RESUMO
BackgroundSevere Covid19 is characterised by a hyperactive immune response. Carnitine, an essential nutrient, and its derivative acetyl-carnitine can downregulate proinflammatory cytokines and has been suggested as a potential treatment for the disease. MethodsWe carried out Mendelian randomization analyses using publicly available data from a large genome wide association study (GWAS) of metabolites and a collaborative genome wide study of Covid19 to investigate the nature of the relationship between carnitine and acetyl-carnitine and Covid19 infection, hospitalisation with Covid19 and very severe Covid19. We used the same methodology to determine whether carnitine was associated with co-morbidities commonly found among those with severe Covid19. ResultsWe found evidence of a protective effect against very severe Covid19 for both carnitine and acetyl-carnitine, with around a 40% reduction in risk associated with a doubling of carnitine or acetyl-carnitine (carnitine odds ratio (OR) = 0.56, 95% confidence intervals (CI) 0.33 to 0.95, p=0.03 and acetyl-carnitine OR=0.60, 95% CI 0.35 to 1.02, p=0.06), and evidence of protective effects on hopitalisation with Covid19. For acetyl-carnitine the largest protective effect was seen in the comparison between those hospitalised with Covid19 and those infected but not hospitalised (OR=0.34, 95%CI 0.18 to 0.62, p=0.0005). ConclusionCarnitine and acetyl-carnitine merit further investigation in respect to the prevention of severe Covid19.
RESUMO
ObjectivesTo estimate occupation risk from Covid19 among teachers and others working in schools using publicly available data on mortality in England and Wales. DesignAnalysis of national death registration data from the Office for National Statistics. SettingEngland and Wales, March 20th to 28th December 2020, during the Covid19 pandemic. ParticipantsThe total working age population in England and Wales plus those still working aged over 65. Primary and Secondary outcomesDeath with Covid19 as a primary outcome and death from all causes as a secondary outcome. ResultsAcross occupational groups there was a strong correlation between Covid19 mortality and both non-Covid19 and all-cause mortality. The absolute mortality rates for deaths with Covid19 were low amongst those working in schools (from 10 per 100,000 in female primary school teachers to 39 per 100,000 male secondary school teachers) relative to many other occupations (range: 10 to 143 per 100,000 in men; 9 to 50 per 100,000 in women).There was weak evidence that secondary school teachers had slightly higher risks of dying with Covid19 compared to the average for all working aged people, but stronger evidence of a higher risk compared to the average for all professionals; primary school teachers had a lower risk. All-cause mortality was also higher amongst all teachers compared to all professionals. Teaching and lunchtime assistants were not at higher risk of death from Covid19 compared with all working aged people. ConclusionThere was weak evidence that Covid19 mortality risk for secondary school teachers was above expectation, but in general school staff had Covid19 mortality risks which were proportionate to their non-covid mortality risk. Strengths and limitations of this studyO_LIWe used routinely collected data on all deaths in England and Wales;, which are near-complete and not susceptible to serious ascertainment biases. C_LIO_LIWe were able to compare mortality data for teachers and other school workers with all other occupational groups and with the working-age population. C_LIO_LIThe number of deaths due to Covid19 were small and thus differences between the specific occupational groups were imprecisely estimated. C_LIO_LIWe did not have access to individual level mortality data so were not able to account for potential confounders such as comorbidities or household size. C_LIO_LIFor those working in school aged over 65 we had neither mortality rates per 100,000 nor total numbers within the group; we only had number of deaths and a 5-year average and we do not know whether the denominators have changed for this group over the last 5 years. C_LI
