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Background: Severe outcomes of COVID-19 are associated with advancing age, and multiple medical comorbidities. The impact of COVID-19 on the clinical course of patients with cirrhosis has not been well studied. We determined the effect of SARS-CoV-2 infection on the hospitalization and survival rates of patients with cirrhosis. Method(s): Using ICD-10-CM codes, we identified all Veterans with a diagnosis of cirrhosis in the VA Corporate Data Warehouse and COVID-19 Shared Data Resource. Study cohort included Veterans who were tested for SARS-CoV-2 and had no history of organ transplantation or malignancies. Each SARS-CoV-2 positive case was propensity-score matched by demographics and comorbidities with up to two SARS-CoV-2 negative controls. The primary endpoints were acute care hospitalization, admission to intensive care, respiratory support, or death. Result(s): Of 1,115,037 individuals tested for SARS-CoV-2, 31,680 were noted to have cirrhosis and among them 5,047 (16%) were SARS-CoV-2 positive. After exclusions and propensity-score matching, 5,047 SARS-CoV-2 positive and 9,913 propensity score matched SARS-CoV-2 negative individuals were included in the analysis cohort. Median age was 67 years, 95% were men and 25% were of black race. Median BMI was 30 and history of hypertension, diabetes, cardiovascular and chronic pulmonary disease was noted among 81%, 54%, 56% and 32% respectively. Among all cirrhotic individuals, SARS-CoV-2 positive individuals less frequently progressed to hepatic decompensation (3.1% vs 4.8%, P< 0.0001) or hospitalization (35.7% vs 38.2%, P=0.002), but more frequently required ICU admission 15% vs 12.2%, P< 0.0001) or respiratory support (7.3% vs 8.4%, P=0.01). Among those admitted, length of hospital stay was longer among SARS-CoV-2 positive individuals (7 vs 4 days, P< 0.0001). In Cox regression analysis, SARS-CoV-2 positivity was associated with a higher risk of all-cause mortality (HR 1.37, 95% CI 1.19,1.56). Conclusion(s): Although patients with cirrhosis and COVID-19 were less often hospitalized, they had longer duration of hospitalization and were at higher risk of severe or critical illness and death. (Figure Presented).
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Background: Nirmatrelvir/ritonavir (NMV/r) was granted Emergency Use Authorization in December 2021 for treatment of early symptomatic patients with mild to moderate COVID-19 at high risk of progression. However, its benefit is specific population subgroups remains unclear. Method(s): We used a matched cohort design to emulate a target trial within the VA COVID-19 Shared Data Resource database. Eligible individuals were those with at least two episodes of care in the VA in the last 2 years, who had a first confirmed SARS-CoV-2 infection between January 1 and August 31, 2022 and were free of hospitalization or death within 3 days of testing positive. Those hospitalized in the previous 60-days and those who received Molnupiravir after diagnosis were ineligible. Among the eligible individuals, we matched those prescribed NMV/r with those not prescribed NMV/r within 3 days of diagnosis. Controls were matched 1:1 on age (5-year blocks), race, sex, body mass index, Charlson Comorbidity Index, VA facility where NMV/r was prescribed, and vaccination status. Our primary outcome measure was hospitalization or death within 30 days of the index COVID-19 diagnosis date. Result(s): Among 90,432 persons with a confirmed first SARS-CoV-2 positive test, 68,236 persons met the eligibility criteria. Of those, 4,886 were prescribed NMV/r. Final primary analysis dataset included 4,148 matched pairs of NMV/r treated cases and controls. The incidence of hospitalization or death was significantly lower among those who were prescribed NMV/r overall (73 vs. 109 events;ARD [95% CI] -0.87 [-1.49 to -0.25]), for those older than 60 years (60 vs. 88 events;ARD [95% CI] -1.05 [-1.93 to -0.18]), for unvaccinated/incomplete primary series (ARD -1.88 [-3.54 to -0.22]), and those asymptomatic at baseline (ARD -1.96 [-3.00 to -0.92]). Those who were <60 years old, vaccinated with or without a booster, and those symptomatic at baseline did not experience a significant benefit. Conclusion(s): NMV/r use is associated with a modest but statistically significant reduction in hospitalization or death among previously uninfected, nonhospitalized population with COVID-19 who are at a high risk of progression to severe disease. The benefit is evident in older, unvaccinated, asymptomatic persons and those with certain comorbidities. But not in younger, vaccinated, and symptomatic persons.
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Background: Clinical benefit of Molnupiravir (MPV) in COVID-19 infected subpopulations is unclear. Method(s): We used a matched cohort design emulating a target trial to analyze the VA COVID-19 Shared Resource database to determine the association of MPV with hospitalization or death within 30 days compared with untreated controls in previously uninfected non-hospitalized persons. Incidence of hospitalization/ death and absolute risk difference (ARD) with 95% confidence intervals were calculated for the treated and untreated groups. Result(s): Among 1,459 matched pairs, the incidence of hospitalization/death was not different among MPV treated vs. untreated controls (48 vs. 44 cases;ARD [95% CI] 0.27 [-0.94,1.49]). No benefit was observed among those >60 or <60 years old (ARD 0.27 [-1.25,1.79] vs. -0.29 [-1.22,1.80]), those with specific comorbidities, or by vaccination status. A significant benefit was observed in asymptomatic but not in symptomatic persons (ARD -2.80 [-4.74,-0.87] vs. 1.12 [-0.31,2.55]). Kaplan-Meier curves did not show a significant reduction in proportion of persons who were hospitalized or died among those treated with MPV compared with untreated controls (logrank P=0.7). Conclusion(s): MPV was not associated with a significant reduction in hospitalization or death within 30 days of COVID-19 diagnosis overall. A subgroup of patients presenting without symptoms experienced a benefit.
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Background: The role of remdesivir in hospitalized patients with COVID-19 is not clear. Some studies have demonstrated improved clinical outcomes and reduced mortality, while others have failed to show a benefit. Method(s): We used the Department of Veterans Affairs' (VA) national COVID-19 Shared Data Resource database to identify confirmed SARS-CoV-2 infected Veterans between July 1, 2020 and December 31, 2021 who were hospitalized and received remdesivir and propensity-score matched controls who had not received remdesivir. Variables for propensity-score matching included demographics, comorbidities, time and location of diagnosis/admission, severity of illness, and use of other potential COVID-19 therapeutics. Primary outcome of interest was 28-day mortality in the entire matched cohort, and among subgroups stratified by use of supplemental oxygen. Result(s): Among 238,298 SARS-CoV-2 infected Veterans, 31,632 were hospitalized, and 13,147 received remdesivir. Our final dataset included 3,583 remdesivir recipients and 3,583 propensity-score matched controls. Probability of survival at 28 days overall was higher in those who had received remdesivir (P=0.032). Remdesivir recipients had better survival among the group who received supplemental oxygen but did not require mechanical ventilation (P=0.005). Conclusion(s): Remdesivir demonstrated a survival benefit among hospitalized patients with COVID-19 which was limited to those who received supplemental oxygen but did not require mechanical ventilation.
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Since the COVID-19 pandemic, businesses have faced unprecedented challenges when trying to remain open. Because COVID-19 spreads through aerosolized droplets, businesses were forced to distance their services;in some cases, distancing may have involved moving business services online. In this work, we explore digitization strategies used by small businesses that remained open during the pandemic, and survey/interview small businesses owners to understand preliminary challenges associated with moving online. Furthermore, we analyze payments from 400K businesses across Japan, Australia, United States, Great Britain, and Canada. Following initial government interventions, we observe (at minimum for each country) a 47% increase in digitizing businesses compared to pre-pandemic levels, with about 80% of surveyed businesses digitizing in under a week. From both our quantitative models and our surveys/interviews, we find that businesses rapidly digitized at the start of the pandemic in preparation of future uncertainty. We also conduct a case-study of initial digitization in the United States, examining finer relationships between specific government interventions, business sectors, political orientation, and resulting digitization shifts. Finally, we discuss the implications of rapid & widespread digitization for small businesses in the context of usability challenges and interpersonal interactions, while highlighting potential shifts in pre-existing social norms. © 2022 Owner/Author.
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Background: The COVID-19 first surfaced when cluster of pneumonia patients arose in Wuhan, Hubei Province, China. Although the current gold standard for COVID-19 diagnosis is reverse transcriptase-polymerase chain reaction (RT-PCR), chest x-ray (CXR) and computed tomography (CT) play a vital role in sickness diagnosis due to their limited sensitivity and availability. Aim: To evaluate retrospectively the role of CXR, the main radiological findings in it and its diagnostic accuracy in COVID-19 pneumonia. Methods: This is a cross sectional study involving 264 PCR positive COVID-19 patients with their clinical-epidemiological findings admitted at Ziauddin Hospital from May-July 2020. CXRs were taken as digital radiographs in our emergency department's isolation wards using the same portable X-ray device, according to local norms. CXRs were taken in two directions: antero-posterior (AP) and postero-anterior (PA). The hospitals' database had all of the images. To determine the number of radiological findings, multiple radiologists on duty completed an independent and retrospective examination of each CXR. In the event of disagreement, a mutual agreement was reached. SPSS version 20 was used for statistical analysis. Results: We were able to find 264 patients who met our criteria. With a mean age of 56.4214.89, the majority of individuals were determined to be males 189(71.6%) and females 75(28.4%). (Range of 16 to 87 years). 127 patients (48.1%) had severe illness symptoms and were admitted to the ICU, while the remaining 102(38.6%) had mild to moderate disease 35(13.3%). Diffuse (29.2%) and middle and lower co-existing distribution (25.8%) whereas just lower lobe (13.3%) were the most common predominance in severity. Peripheral involvement was also seen in (8.7%) cases. Conclusion: Both lungs are equally affected with the disease having the consolidation and opacifications while the effusion is the major complication in the severe cases. Diffuse involvement of the lung lobes is seen in the study followed by the middle and lower lobe involvement.