ABSTRACT
BackgroundIndividuals with immune dysfunction, including people with HIV (PWH) or solid organ transplant recipients (SOT), might have worse outcomes from COVID-19. We compared odds of COVID-19 outcomes between patients with and without immune dysfunction. MethodsWe evaluated data from the National COVID-19 Cohort Collaborative (N3C), a multicenter retrospective cohort of electronic medical record (EMR) data from across the United States, on. 1,446,913 adult patients with laboratory-confirmed SARS-CoV-2 infection. HIV, SOT, comorbidity, and HIV markers were identified from EMR data prior to SARS-CoV-2 infection. COVID-19 disease severity within 45 days of SARS-CoV-2 infection was classified into 5 categories: asymptomatic/mild disease with outpatient care; mild disease with emergency department (ED) visit; moderate disease requiring hospitalization; severe disease requiring ventilation or extracorporeal membrane oxygenation (ECMO); and death. We used multivariable, multinomial logistic regression models to compare odds of COVID-19 outcomes between patients with and without immune dysfunction. FindingsCompared to patients without immune dysfunction, PWH and SOT had a greater likelihood of having ED visits (adjusted odds ratio [aOR]: 1.28, 95% confidence interval [CI] 1.27-1.29; aOR: 2.61, CI: 2.58-2.65, respectively), requiring ventilation or ECMO (aOR: 1.43, CI: 1.43-1.43; aOR: 4.82, CI: 4.78-4.86, respectively), and death (aOR: 1.20, CI: 1.19-1.20; aOR: 3.38, CI: 3.35-3.41, respectively). Associations were independent of sociodemographic and comorbidity burden. Compared to PWH with CD4>500 cells/mm3, PWH with CD4<350 cells/mm3 were independently at 4.4-, 5.4-, and 7.6-times higher odds for hospitalization, requiring ventilation, and death, respectively. Increased COVID-19 severity was associated with higher levels of HIV viremia. InterpretationIndividuals with immune dysfunction have greater risk for severe COVID-19 outcomes. More advanced HIV disease (greater immunosuppression and HIV viremia) was associated with higher odds of severe COVID-19 outcomes. Appropriate prevention and treatment strategies should be investigated to reduce the higher morbidity and mortality associated with COVID-19 among PWH and SOT.
ABSTRACT
ObjectiveTo characterize the SARS-CoV-2 testing cascade and associated barriers in three US states. MethodsWe recruited participants from Florida, Illinois, and Maryland ([~]1000/state) for an online survey September 16 - October 15, 2020. The survey covered demographics, COVID-19 symptoms, and experiences around SARS-CoV-2 PCR testing in the prior 2 weeks. Logistic regression was used to analyze associations with outcomes of interest. ResultsOverall, 316 (10%) of 3,058 respondents wanted/needed a test in the two weeks prior to the survey. Of these, 166 (53%) were able to get tested and 156 (94%) received results; 53% waited [≥] 8 days to get results from when they wanted/needed a test. There were no significant differences by state. Among those wanting/needing a test, getting tested was significantly less common among men (aOR: 0.46) and those reporting black race (aOR: 0.53) and more common in those reporting recent travel (aOR: 3.35). ConclusionsThere is an urgent need for a national communication strategy on who should get tested and where one can get tested. Additionally, measures need to be taken to improve access and reduce turn-around-time.
ABSTRACT
BackgroundLimited prior data suggest that pre-existing liver disease was associated with adverse outcomes among patients with COVID-19. FIB-4 is a noninvasive index of readily available laboratory measurements that represents hepatic fibrosis. The association of FIB-4 with COVID-19 outcomes has not been previously evaluated. MethodsFIB-4 was evaluated at admission in a cohort of 267 patients admitted with early-stage COVID-19 confirmed through RT-PCR. Hazard of ventilator use and of high-flow oxygen was estimated using Cox regression models controlled for covariates. Risk of progress to severe cases and of death/prolonged hospitalization (>30 days) were estimated using logistic regression models controlled for same covariates. ResultsForty-one (15%) patients progressed to severe cases, 36 (14%) required high-flow oxygen support, 10 (4%) required mechanical ventilator support, and 1 died. Patients with high FIB-4 score (>3.25) were more likely to be older with pre-existing conditions. FIB-4 between 1.45-3.25 was associated with over 5-fold (95% CI: 1.2-28) increased hazard of high-flow oxygen use, over 4-fold (95% CI: 1.5-14.6) increased odds of progress to severe stage, and over 3-fold (95% CI: 1.4-7.7) increased odds of death or prolonged hospitalization. FIB-4>3.25 was associated with over 12-fold (95% CI: 2.3-68. 7) increased hazard of high-flow oxygen use and over 11-fold (95% CI: 3.1-45) increased risk of progress to severe disease. All associations were independent of sex, number of comorbidities, and inflammatory markers (D-dimer, C-reactive protein). ConclusionsFIB-4 at early-stage of COVID-19 disease had an independent and dose-dependent association with adverse outcomes during hospitalization. FIB-4 provided significant prognostic value to adverse outcomes among COVID-19 patients.
ABSTRACT
BackgroundCurrent mitigation strategies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rely on population-wide adoption of non-pharmaceutical interventions (NPIs). Collecting demographically and geographically resolved data on NPIs and their association with SARS-CoV-2 infection history can provide critical information related to reopening geographies. MethodsWe sampled 1,030 individuals in Maryland from June 17 - June 28, 2020 to capture socio-demographically and geographically resolved information about NPI adoption, access to SARS-CoV-2 testing, and examine associations with self-reported SARS-CoV-2 positivity. ResultsMedian age of the sample was 43 years and 45% were men; Whites and Blacks/African Americans represented 60% and 23%, respectively. Overall, 96% of the sample reported traveling outside their home for non-employment related services: most commonly cited reasons were essential services (92%) and visiting friends/family (66%). Use of public transport was reported by 18% of respondents. 68% reported always social distancing indoors and 53% always wearing masks indoors; indoor social distancing was significantly less common among younger vs. older individuals, and race/ethnicity and income were significantly associated with mask use (p<0.05 for all). 55 participants (5.3%) self-reported ever testing positive for SARS-CoV-2 with strong dose-response relationships between movement frequency and SARS-CoV-2 positivity that were significantly attenuated by social distancing. In multivariable analysis, history of SARS-CoV-2 infection was negatively associated with the practice of social distancing (adjusted Odd Ratio [aOR]: 0.10; 95% Confidence Interval: 0.03 - 0.33); the only travel associated with higher likelihood of SARS-CoV-2 infection was use of public transport (aOR for [≥]7 times vs. never: 4.29) and visiting a place of worship (aOR for [≥]3 times vs. never: 16.0) after adjusting for social distancing. ConclusionsUsing a rapid cost-efficient approach, we highlight the role of movement and social distancing on SARS-CoV-2 transmission risk. Continued monitoring of NPI uptake, access to testing, and the subsequent impact on SARS-CoV-2 transmission will be critical for pandemic control and decisions about reopening geographies. Key PointsO_ST_ABSWhat we didC_ST_ABSO_LIWe utilized an online survey approach to sample residents of Maryland consistent with the distributions of age, gender, race/ethnicity, and income in the state. C_LIO_LIWe asked questions about places (and the frequency) visited for essential and nonessential services in the prior 2 weeks, practice of non-pharmaceutical interventions (NPIs) while visiting various places, and access to SARS-CoV-2 testing. C_LIO_LIWe characterized how movement and adoption of NPIs differed by key demographics (age, race, gender, income) and how these were associated with self-reported SARS-CoV-2 positivity. C_LI What we foundO_LI96% of the sample reported traveling for either essential or non-essential services in the prior 2 weeks; 82% reported traveling for non-essential services. C_LIO_LIThe adoption of NPIs varied by age, race/ethnicity, and income. C_LIO_LISelf-reported SARS-CoV-2 positivity was highest among Latinos followed by Blacks/African Americans and then Whites. C_LIO_LIThe more frequently a person traveled/visited places for non-essential services, the more likely they were to report ever having tested positive for SARS-CoV-2. C_LIO_LIThe strict practice of social distancing was associated with a lower likelihood of ever having tested positive for SARS-CoV-2; moreover, strict social distancing attenuated the association between most forms of movement and SARS CoV-2 positivity C_LIO_LIUsing public transport and attending places of worship remained associated with a higher likelihood of having tested positive for SARS-CoV-2 even when practicing social distancing. C_LIO_LIAbout 70% of people who wanted a SARS-CoV-2 test were able to get a test but there were delays of a week or more from wanting a test to getting a result among the majority of the sample. C_LI What it meansO_LIThe more people move the more likely they are to test positive for SARS-CoV-2; if you must travel, practice social distancing as it reduces the likelihood of testing positive. C_LIO_LIAvoid public transport to the extent possible. C_LIO_LIStrategies to reduce time from wanting a test to getting a result are critical to enhance early case detection and isolation to curb transmission. C_LI
