Subject(s)COVID-19/epidemiology , Organ Transplantation/adverse effects , Transplant Recipients/statistics & numerical data , Adult , COVID-19/immunology , COVID-19/virology , COVID-19 Vaccines/immunology , Centers for Disease Control and Prevention, U.S./statistics & numerical data , Graft Rejection/immunology , Graft Rejection/prevention & control , Humans , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/adverse effects , Mass Vaccination/statistics & numerical data , Risk Assessment/statistics & numerical data , SARS-CoV-2/immunology , United States/epidemiology
OBJECTIVE: The primary aim of this article was to describe SARS-CoV-2 infection among pregnant women during the wild-type and Alpha-variant periods in Italy. The secondary aim was to compare the impact of the virus variants on the severity of maternal and perinatal outcomes. DESIGN: National population-based prospective cohort study. SETTING: A total of 315 Italian maternity hospitals. SAMPLE: A cohort of 3306 women with SARS-CoV-2 infection confirmed within 7 days of hospital admission. METHODS: Cases were prospectively reported by trained clinicians for each participating maternity unit. Data were described by univariate and multivariate analyses. MAIN OUTCOME MEASURES: COVID-19 pneumonia, ventilatory support, intensive care unit (ICU) admission, mode of delivery, preterm birth, stillbirth, and maternal and neonatal mortality. RESULTS: We found that 64.3% of the cohort was asymptomatic, 12.8% developed COVID-19 pneumonia and 3.3% required ventilatory support and/or ICU admission. Maternal age of 30-34 years (OR 1.43, 95% CI 1.09-1.87) and ≥35 years (OR 1.62, 95% CI 1.23-2.13), citizenship of countries with high migration pressure (OR 1.75, 95% CI 1.36-2.25), previous comorbidities (OR 1.49, 95% CI 1.13-1.98) and obesity (OR 1.72, 95% CI 1.29-2.27) were all associated with a higher occurrence of pneumonia. The preterm birth rate was 11.1%. In comparison with the pre-pandemic period, stillbirths and maternal and neonatal deaths remained stable. The need for ventilatory support and/or ICU admission among women with pneumonia increased during the Alpha-variant period compared with the wild-type period (OR 3.24, 95% CI 1.99-5.28). CONCLUSIONS: Our results are consistent with a low risk of severe COVID-19 disease among pregnant women and with rare adverse perinatal outcomes. During the Alpha-variant period there was a significant increase of severe COVID-19 illness. Further research is needed to describe the impact of different SARS-CoV-2 viral strains on maternal and perinatal outcomes.
Subject(s)COVID-19 , Intensive Care Units/statistics & numerical data , Pregnancy Complications, Infectious , Premature Birth/epidemiology , SARS-CoV-2 , Adult , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , COVID-19 Testing/methods , COVID-19 Testing/statistics & numerical data , Cohort Studies , Comorbidity , Female , Hospitalization/statistics & numerical data , Hospitals, Maternity/statistics & numerical data , Humans , Italy/epidemiology , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/therapy , Pregnancy Outcome/epidemiology , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Risk Factors , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , Severity of Illness Index
OBJECTIVE: To assess associations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and pregnancy outcomes considering testing policy and test-positivity-to-delivery interval. DESIGN: Nationwide cohort study. SETTING: Sweden. POPULATION: From the Pregnancy-Register we identified 88 593 singleton births, 11 March 2020-31 January 2021, linked to data on SARS-CoV-2-positivity from the Public Health Agency, and information on neonatal care admission from the Neonatal Quality Register. Adjusted odds ratios (aORs) were estimated stratified by testing-policy and test-positivity-to-delivery interval. MAIN OUTCOME MEASURES: Five-minute Apgar score, neonatal care admission, stillbirth and preterm birth. RESULTS: During pregnancy, SARS-CoV-2 test-positivity was 5.4% (794/14 665) under universal testing and 1.9% (1402/73 928) under non-universal testing. There were generally lower risks associated with SARS-CoV-2 under universal than non-universal testing. In women testing positive >10 days from delivery, generally no significant differences in risk were observed under either testing policy. Neonatal care admission was more common (15.3% versus 8.0%; aOR 2.24, 95% CI 1.62-3.11) in women testing positive ≤10 days before delivery under universal testing. There was no significant association with 5-minute Apgar score below 7 (1.0% versus 1.7%; aOR 0.64, 95% CI 0.24-1.72) or stillbirth (0.3% versus 0.4%; aOR 0.72, 95% CI 0.10-5.20). Compared with term births (2.1%), test-positivity was higher in medically indicated preterm birth (5.7%; aOR 2.70, 95% CI 1.60-4.58) but not significantly increased in spontaneous preterm birth (2.3%; aOR 1.12, 95% CI 0.62-2.02). CONCLUSIONS: Testing policy and timing of test-positivity impact associations between SARS-CoV-2-positivity and pregnancy outcomes. Under non-universal testing, women with complications near delivery are more likely to be tested than women without complications, thereby inflating any association with adverse pregnancy outcomes compared with findings under universal testing. TWEETABLE ABSTRACT: Testing policy and time from SARS-CoV-2 infection to delivery influence the association with pregnancy outcomes.
Subject(s)COVID-19 Testing , COVID-19 , Intensive Care Units, Neonatal/statistics & numerical data , Pregnancy Complications, Infectious , Pregnancy Outcome/epidemiology , SARS-CoV-2/isolation & purification , Apgar Score , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , COVID-19 Testing/methods , COVID-19 Testing/statistics & numerical data , Cohort Studies , Female , Humans , Infant, Newborn , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/therapy , Premature Birth/epidemiology , Prenatal Care/methods , Prenatal Care/standards , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Stillbirth/epidemiology , Sweden/epidemiology
We determined player-to-player distance, body-to-ball contact, and exercise intensity during three training modalities in various football populations. 213 participants were recruited, ranging from 9-year-old boys to young men and 11-year-old girls to middle-aged women. All groups were analysed with video-filming and GPS-based Polar Pro monitors during three types of football training for 20 min, i.e., COVID-19-modified training (CMT) with >2-metre player-to-player distance, small-sided games (SSG), and simulated match-play with normal rules (SMP), in randomised order. Time spent in a danger zone (1.5 m) per-percent-infected-player (DZ PPIP) ranged from 0.015 to 0.279% of playing time. DZ PPIP for SSG was higher (P < 0.05) than CMT and SMP. The average number of contacts (within 1.5 m) with a potentially infected player ranged from 12 to 73 contacts/hour. SSG had more (P < 0.05) contacts than CMT and SMP, with SMP having a higher (P < 0.05) number of contacts than CMT. Time/contact ranged from 0.87 to 3.00 seconds for the groups. No player-to-player and body-to-ball touches were registered for CMT. Total player-to-player contacts were 264% higher (P < 0.05) in SSG than SMP, ranging from 80 to 170 and 25 to 56 touches, respectively. In all groups, a greater total distance was covered during SMP compared to CMT (38-114%; P < 0.05). All groups performed more high-intensity running (33-54%; P < 0.05) and had higher heart rates during SMP compared to CMT. Different types of football training all appear to exert a minor COVID-19 infection risk; however, COVID-19-modified training may be safer than small-sided game training, but also match-play. In contrast, exercise intensity is lower during COVID-19-modified training than match-play.
Subject(s)Athletic Performance/physiology , Athletic Performance/statistics & numerical data , COVID-19/diagnosis , Football/physiology , Football/statistics & numerical data , Physical Fitness/physiology , Risk Assessment/statistics & numerical data , Adolescent , Adult , Child , Denmark , Female , Humans , Male , Middle Aged , Young Adult
Importance: Given limited COVID-19 vaccine availability early in the pandemic, optimizing immunization strategies was of paramount importance. Ring vaccination has been used successfully to control transmission of other airborne respiratory viruses. Objective: To assess the association of a ring vaccination intervention on COVID-19 spread in the initial epicenter of SARS-CoV-2 Alpha variant transmission in Montreal, Canada. Design, Setting, and Participants: This cohort study compared COVID-19 daily disease risk in 3 population-based groups of neighborhoods in Montreal, Canada, defined by their intervention-specific vaccine coverage at the neighborhood level: the primary intervention group (500 or more vaccinated persons per 10â¯000 persons), secondary intervention group (95 to 499), and control group (0 to 50). The groups were compared within each of 3 time periods: before intervention (December 1, 2020, to March 16, 2021), during and immediately after intervention (March 17 to April 17, 2021), and 3 weeks after the intervention midpoint (April 18 to July 18, 2021). Data were analyzed between June 2021 and November 2021. Exposures: Vaccination targeted parents and teachers of children attending the 32 schools and 48 childcare centers in 2 adjacent neighborhoods with highest local transmission (case counts) of Alpha variant shortly after its introduction. Participants were invited to receive 1 dose of mRNA vaccine between March 22 and April 9, 2021 (before vaccine was available to these age groups). Main Outcomes and Measures: COVID-19 risk in 3 groups of neighborhoods based on intervention-specific vaccine coverage. Results: A total of 11â¯794 residents were immunized, with a mean (SD) age of 43 (8) years (range, 16-93 years); 5766 participants (48.9%) lived in a targeted neighborhood, and 9784 (83.0%) were parents. COVID-19 risk in the primary intervention group was significantly higher than in the control group before (unadjusted risk ratio [RR], 1.58; 95% CI 1.52-1.65) and during (RR, 1.63; 95% CI, 1.52-1.76) intervention, and reached a level similar to the other groups in the weeks following the intervention (RR, 1.03; 95% CI, 0.94-1.12). A similar trend was observed when restricting to SARS-CoV-2 variants and persons aged 30 to 59 years (before: RR, 1.72; 95% CI, 1.63-1.83 vs after: RR, 1.01; 95% CI, 0.88-1.17). Conclusions and Relevance: Our findings show that ring vaccination was associated with a reduction in COVID-19 risk in areas with high local transmission of Alpha variant shortly after its introduction. Ring vaccination may be considered as an adjunct to mass immunization to control transmission in specific areas, based on local epidemiology.
Subject(s)COVID-19 Drug Treatment , COVID-19/transmission , Risk Assessment/methods , Vaccination/standards , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Child , Cohort Studies , Female , Humans , Male , Mass Vaccination/methods , Mass Vaccination/standards , Mass Vaccination/statistics & numerical data , Middle Aged , Odds Ratio , Population Surveillance/methods , Quebec/epidemiology , Risk Assessment/statistics & numerical data , SARS-CoV-2/drug effects , SARS-CoV-2/pathogenicity , Vaccination/methods , Vaccination/statistics & numerical data
BACKGROUND: A more transmissible variant of SARS-CoV-2, the variant of concern 202012/01 or lineage B.1.1.7, has emerged in the UK. We aimed to estimate the risk of critical care admission, mortality in patients who are critically ill, and overall mortality associated with lineage B.1.1.7 compared with non-B.1.1.7. We also compared clinical outcomes between these two groups. METHODS: For this observational cohort study, we linked large primary care (QResearch), national critical care (Intensive Care National Audit & Research Centre Case Mix Programme), and national COVID-19 testing (Public Health England) databases. We used SARS-CoV-2 positive samples with S-gene molecular diagnostic assay failure (SGTF) as a proxy for the presence of lineage B.1.1.7. We extracted two cohorts from the data: the primary care cohort, comprising patients in primary care with a positive community COVID-19 test reported between Nov 1, 2020, and Jan 26, 2021, and known SGTF status; and the critical care cohort, comprising patients admitted for critical care with a positive community COVID-19 test reported between Nov 1, 2020, and Jan 27, 2021, and known SGTF status. We explored the associations between SARS-CoV-2 infection with and without lineage B.1.1.7 and admission to a critical care unit (CCU), 28-day mortality, and 28-day mortality following CCU admission. We used Royston-Parmar models adjusted for age, sex, geographical region, other sociodemographic factors (deprivation index, ethnicity, household housing category, and smoking status for the primary care cohort; and ethnicity, body-mass index, deprivation index, and dependency before admission to acute hospital for the CCU cohort), and comorbidities (asthma, chronic obstructive pulmonary disease, type 1 and 2 diabetes, and hypertension for the primary care cohort; and cardiovascular disease, respiratory disease, metastatic disease, and immunocompromised conditions for the CCU cohort). We reported information on types and duration of organ support for the B.1.1.7 and non-B.1.1.7 groups. FINDINGS: The primary care cohort included 198 420 patients with SARS-CoV-2 infection. Of these, 117 926 (59·4%) had lineage B.1.1.7, 836 (0·4%) were admitted to CCU, and 899 (0·4%) died within 28 days. The critical care cohort included 4272 patients admitted to CCU. Of these, 2685 (62·8%) had lineage B.1.1.7 and 662 (15·5%) died at the end of critical care. In the primary care cohort, we estimated adjusted hazard ratios (HRs) of 2·15 (95% CI 1·75-2·65) for CCU admission and 1·65 (1·36-2·01) for 28-day mortality for patients with lineage B.1.1.7 compared with the non-B.1.1.7 group. The adjusted HR for mortality in critical care, estimated with the critical care cohort, was 0·91 (0·76-1·09) for patients with lineage B.1.1.7 compared with those with non-B.1.1.7 infection. INTERPRETATION: Patients with lineage B.1.1.7 were at increased risk of CCU admission and 28-day mortality compared with patients with non-B.1.1.7 SARS-CoV-2. For patients receiving critical care, mortality appeared to be independent of virus strain. Our findings emphasise the importance of measures to control exposure to and infection with COVID-19. FUNDING: Wellcome Trust, National Institute for Health Research Oxford Biomedical Research Centre, and the Medical Sciences Division of the University of Oxford.
Subject(s)COVID-19/mortality , Critical Care/statistics & numerical data , Intensive Care Units/statistics & numerical data , SARS-CoV-2/isolation & purification , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/therapy , COVID-19/virology , COVID-19 Nucleic Acid Testing/statistics & numerical data , England/epidemiology , Female , Hospital Mortality , Humans , Male , Middle Aged , Risk Assessment/statistics & numerical data , Risk Factors , SARS-CoV-2/genetics , SARS-CoV-2/pathogenicity , Severity of Illness Index , Young Adult
Subject(s)COVID-19 Vaccines/immunology , COVID-19/immunology , Pregnant Women , SARS-CoV-2/immunology , Vaccination/methods , COVID-19/epidemiology , COVID-19/virology , COVID-19 Vaccines/administration & dosage , Child , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Pandemics/prevention & control , Pregnancy , Pregnancy Complications, Infectious/immunology , Pregnancy Complications, Infectious/prevention & control , Pregnancy Complications, Infectious/virology , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Risk Factors , SARS-CoV-2/physiology , Vaccination/statistics & numerical data
Subject(s)COVID-19 Vaccines/administration & dosage , COVID-19/mortality , Organ Transplantation/adverse effects , Transplant Recipients/statistics & numerical data , COVID-19/immunology , COVID-19/prevention & control , COVID-19/virology , COVID-19 Nucleic Acid Testing , Humans , Immunization Schedule , Mass Vaccination/statistics & numerical data , RNA, Viral/isolation & purification , Registries/statistics & numerical data , Risk Assessment/statistics & numerical data , SARS-CoV-2/genetics , SARS-CoV-2/immunology , United Kingdom/epidemiology
BACKGROUND: The more infectious SARS-CoV-2 lineage B.1.1.7 rapidly spread in Europe after December, 2020, and a concern that B.1.1.7 could cause more severe disease has been raised. Taking advantage of Denmark's high RT-PCR testing and whole genome sequencing capacities, we used national health register data to assess the risk of COVID-19 hospitalisation in individuals infected with B.1.1.7 compared with those with other SARS-CoV-2 lineages. METHODS: We did an observational cohort study of all SARS-CoV-2-positive cases confirmed by RT-PCR in Denmark, sampled between Jan 1 and March 24, 2021, with 14 days of follow-up for COVID-19 hospitalisation. Cases were identified in the national COVID-19 surveillance system database, which includes data from the Danish Microbiology Database (RT-PCR test results), the Danish COVID-19 Genome Consortium, the National Patient Registry, the Civil Registration System, as well as other nationwide registers. Among all cases, COVID-19 hospitalisation was defined as first admission lasting longer than 12 h within 14 days of a sample with a positive RT-PCR result. The study population and main analysis were restricted to the proportion of cases with viral genome data. We calculated the risk ratio (RR) of admission according to infection with B.1.1.7 versus other co-existing lineages with a Poisson regression model with robust SEs, adjusted a priori for sex, age, calendar time, region, and comorbidities. The contribution of each covariate to confounding of the crude RR was evaluated afterwards by a stepwise forward inclusion. FINDINGS: Between Jan 1 and March 24, 2021, 50 958 individuals with a positive SARS-CoV-2 test and at least 14 days of follow-up for hospitalisation were identified; 30 572 (60·0%) had genome data, of whom 10 544 (34·5%) were infected with B.1.1.7. 1944 (6·4%) individuals had a COVID-19 hospitalisation and of these, 571 (29·4%) had a B.1.1.7 infection and 1373 (70·6%) had an infection with other SARS-CoV-2 lineages. Although the overall number of hospitalisations decreased during the study period, the proportion of individuals infected with B.1.1.7 increased from 3·5% to 92·1% per week. B.1.1.7 was associated with a crude RR of hospital admission of 0·79 (95% CI 0·72-0·87; p<0·0001) and an adjusted RR of 1·42 (95% CI 1·25-1·60; p<0·0001). The adjusted RR was increased in all strata of age and calendar period-the two covariates with the largest contribution to confounding of the crude RR. INTERPRETATION: Infection with SARS-CoV-2 lineage B.1.1.7 was associated with an increased risk of hospitalisation compared with that of other lineages in an analysis adjusted for covariates. The overall effect on hospitalisations in Denmark was lessened due to a strict lockdown, but our findings could support hospital preparedness and modelling of the projected impact of the epidemic in countries with uncontrolled spread of B.1.1.7. FUNDING: None.
Subject(s)COVID-19/epidemiology , Hospitalization/statistics & numerical data , SARS-CoV-2/isolation & purification , Adolescent , Adult , COVID-19/diagnosis , COVID-19/therapy , COVID-19/transmission , COVID-19 Nucleic Acid Testing/statistics & numerical data , Child , Child, Preschool , Cohort Studies , Comorbidity , Denmark/epidemiology , Female , Genome, Viral/genetics , Humans , Infant , Infant, Newborn , Male , Middle Aged , RNA, Viral/genetics , RNA, Viral/isolation & purification , Risk Assessment/statistics & numerical data , SARS-CoV-2/genetics , SARS-CoV-2/pathogenicity , Whole Genome Sequencing/statistics & numerical data , Young Adult
INTRODUCTION: In daily practice management of psoriasis, evaluation of risk factors for infections is having a growing influence. Indeed, in psoriatic patients, risk of infections may be due to psoriasis itself, immunomodulatory therapy, and comorbidities that may increase this risk and patient hospitalization. AREAS COVERED: Given the greater understanding of psoriasis pathogenesis and the increasing number of treatment options, it is particularly important to customize therapy according to each, single patient; psoriasis features and comorbidities are also essential to tailor treatment goals. EXPERT OPINION: In this perspective, the current knowledge on the infectious risk in psoriatic patient, related to comorbidities, such as diabetes mellitus, cardiovascular disease, and chronic obstructive pulmonary, to 'special populations,' to chronic infections, such as latent tuberculosis, chronic hepatitis B and C, and HIV, and to the most recent Covid-19 pandemic scenario, is reviewed and discussed in order to suggest the most appropriate approach and achieve the best available therapeutic option.
Subject(s)COVID-19/prevention & control , Psoriasis/therapy , Risk Assessment/methods , SARS-CoV-2/isolation & purification , COVID-19/epidemiology , COVID-19/virology , Cardiovascular Diseases/epidemiology , Comorbidity , Humans , Pandemics , Psoriasis/epidemiology , Risk Assessment/statistics & numerical data , Risk Factors , SARS-CoV-2/physiology , Virus Diseases/epidemiology
PURPOSE OF REVIEW: As of June 2021, coronavirus disease 2019 (COVID-19) exceeded 180 million reported cases and was responsible for almost 4 million deaths globally. Asthma affects approximately 262 million people worldwide and is an important cause of morbidity and mortality. Presently, it appears asthma is neither associated with an increased risk of contracting COVID-19 nor with a risk of severe COVID-19 or COVID-19 related death. Regarding the severe asthma patients on biologics, questions remain. The purpose of this review is to discuss the evidence regarding the relationship between asthma, biologics and COVID-19. RECENT FINDINGS: The available evidence does not suggest that severe asthmatics on treatment with biologics have a higher risk of severe acute respiratory syndrome coronavirus 2 infection compared to the general population. It does not appear that they have a higher risk of severe disease or COVID-19 related death either. SUMMARY: This review suggests that treatment with biologics for severe asthma is safe and should be maintained during the COVID-19 pandemic. However, more studies are needed to address this question and the role of biological therapy on different asthma phenotypes.
Subject(s)Asthma/drug therapy , Biological Products/adverse effects , COVID-19/immunology , Immunologic Factors/adverse effects , SARS-CoV-2/immunology , Asthma/diagnosis , Asthma/immunology , Biological Products/administration & dosage , COVID-19/diagnosis , COVID-19/mortality , Humans , Immunologic Factors/administration & dosage , Risk Assessment/statistics & numerical data , Risk Factors , Severity of Illness Index
Subject(s)Asthma/epidemiology , COVID-19 , Diabetes Mellitus/epidemiology , Hospitalization/statistics & numerical data , Hypertension/epidemiology , Obesity/epidemiology , Body Mass Index , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/physiopathology , COVID-19/therapy , Comorbidity , Cost of Illness , Female , Humans , Israel/epidemiology , Male , Middle Aged , Prevalence , Risk Assessment/methods , Risk Assessment/statistics & numerical data , SARS-CoV-2/isolation & purification , Severity of Illness Index , Sex Factors
The Coronavirus Disease (COVID-19) pandemic imposed a high burden of morbidity and mortality. In COVID-19, direct lung parenchymal involvement and pulmonary microcirculation dysfunction may entail pulmonary hypertension (PH). PH and direct cardiac injury beget right ventricular dysfunction (RVD) occurrence, which has been frequently reported in COVID-19 patients; however, the prevalence of RVD and its impact on outcomes during COVID-19 are still unclear. This study aims to evaluate the prevalence of RVD and associated outcomes in patients with COVID-19, through a Systematic Review and Meta-Analysis. MEDLINE and EMBASE were systematically searched from inception to 15th July 2021. All studies reporting either the prevalence of RVD in COVID-19 patients or all-cause death according to RVD status were included. The pooled prevalence of RVD and Odds Ratio (OR) for all-cause death according to RVD status were computed and reported. Subgroup analysis and meta-regression were also performed. Among 29 studies (3813 patients) included, pooled prevalence of RVD was 20.4% (95% CI 17.1-24.3%; 95% PI 7.8-43.9%), with a high grade of heterogeneity. No significant differences were found across geographical locations, or according to the risk of bias. Severity of COVID-19 was associated with increased prevalence of RVD at meta-regression. The presence of RVD was found associated with an increased likelihood of all-cause death (OR 3.32, 95% CI 1.94-5.70). RVD was found in 1 out of 5 COVID-19 patients, and was associated with all-cause mortality. RVD may represent one crucial marker for prognostic stratification in COVID-19; further prospective and larger are needed to investigate specific management and therapeutic approach for these patients.
Subject(s)COVID-19/complications , Hospitalization/statistics & numerical data , Pandemics/statistics & numerical data , Ventricular Dysfunction, Right/epidemiology , COVID-19/mortality , COVID-19/therapy , COVID-19/virology , Cause of Death , Hospital Mortality , Humans , Prevalence , Prognosis , Risk Assessment/statistics & numerical data , Risk Factors , SARS-CoV-2/pathogenicity , Ventricular Dysfunction, Right/therapy , Ventricular Dysfunction, Right/virology
Subject(s)Betacoronavirus , Coronavirus Infections/transmission , Family Characteristics , Income , Occupational Diseases/etiology , Pneumonia, Viral/transmission , Workforce/economics , Black or African American/statistics & numerical data , Aged/statistics & numerical data , COVID-19 , Censuses , Coronavirus Infections/epidemiology , Female , Health Workforce/classification , Health Workforce/economics , Health Workforce/statistics & numerical data , Hispanic or Latino/statistics & numerical data , Humans , Income/classification , Income/statistics & numerical data , Industry/classification , Industry/statistics & numerical data , Male , Medically Uninsured/statistics & numerical data , Occupational Diseases/epidemiology , Occupations/classification , Occupations/statistics & numerical data , Pandemics , Pneumonia, Viral/epidemiology , Public Health , Risk Assessment/economics , Risk Assessment/statistics & numerical data , SARS-CoV-2 , Sex Distribution , United States/epidemiology , Workforce/classification , Workforce/statistics & numerical data
Background: Thymosin alpha 1 (Tα1) is widely used to treat patients with COVID-19 in China; however, its efficacy remains unclear. This study aimed to explore the efficacy of Tα1 as a COVID-19 therapy. Methods: We performed a multicenter cohort study in five tertiary hospitals in the Hubei province of China between December 2019 and March 2020. The patient non-recovery rate was used as the primary outcome. Results: All crude outcomes, including non-recovery rate (65/306 vs. 290/1,976, p = 0.003), in-hospital mortality rate (62/306 vs. 271/1,976, p = 0.003), intubation rate (31/306 vs. 106/1,976, p = 0.001), acute respiratory distress syndrome (ARDS) incidence (104/306 vs. 499/1,976, p = 0.001), acute kidney injury (AKI) incidence (26/306 vs. 66/1,976, p < 0.001), and length of intensive care unit (ICU) stay (14.9 ± 12.7 vs. 8.7 ± 8.2 days, p < 0.001), were significantly higher in the Tα1 treatment group. After adjusting for confounding factors, Tα1 use was found to be significantly associated with a higher non-recovery rate than non-Tα1 use (OR 1.5, 95% CI 1.1-2.1, p = 0.028). An increased risk of non-recovery rate associated with Tα1 use was observed in the patient subgroups with maximum sequential organ failure assessment (SOFA) scores ≥2 (OR 2.0, 95%CI 1.4-2.9, p = 0.024), a record of ICU admission (OR 5.4, 95%CI 2.1-14.0, p < 0.001), and lower PaO2/FiO2 values (OR 1.9, 95%CI 1.1-3.4, p = 0.046). Furthermore, later initiation of Tα1 use was associated with a higher non-recovery rate. Conclusion: Tα1 use in COVID-19 patients was associated with an increased non-recovery rate, especially in those with greater disease severity.
Subject(s)COVID-19 Drug Treatment , Respiratory Distress Syndrome/epidemiology , Thymalfasin/adverse effects , Adult , Aged , COVID-19/complications , COVID-19/diagnosis , COVID-19/mortality , Female , Hospital Mortality , Humans , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Logistic Models , Male , Middle Aged , Organ Dysfunction Scores , Prognosis , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/prevention & control , Retrospective Studies , Risk Assessment/statistics & numerical data , Thymalfasin/administration & dosage , Treatment Outcome
The rapid spread of the COVID-19 pandemic has raised huge concerns about the prospect of a major health disaster that would result in a huge number of deaths. This anxiety was largely fueled by the fact that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the disease, was so far unknown, and therefore an accurate prediction of the number of deaths was particularly difficult. However, this prediction is of the utmost importance for public health authorities to make the most reliable decisions and establish the necessary precautions to protect people's lives. In this paper, we present an approach for predicting the number of deaths from COVID-19. This approach requires modeling the number of infected cases using a generalized logistic function and using this function for inferring the number of deaths. An estimate of the parameters of the proposed model is obtained using a Particle Swarm Optimization algorithm (PSO) that requires iteratively solving a quadratic programming problem. In addition to the total number of deaths and number of infected cases, the model enables the estimation of the infection fatality rate (IFR). Furthermore, using some mild assumptions, we derive estimates of the number of active cases. The proposed approach was empirically assessed on official data provided by the State of Qatar. The results of our computational study show a good accuracy of the predicted number of deaths.
Subject(s)Algorithms , COVID-19/mortality , Forecasting/methods , SARS-CoV-2/pathogenicity , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/virology , COVID-19 Testing/statistics & numerical data , Child , Child, Preschool , Computer Simulation , Female , Humans , Infant , Infant, Newborn , Logistic Models , Male , Middle Aged , Mortality/trends , Pandemics/statistics & numerical data , Qatar/epidemiology , Risk Assessment/methods , Risk Assessment/statistics & numerical data , SARS-CoV-2/isolation & purification , Young Adult
BACKGROUND: Bedside experience and studies of critically ill patients with coronavirus disease 2019 (COVID-19) indicate COVID-19 to be a devastating multisystem disease. We aim to describe the incidence, associated variables, and outcomes of rhabdomyolysis in critically ill COVID-19 patients. MATERIALS AND METHODS: Data for all critically ill adult patients (≥18 years old) admitted to the ICU at a large academic medical center with confirmed COVID-19 between March 13, 2020 and April 18, 2020 were prospectively collected. Patients with serum creatine kinase (CK) concentrations greater than 1000 U/L were diagnosed with rhabdomyolysis. Patients were further stratified as having moderate (serum CK concentration 1000-4999 U/L) or severe (serum CK concentration ≥5000 U/L) rhabdomyolysis. Univariate and multivariate analyses were performed to identify outcomes and variables associated with the development of rhabdomyolysis. RESULTS: Of 235 critically ill COVID-19 patients, 114 (48.5%) met diagnostic criteria for rhabdomyolysis. Patients with rhabdomyolysis more often required mechanical ventilation (P < 0.001), prone positioning (P < 0.001), pharmacological paralysis (P < 0.001), renal replacement therapy (P = 0.010), and extracorporeal membrane oxygenation (ECMO) (P = 0.025). They also had longer median ICU length of stay (LOS) (P < 0.001) and hospital LOS (P < 0.001). No difference in mortality was observed. Male sex, patients with morbid obesity, SOFA score, and prone positioning were independently associated with rhabdomyolysis. CONCLUSIONS: Nearly half of critically ill COVID-19 patients in our cohort met diagnostic criteria for rhabdomyolysis. Male sex, morbid obesity, SOFA score, and prone position were independently associated with rhabdomyolysis.
Subject(s)COVID-19/complications , Obesity, Morbid/epidemiology , Rhabdomyolysis/epidemiology , Aged , Body Mass Index , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Comorbidity , Creatine Kinase/blood , Critical Illness , Female , Hospital Mortality , Humans , Incidence , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Middle Aged , Obesity, Morbid/complications , Obesity, Morbid/diagnosis , Organ Dysfunction Scores , Prone Position , Prospective Studies , Rhabdomyolysis/blood , Rhabdomyolysis/diagnosis , Rhabdomyolysis/etiology , Risk Assessment/statistics & numerical data , Risk Factors , SARS-CoV-2/isolation & purification , Sex Factors
Background Considering the widespread risk of collider bias and confounding by indication in previous research, the associations between renin-angiotensin aldosterone system (RAAS) inhibitor use and COVID-19 remain unknown. Accordingly, this study tested the hypothesis that RAAS inhibitors influence the summation effect of COVID-19 and its progression to severe outcomes. Methods and Results This nationwide cohort study compared all residents of Sweden, without prior cardiovascular disease, in monotherapy (as of January 1, 2020) with a RAAS inhibitor to those using a calcium channel blocker or a thiazide diuretic. Comparative cohorts were balanced using machine-learning-derived propensity score methods. Of 165 355 people in the analysis (51% women), 367 were hospitalized or died with COVID-19 (246 using a RAAS inhibitor versus 121 using a calcium channel blocker or thiazide diuretic; Cox proportional hazard ratio [HR], 0.97; 95% CI, 0.74-1.27). When each outcome was assessed separately, 335 people were hospitalized with COVID-19 (HR, 0.92; 95% CI, 0.70-1.22), and 64 died with COVID-19 (HR, 1.22; 95% CI, 0.68-2.19). The severity of COVID-19 outcomes did not differ between those using a RAAS inhibitor and those using a calcium channel blocker or thiazide diuretic (ordered logistic regression odds ratio, 1.01; 95% CI, 0.89-1.14). Conclusions Despite potential limitations, this study is among the best available evidence that RAAS inhibitor use in primary prevention does not increase the risk of severe COVID-19 outcomes; presenting strong data from which scientists and policy makers alike can base, with greater confidence, their current position on the safety of using RAAS inhibitors during the COVID-19 pandemic.
Subject(s)Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , COVID-19 , Hypertension/drug therapy , Risk Assessment , Aged , Antihypertensive Agents/classification , Antihypertensive Agents/therapeutic use , COVID-19/epidemiology , COVID-19/prevention & control , Calcium Channel Blockers/therapeutic use , Female , Humans , Hypertension/epidemiology , Hypertension/prevention & control , Male , Middle Aged , Outcome Assessment, Health Care , Renin-Angiotensin System/drug effects , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Sodium Chloride Symporter Inhibitors/therapeutic use , Sweden/epidemiology
INTRODUCTION: Severe COVID-19 illness in adults has been linked to underlying medical conditions. This study identified frequent underlying conditions and their attributable risk of severe COVID-19 illness. METHODS: We used data from more than 800 US hospitals in the Premier Healthcare Database Special COVID-19 Release (PHD-SR) to describe hospitalized patients aged 18 years or older with COVID-19 from March 2020 through March 2021. We used multivariable generalized linear models to estimate adjusted risk of intensive care unit admission, invasive mechanical ventilation, and death associated with frequent conditions and total number of conditions. RESULTS: Among 4,899,447 hospitalized adults in PHD-SR, 540,667 (11.0%) were patients with COVID-19, of whom 94.9% had at least 1 underlying medical condition. Essential hypertension (50.4%), disorders of lipid metabolism (49.4%), and obesity (33.0%) were the most common. The strongest risk factors for death were obesity (adjusted risk ratio [aRR] = 1.30; 95% CI, 1.27-1.33), anxiety and fear-related disorders (aRR = 1.28; 95% CI, 1.25-1.31), and diabetes with complication (aRR = 1.26; 95% CI, 1.24-1.28), as well as the total number of conditions, with aRRs of death ranging from 1.53 (95% CI, 1.41-1.67) for patients with 1 condition to 3.82 (95% CI, 3.45-4.23) for patients with more than 10 conditions (compared with patients with no conditions). CONCLUSION: Certain underlying conditions and the number of conditions were associated with severe COVID-19 illness. Hypertension and disorders of lipid metabolism were the most frequent, whereas obesity, diabetes with complication, and anxiety disorders were the strongest risk factors for severe COVID-19 illness. Careful evaluation and management of underlying conditions among patients with COVID-19 can help stratify risk for severe illness.
Subject(s)COVID-19 , Diabetes Complications , Hospitalization/statistics & numerical data , Multimorbidity , Noncommunicable Diseases/epidemiology , Obesity , Phobic Disorders , Age Factors , Aged , COVID-19/mortality , COVID-19/therapy , Comorbidity , Diabetes Complications/diagnosis , Diabetes Complications/epidemiology , Female , Humans , Male , Mortality , Obesity/diagnosis , Obesity/epidemiology , Phobic Disorders/diagnosis , Phobic Disorders/epidemiology , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Risk Factors , SARS-CoV-2 , Severity of Illness Index , United States/epidemiology
BACKGROUND: Children with cancer are not at increased risk of severe SARS-CoV-2 infection; however, adults with haematological malignancies have increased risk of severe infections compared with non-haematological malignancies. METHODS: We compared patients with haematological and non-haematological malignancies enrolled in the UK Paediatric Coronavirus Cancer Monitoring Project between 12 March 2020 and 16 February 2021. Children who received stem cell transplantation were excluded. RESULTS: Only 2/62 patients with haematological malignancy had severe/critical infections, with an OR of 0.5 for patients with haematological compared with non-haematological malignancies. INTERPRETATION: Children with haematological malignancies are at no greater risk of severe SARS-CoV-2 infection than those with non-haematological malignancies.