (NHSII), Nurses' Health Study 3 (NHS3), and the Growing Up Today Study (GUTS) who reported no current or prior SARS-CoV-2 infection at baseline. Chronic depression was assessed during 2010-2019. Depression, anxiety, worry about COVID-19, perceived stress, and loneliness were measured at baseline. SARS-CoV-2 infection and hospitalization due to COVID-19 was self-reported. Relative risks (RRs) were calculated by Poisson regression. RESULTS: 3663 participants reported a positive SARS-CoV-2 test (mean age = 55.0 years, standard deviation = 13.8) during follow-up. Among these participants, chronic depression prior to the pandemic [RR = 1.72; 95% confidence interval (CI) 1.20-2.46], and probable depression (RR = 1.81, 95% CI 1.08-3.03), being very worried about COVID-19 (RR = 1.79; 95% CI 1.12-2.86), and loneliness (RR = 1.81, 95% CI 1.02-3.20) reported at baseline were each associated with subsequent COVID-19 hospitalization, adjusting for demographic factors and healthcare worker status. Anxiety and perceived stress were not associated with hospitalization. Depression, worry about COVID-19, and loneliness were as strongly associated with hospitalization as were high cholesterol and hypertension, established risk factors for COVID-19 severity. CONCLUSIONS: Psychological distress may be a risk factor for hospitalization in patients with SARS-CoV-2 infection. Assessment of psychological distress may identify patients at greater risk of hospitalization. Future work should examine whether addressing distress improves physical health outcomes.

5.
Tijdschrift voor Psychiatrie ; 63(7):514-521, 2021.
Article in Dutch | APA PsycInfo | ID: covidwho-1813088

ABSTRACT

Background: Since the end of 2019, COVID-19 and its consequences are present everywhere. Dutch professionals are concerned about the mental consequences, and in particular that during and after hospitalization little attention is paid to psychological problems. Aim: To monitor the short-term course and severity of (neuro)psychiatric symptoms after hospitalization for COVID-19. To make a recommendation regarding whether or not to follow-up these patients psychiatrically to optimize care. Method: In an observational cohort-study screening questions and additional questionnaires were used during two follow-up contacts to monitor cognition (MoCA), affective symptoms (HADS and IES) and overall functioning. Results: More than half of the 29 included patients showed (neuro)psychiatric problems at both follow-up moments. Two weeks after discharge, we mainly saw symptoms related to anxiety and depression. Except for complaints related to the traumatic experience of the COVID-19, these seemed to have a favorable natural course. A negative time effect was seen for complaints consistent with post-traumatic stress disorder. Two months after discharge limitations in cognition and overall functioning appeared to be the main complaints after COVID-19. Conclusion: (Neuro)psychiatric symptoms after a COVID-19 are common. The natural course for affective complaints is more favorable than for cognitive functions. Specialist follow-up of patients with post-COVID psychological problems is recommended. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Dutch) Achtergrond: Sinds eind 2019 staat de wereld in het teken van COVID-19. Nederlandse professionals maken zich zorgen over de psychische gevolgen van deze pandemie. Na een opname voor COVID-19 is er weinig aandacht voor psychische problemen. Doel: In kaart brengen van het natuurlijke, kortetermijnbeloop en de ernst van (neuro)psychiatrische klachten na ziekenhuisopname voor COVID-19. Aanbevelingen doen betreffende het psychiatrisch volgen van deze patienten om zorg te optimaliseren. Methode: Met een observationeel cohortonderzoek werden tijdens twee follow-upcontactmomenten screeningsvragen en aanvullende vragenlijsten gebruikt om de cognitie (MoCA), affectieve klachten (HADS en IES) en het functioneren (WHODAS) in kaart te brengen. Resultaten: Ruim de helft van de 29 geincludeerde patienten toonde bij beide momenten (neuro)psychiatrische klachten. Twee weken na ontslag zagen we vooral klachten passend bij angst en depressie. Behoudens klachten passend bij het traumatisch ervaren van de COVID-19 leken deze een gunstig natuurlijk beloop te hebben. Een negatief tijdseffect zagen we voor klachten die pasten bij posttraumatische stressstoornis. Twee maanden na ontslag bleken beperkingen in het cognitief en het algehele functioneren de voornaamste klachten na COVID-19 te zijn. Conclusie: (Neuro)psychiatrische klachten na COVID-19 komen veel voor. Het natuurlijk beloop is gunstiger voor het herstel van de affectieve functies dan voor de cognitieve functies. We bevelen aan om patienten met psychische klachten na COVID-19 specialistische follow-up te bieden. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

6.
Am J Med Sci ; 363(5): 403-410, 2022 05.
Article in English | MEDLINE | ID: covidwho-1797255

ABSTRACT

BACKGROUND: Since the beginning of COVID-19 pandemic, there has been a widespread use of remdesivir in adults and children. There is little known information about remdesivir's role in reducing 30-day readmissions after hospitalization with COVID-19. This study aimed to determine whether treatment with remdesivir was associated with reduced risk of 30-day readmission after index hospitalization with COVID-19. METHODS: The study was a multi-center cohort study in Rhode Island, USA. Patients included all adults that were discharged after hospital treatment for COVID-19 between April 1st and December 31st, 2020. The main study outcomes were length of hospital stay, 30-day readmission, and post-discharge 30 days mortality. RESULTS: A total of 2,062 patients (2,279 hospitalizations) were included in the analytic sample. Patients were less likely to be readmitted within 30 days if they received remdesivir relative to not receiving remdesivir; associations were strongest for those with mild disease (RR: 0.31; 95% CI: 0.13,0.75). Remdesivir treatment was associated with reduction in all-cause mortality (HR: 0.65; 95% CI: 0.49,0.85) and an increase in length of stay (estimated average increase of 3.27 days; 95% CI: 2.11,4.44). LIMITATION: Unmeasured factors such as time-to-treatment and severity of disease prior to initiation of remdesivir. CONCLUSIONS: Remdesivir may be an effective strategy for reducing progression to severe COVID-19 disease and limiting morbidity associated with readmission to hospital. Larger prospective studies are justified to study the role of remdesivir in mild or early COVID-19 with high risk of disease progression and readmission to hospital within 30 days.


Subject(s)
COVID-19 , Adenosine Monophosphate/analogs & derivatives , Adult , Aftercare , Alanine/analogs & derivatives , COVID-19/drug therapy , Cohort Studies , Hospitalization , Hospitals , Humans , Pandemics , Patient Discharge , Patient Readmission , Prospective Studies , Retrospective Studies , SARS-CoV-2
7.
J Racial Ethn Health Disparities ; 2022 Jan 21.
Article in English | MEDLINE | ID: covidwho-1641046

ABSTRACT

To assess the presence of racial disparity during the COVID-19 pandemic, the New Mexico Department of Health (NMDOH) sought to compare the case rate and risk of hospitalization between persons of American Indian and Alaska Native (AI/AN) race and persons of other races in New Mexico from March 1 through September 30, 2020. Using NMDOH COVID-19 surveillance data, age-standardized COVID-19 case and hospitalization risks were compared between adults (≥ 18 years old) of AI/AN and other races. We compared age, sex, and comorbidities between hospitalized adults of AI/AN and other races. Among AI/AN persons, age-standardized COVID-19 case and hospitalization risks were 3.7 (95% CI 3.6-3.8) and 10.5 (95% CI 9.8-11.2) times as high as persons of other races. Hospitalized AI/AN patients had higher proportions of diabetes mellitus (48% vs. 33%, P < 0.0001) and chronic liver disease (8% vs. 5%, P = 0.0004) compared to hospitalized patients of other races. AI/AN populations have disproportionately higher risk of COVID-19 hospitalization compared to other races in New Mexico. By identifying etiologic factors that contribute to inequity, public health partners can implement culturally appropriate health interventions to mitigate disease severity within AI/AN communities.

8.
2021 Workshop on Towards Smarter Health Care: Can Artificial Intelligence Help?, SMARTERCARE 2021 ; 3060:79-84, 2021.
Article in English | Scopus | ID: covidwho-1619317

ABSTRACT

The ongoing pandemics of coronavirus disease has accelerated the implementation of machine learning methods (ML) to support clinical decisions. Within this context, we present the ALFABETO project, whose aim is to aid clinicians during COVID-19 patients hospital admission through the application of ML approaches exploiting clinical and chest x-ray features. Yet, non linear ML classifiers are often perceived as not easily interpretable by users, thus hampering trust in ML predictions. Moreover, these ML models, such as Neural Networks or Random Forest, are not able to include pre-exisisting knowledge about a specific domain and are not designed to find causal relationships between variables. For these reasons, we wanted to investigate if Bayesian Networks were able to properly describe the hospital admission decision process. Bayesian Networks are probabilistic graphical models representing a set of variables and their conditional dependencies. The network structure was derived both from existing medical knowledge and from patients data collected during the first wave of the pandemic. While being explainable, we show that the Bayesian network has similar performance when compared to a less explainable ML model and that was able to generalize well across COVID-19 waves. © 2021 Copyright for this paper by its authors.

9.
Am J Epidemiol ; 191(1): 137-146, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1621545

ABSTRACT

During the spring of 2020, the coronavirus disease 2019 (COVID-19) epidemic caused an unprecedented demand for intensive-care resources in the Lombardy region of Italy. Using data on 43,538 hospitalized patients admitted between February 21 and July 12, 2020, we evaluated variations in intensive care unit (ICU) admissions and mortality over the course of 3 periods: the early phase of the pandemic (February 21-March 13), the period of highest pressure on the health-care system (March 14-April 25, when numbers of COVID-19 patients exceeded prepandemic ICU bed capacity), and the declining phase (April 26-July 12). Compared with the early phase, patients aged 70 years or more were less often admitted to an ICU during the period of highest pressure on the health-care system (odds ratio (OR) = 0.47, 95% confidence interval (CI): 0.41, 0.54), with longer ICU delays (incidence rate ratio = 1.82, 95% CI: 1.52, 2.18) and lower chances of dying in the ICU (OR = 0.47, 95% CI: 0.34, 0.64). Patients under 56 years of age had more limited changes in the probability of (OR = 0.65, 95% CI: 0.56, 0.76) and delay to (incidence rate ratio = 1.16, 95% CI: 0.95, 1.42) ICU admission and increased mortality (OR = 1.43, 95% CI: 1.00, 2.07). In the declining phase, all quantities decreased for all age groups. These patterns may suggest that limited health-care resources during the peak phase of the epidemic in Lombardy forced a shift in ICU admission criteria to prioritize patients with higher chances of survival.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Delivery of Health Care/statistics & numerical data , Intensive Care Units/statistics & numerical data , Adult , Age Factors , Aged , Aged, 80 and over , COVID-19/mortality , Comorbidity , Humans , Italy/epidemiology , Middle Aged , Pandemics , Retrospective Studies , Risk Factors , SARS-CoV-2 , Sex Factors , Time Factors
10.
Vaccine ; 40(5): 701-705, 2022 01 31.
Article in English | MEDLINE | ID: covidwho-1586273

ABSTRACT

Recently, Covid-19 vaccine effectiveness has decreased especially against mild disease due to emergence of the Delta variant and waning protection. In this register-based study among healthcare workers in Finland, the vaccine effectiveness of two-dose mRNA vaccine series against SARS-CoV-2 infection decreased from 82% (95% CI 79-85%) 14-90 days after vaccination to 53% (43-62%) after 6 months. Similar trend was observed for other series. Waning was not observed against Covid-19 hospitalization. These results facilitate decision-making of booster doses for healthcare workers.


Subject(s)
COVID-19 Vaccines , COVID-19 , Cohort Studies , Finland/epidemiology , Health Personnel , Humans , SARS-CoV-2 , Vaccines, Synthetic
11.
Influenza Other Respir Viruses ; 16(3): 532-541, 2022 05.
Article in English | MEDLINE | ID: covidwho-1555268

ABSTRACT

BACKGROUND: COVID-19 hospitalizations of non-institutionalized persons during the first COVID-19 wave in Connecticut disproportionately affected the elderly, communities of color, and individuals of low socioeconomic status (SES). Whether the magnitude of these disparities changed after the initial lockdown and before vaccine rollout is not well documented. METHODS: All first-time hospitalizations with laboratory-confirmed COVID-19 during July to December 2020, including patients' geocoded residential addresses, were obtained from the Connecticut Department of Public Health. Those living in congregate settings, including nursing homes, were excluded. Community-dwelling patients were assigned census tract-level poverty and crowding measures from the 2014-2018 American Community Survey by linking their geocoded addresses to census tracts. Age-adjusted incidence and relative rates were calculated across demographic and SES measures and compared with those from a similar analysis of hospitalized cases during the initial wave. RESULTS: During July to December 2020, there were 5652 COVID-19 hospitalizations in community residents in Connecticut. Incidence was highest among those >85 years, non-Hispanic Blacks and Hispanic/Latinx compared with non-Hispanic Whites {relative rate (RR) 3.1 (95% confidence interval [CI] 2.83-3.32) and 5.9 (95% CI 5.58-6.28)}, and persons living in high poverty and high crowding census tracts. Although racial/ethnic and SES disparities during the study period were substantial, they were significantly decreased compared with the first wave of COVID-19. CONCLUSIONS: The finding of persistent, if reduced, large racial/ethnic disparities in COVID-19 hospitalizations 2-7 months after the initial lockdown was relaxed and before vaccination was widely available is of concern. These disparities cause a challenge to achieving health equity and are relevant for future pandemic planning.


Subject(s)
COVID-19 , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control , Connecticut/epidemiology , Health Status Disparities , Hospitalization , Humans , Social Class
12.
Mediterr J Hematol Infect Dis ; 13(1): e2021061, 2021.
Article in English | MEDLINE | ID: covidwho-1528954

ABSTRACT

BACKGROUND AND OBJECTIVE: The use of monoclonal antibodies to the SARS-Cov-2 spike protein for early treatment of COVID-19 disease is being evaluated, with only phase 2 studies available to date. The emergency authorization of bamlanivimab monotherapy was obtained in November 2020 by the FDA and in March 2021 by Italian agency AIFA. Its use was then revoked in April 2021 by both. This study reports the results of bamlanivimab utilization in monotherapy in Umbria (Italian region) to verify whether, in a population with multiple risk factors, comparable results to the phase 2 BLAZE1 trial had been obtained. METHODS: Between March and April 2021, a retrospective observational study was performed on patients treated with bamlanivimab. Demographic and clinical characteristics before and after infusion were evaluated. Moreover, a telephone interview was conducted about 30 days after the infusion to evaluate the overall course. RESULTS: All patients had an early infection (mean 4±1.73 days), almost all by alpha variant (97%). No adverse events to treatment were observed. Altogether within 30 days, the hospitalization rate was 20%, 15% for COVID-19 related pathologies, versus 4% at 11 days in the BLAZE1 phase 2 study. In addition, worsening of some symptoms observed at baseline such as asthenia (77 vs. 51.3%), shortness of breath (38 vs. 23%) was registered, as well as the onset of non-restorative sleep (41%). CONCLUSION: The clinical outcome after bamlanivimab monotherapy was far below the expectation despite the patients had been infected by a theoretically sensitive viral variant.

13.
Viruses ; 13(11)2021 10 29.
Article in English | MEDLINE | ID: covidwho-1488760

ABSTRACT

The SARS-CoV-2 pandemic is one of the most concerning health problems around the globe. We reported the emergence of SARS-CoV-2 variant B.1.1.519 in Mexico City. We reported the effective reproduction number (Rt) of B.1.1.519 and presented evidence of its geographical origin based on phylogenetic analysis. We also studied its evolution via haplotype analysis and identified the most recurrent haplotypes. Finally, we studied the clinical impact of B.1.1.519. The B.1.1.519 variant was predominant between November 2020 and May 2021, reaching 90% of all cases sequenced in February 2021. It is characterized by three amino acid changes in the spike protein: T478K, P681H, and T732A. Its Rt varies between 0.5 and 2.9. Its geographical origin remain to be investigated. Patients infected with variant B.1.1.519 showed a highly significant adjusted odds ratio (aOR) increase of 1.85 over non-B.1.1.519 patients for developing a severe/critical outcome (p = 0.000296, 1.33-2.6 95% CI) and a 2.35-fold increase for hospitalization (p = 0.005, 1.32-4.34 95% CI). The continuous monitoring of this and other variants will be required to control the ongoing pandemic as it evolves.


Subject(s)
COVID-19/epidemiology , COVID-19/virology , SARS-CoV-2/genetics , Spike Glycoprotein, Coronavirus/genetics , Basic Reproduction Number/statistics & numerical data , Biological Evolution , Genome, Viral , Haplotypes , Humans , Mexico/epidemiology , Mutation , Nasopharynx/virology , Phylogeny , RNA, Viral , SARS-CoV-2/classification
14.
Int J Environ Res Public Health ; 18(18)2021 Sep 08.
Article in English | MEDLINE | ID: covidwho-1403607

ABSTRACT

The objective of this study was to assess the relationship between public protests and county-level, novel coronavirus disease (COVID-19) hospitalization rates across California. Publicly available data were included in the analysis from 55 of 58 California state counties (29 March-14 October 2020). Mixed-effects negative binomial regression models were used to examine the relationship between daily county-level COVID-19 hospitalizations and two main exposure variables: any vs. no protests and 1 or >1 protest vs. no protests on a given county-day. COVID-19 hospitalizations were used as a proxy for viral transmission since such rates are less sensitive to temporal changes in testing access/availability. Models included covariates for daily county mobility, county-level characteristics, and time trends. Models also included a county-population offset and a two-week lag for the association between exposure and outcome. No significant associations were observed between protest exposures and COVID-19 hospitalization rates among the 55 counties. We did not find evidence to suggest that public protests were associated with COVID-19 hospitalization within California counties. These findings support the notion that protesting during a pandemic may be safe, ostensibly, so long as evidence-based precautionary measures are taken.


Subject(s)
COVID-19 , SARS-CoV-2 , California/epidemiology , Hospitalization , Humans , Pandemics
15.
J Clin Med ; 10(12)2021 Jun 13.
Article in English | MEDLINE | ID: covidwho-1389413

ABSTRACT

We conducted a prospective population-based cohort study to assess risk factors for infection, hospitalization, and death from SARS-CoV-2. The study comprised the people covered by the Health Service of Navarre, Spain. Sociodemographic variables and chronic conditions were obtained from electronic healthcare databases. Confirmed infections, hospitalizations, and deaths from SARS-CoV-2 were obtained from the enhanced epidemiological surveillance during the second SARS-CoV-2 epidemic surge (July-December 2020), in which diagnostic tests were widely available. Among 643,757 people, 5497 confirmed infections, 323 hospitalizations, 38 intensive care unit admissions, and 72 deaths from SARS-CoV-2 per 100,000 inhabitants were observed. A higher incidence of confirmed infection was associated with people aged 15-29 years, nursing home residents, healthcare workers, people born in Latin America or Africa, as well as in those diagnosed with diabetes, cardiovascular disease, chronic obstructive pulmonary disease (COPD), chronic kidney disease, dementia, severe obesity, hypertension and functional dependence. The risk of hospitalization in the population was associated with males, higher age, nursing home residents, Latin American or African origin, and those diagnosed with immunodeficiency, diabetes, cardiovascular disease, COPD, asthma, kidney disease, cerebrovascular disease, cirrhosis, dementia, severe obesity, hypertension and functional dependence. The risk of death was associated with males, higher age, nursing home residents, Latin American origin, low income level, immunodeficiency, diabetes, cardiovascular disease, COPD, kidney disease, dementia, and functional dependence. This study supports the prioritization of the older population, nursing home residents, and people with chronic conditions and functional dependence for SARS-CoV-2 prevention and vaccination, and highlights the need for additional preventive support for immigrants.

16.
Respirology ; 26(12): 1181-1187, 2021 12.
Article in English | MEDLINE | ID: covidwho-1378057

ABSTRACT

BACKGROUND AND OBJECTIVE: Ecological studies have suggested an association between exposure to particulate matter ≤2.5 µm (PM2.5 ) and coronavirus disease 2019 (COVID-19) severity. However, these findings are yet to be validated in individual-level studies. We aimed to determine the association of long-term PM2.5 exposure with hospitalization among individual patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We estimated the 10-year (2009-2018) PM2.5 exposure at the residential zip code of COVID-19 patients diagnosed at the University of Cincinnati healthcare system between 13 March 2020 and 30 September 2020. Logistic regression was used to determine the odds ratio (OR) and 95% CI for COVID-19 hospitalizations associated with PM2.5 , adjusting for socioeconomic characteristics and comorbidities. RESULTS: Among the 14,783 COVID-19 patients included in our study, 13.6% were hospitalized; the geometric mean (SD) PM2.5 was 10.48 (1.12) µg/m3 . In adjusted analysis, 1 µg/m3 increase in 10-year annual average PM2.5 was associated with 18% higher hospitalization (OR: 1.18, 95% CI: 1.11-1.26). Likewise, 1 µg/m3 increase in PM2.5 estimated for the year 2018 was associated with 14% higher hospitalization (OR: 1.14, 95% CI: 1.08-1.21). CONCLUSION: Long-term PM2.5 exposure is associated with increased hospitalization in COVID-19. Therefore, more stringent COVID-19 prevention measures may be needed in areas with higher PM2.5 exposure to reduce the disease morbidity and healthcare burden.


Subject(s)
Air Pollutants , Air Pollution/adverse effects , COVID-19/epidemiology , Environmental Exposure/adverse effects , Hospitalization/statistics & numerical data , Particulate Matter/adverse effects , Adult , Aged , Aged, 80 and over , Air Pollutants/adverse effects , Air Pollutants/analysis , Air Pollution/analysis , COVID-19/etiology , Female , Humans , Male , Middle Aged , Pandemics , Particulate Matter/analysis , SARS-CoV-2 , Severity of Illness Index
17.
Arch Pharm Res ; 44(7): 725-740, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1321878

ABSTRACT

Anecdotal evidence suggests that the severity of coronavirus disease of 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is likely to be distinguished by variations in loss of smell (LOS). Thus, we conducted a meta-analysis of 45 articles that include a total of 42,120 COVID-19 patients from 17 different countries to demonstrate that severely ill or hospitalized COVID-19 patients have a lesser chance of experiencing LOS than non-severely ill or non-hospitalized COVID-19 patients (odds ratio = 0.527 [95% CI 0.373-0.744; p < 0.001] and 0.283 [95% CI 0.173-0.462; p < 0.001], respectively). We also proposed a possible mechanism underlying the association of COVID-19 severity with anosmia, which may explain why patients without sense of smell develop severe COVID-19. Variations in LOS according to the severity of COVID-19 is a global phenomenon, with few exceptions. Since severely ill patients have a lower rate of anosmia, patients without anosmia should be monitored more closely in the early stages of COVID-19, for early diagnosis of severity of illness. An understanding of how the severity of COVID-19 infection and LOS are associated has profound implications for the clinical management and mitigation strategies for the disease.


Subject(s)
Anosmia/etiology , COVID-19/complications , Odorants , Olfactory Perception , Smell , Anosmia/diagnosis , Anosmia/physiopathology , Anosmia/psychology , COVID-19/diagnosis , COVID-19/therapy , Early Diagnosis , Female , Hospitalization , Humans , Male , Predictive Value of Tests , Prognosis , Risk Assessment , Risk Factors , Severity of Illness Index
18.
Glob Pediatr Health ; 8: 2333794X211022710, 2021.
Article in English | MEDLINE | ID: covidwho-1262444

ABSTRACT

Background. The COVID-19 pandemic has shed light on communities of racial/ethnic minority groups in the US where long-standing health issues and structural inequities are now known to have resulted in increased risk for infection, severe illness, and death from the virus. The objective of our study was to describe demographic characteristics, clinical presentations, medical interventions and outcomes of pediatric patients with COVID-19 treated at Children's Hospital of Michigan (CHM), a tertiary care center in urban Detroit, an early hotspot during the initial surge of the SARS-CoV-2 pandemic. Methods. A retrospective chart review was performed of children ≤18 years of age who had polymerase chain reaction (RT-PCR) testing via NP swab or serum IgG antibody testing for SARS-CoV-2 during March 1, 2020-June 30, 2020. Results. Seventy-eight COVID-19 infected children were identified of whom 85.8% (67/78) were from minority populations (African American, Hispanic). Hospitalization rate was 82% (64/78). About 44% (34/78) had an associated comorbidity with asthma and obesity being most common. Although all ages were affected, infants <1 year of age had the highest hospitalization rate (19/64, 30%). In all disease severity categories, dichotomized non-whites had more severe disease by percentage within race/ethnicity than Whites, and also within percent disease severity (P-value = .197). Overall, 37% of hospitalized patients required intensive care. Conclusions. Extremely high rates of COVID-19 hospitalization and requirement of ICU care were identified in our patient population. Further studies are needed to better understand the contributing factors to this health disparity in disadvantaged communities.

19.
J Clin Med ; 10(6)2021 Mar 12.
Article in English | MEDLINE | ID: covidwho-1158378

ABSTRACT

The independent role of hypertension for COVID-19 outcomes in the population remains unclear. We aimed to estimate the independent effect of hypertension and hypertension-related conditions, i.e., cardiovascular, cerebrovascular and chronic kidney diseases, as potential risk factors for COVID-19 hospitalization and severe COVID-19 (i.e., intensive care unit admission or death) in the population. The risk for severe COVID-19 among hospitalized patients was also evaluated. A Spanish population-based cohort of people aged 25-79 years was prospectively followed from March to May 2020 to identify hospitalizations for laboratory-confirmed COVID-19. Poisson regression was used to estimate the adjusted relative risk (aRR) for COVID-19 hospitalization and severe COVID-19 among the whole cohort, and for severe COVID-19 among hospitalized patients. Of 424,784 people followed, 1106 were hospitalized by COVID-19 and 176 were severe cases. Hypertension was not independently associated with a higher risk of hospitalization (aRR 0.96, 95% CI 0.83-1.12) nor severe COVID-19 (aRR 1.12, 95% CI 0.80-1.56) in the population. Persons with cardiovascular, cerebrovascular and chronic kidney diseases were at higher risk for COVID-19 hospitalization (aRR 1.33, 95% CI 1.13-1.58; aRR 1.41, 95% CI 1.04-1.92; and aRR 1.52, 95% CI 1.21-1.91; respectively) and severe COVID-19 (aRR 1.61, 95% CI 1.13-2.30; aRR 1.91, 95% CI 1.13-3.25; and aRR 1.78, 95% CI 1.14-2.76; respectively). COVID-19 hospitalized patients with cerebrovascular diseases were at higher risk of mortality (aRR 1.80, 95% CI 1.00-3.23). The current study shows that, in the general population, persons with cardiovascular, cerebrovascular and chronic kidney diseases, but not those with hypertension only, should be considered as high-risk groups for COVID-19 hospitalization and severe COVID-19.

20.
J Med Econ ; 24(1): 308-317, 2021.
Article in English | MEDLINE | ID: covidwho-1069172

ABSTRACT

OBJECTIVE: The aims of this study were to evaluate health outcomes and the economic burden of hospitalized COVID-19 patients in the United States. METHODS: Hospitalized patients with a primary or secondary discharge diagnosis code for COVID-19 (ICD-10 code U07.1) from 1 April to 31 October 2020 were identified in the Premier Healthcare COVID-19 Database. Patient demographics, hospitalization characteristics, and concomitant medical conditions were assessed. Hospital length of stay (LOS), in-hospital mortality, hospital charges, and hospital costs were evaluated overall and stratified by age groups, insurance types, and 4 COVID-19 disease progression states based on intensive care unit (ICU) and invasive mechanical ventilation (IMV) usage. RESULTS: Of the 173,942 hospitalized COVID-19 patients, the median age was 63 years, 51.0% were male, and 48.5% were covered by Medicare. The most prevalent concomitant medical conditions were cardiovascular disease (73.5%), hypertension (64.8%), diabetes (40.7%), obesity (27.0%), and chronic kidney disease (24.2%). Approximately one-fifth (21.9%) of the hospitalized COVID-19 patients were admitted to the ICU and 16.9% received IMV; most patients (73.6%) did not require ICU admission or IMV, and 12.4% required both. The median hospital LOS was 5 days, in-hospital mortality was 13.6%, median hospital charges were $43,986, and median hospital costs were $12,046. Hospital LOS and in-hospital mortality increased with ICU and/or IMV usage and age; hospital charges and costs increased with ICU and/or IMV usage. Patients with both ICU and IMV usage had the longest median hospital LOS (15 days), highest in-hospital mortality (53.8%), and highest hospital charges ($198,394) and hospital costs ($54,402). LIMITATIONS: This retrospective administrative database analysis relied on coding accuracy and a subset of admissions with validated/reconciled hospital costs. CONCLUSIONS: This study summarizes the severe health outcomes and substantial hospital costs of hospitalized COVID-19 patients in the US. The findings support the urgent need for rapid implementation of effective interventions, including safe and efficacious vaccines.


Subject(s)
COVID-19/economics , Hospital Charges/statistics & numerical data , Hospitalization/economics , Outcome Assessment, Health Care , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/mortality , Cost of Illness , Disease Progression , Female , Hospital Mortality , Humans , Insurance Coverage/economics , Intensive Care Units/economics , Length of Stay/economics , Male , Middle Aged , Respiration, Artificial/economics , Retrospective Studies , SARS-CoV-2 , United States/epidemiology
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