S. Ahmar Shah et al.
Impact of COVID-19 pandemic on asthma exacerbations: Retrospective cohort study of over 500,000 patients in a national English primary care database
The Lancet Regional Health - Europe, June 2022; doi.org/10.1016/j.lanepe.2022.100428
Several countries reported a substantial reduction in asthma exacerbations associated with COVID-19 pandemic-related restrictions. However, it is not known if these early reported declines were short-term and if these have rebounded to pre-pandemic levels following easing of lockdown restrictions.
We undertook a retrospective, cohort study of all asthma patients in a national primary care database of almost 10 million patients, Optimum Patient Care Database (OPCRD), identified from January 1, 2010, to December 31, 2015, using a previously validated algorithm. We subsequently followed the identified cohort of asthma patients from January 1, 2016, to October 3, 2021, and identified every asthma exacerbation episode with a validated algorithm. To quantify any pandemic-related change in exacerbations, we created a control time-series (mean of 2016-2019) and then compared the change in exacerbation rate in 2020-2021 over quarterly periods when compared with the control period (the pre-pandemic period). We undertook overall and stratified analyses by age group, sex, and English region.
We identified 100,362 asthma patients (502,669 patient-years) from across England who experienced at least one exacerbation episode (298,390 exacerbation episodes during the entire follow-up). Except for the first quarter of 2020, the exacerbation rates were substantially lower (>25%) during all quarters in 2020-2021 when compared with the rates during 2016-2019 (39.7% (95% Confidence Interval (CI): 34.6, 44.9) in quarter-2, 2020; 46.5% (95%CI: 36.7, 56.4) in quarter-3, 2020; 56.3% (95%CI: 48.7, 63.9) in quarter-4, 2020; 63.2% (95%CI: 53.9, 72.5) in quarter-1, 2021; 57.7% (95%CI: 52.9, 62.4) in quarter-2, 2021; 53.3% (95%CI: 43.8, 62.8) in quarter-3, 2021).
There was a substantial and persistent reduction in asthma exacerbations across England over the first 18 months after the first lockdown. This is unlikely to be adequately explained by changes in health-seeking behaviour, pandemic-related healthcare service disruption, or any air-quality improvements.
COVID-19 pandemic disturbs respiratory virus dynamics
The Lancet Respiratory Medicine, July 2022; doi.org/10.1016/ S2213-2600(22)00255-7
The winter months normally bring a higher number of respiratory viruses as people spend more time indoors together and the cold, dry air allows viruses to survive, and infect people, more easily. The last two winters, however, have been very different. During both the 2020–21 and 2021–22 winter seasons, rates of COVID-19 were high and people were physical distancing, and wearing masks. This meant that the rates of influenza, RSV, rhinovirus, and other respiratory viral infections were incredibly low compared with previous winters. But as we have entered the warmer summer months in 2022, when rates of respiratory viral infections would normally be very low or absent, some countries have seen unusual seasonal changes in the prevalence of RSV, influenza, and parainfluenza.
Publications Lancet Diabetes Endocrinol.
Prioritising COVID-19 over everything: the unintended harm
June 2022; doi: 10.1016/S2213-8587(21)00147-9
No abstract available
Amass et al.
Stress-Related Disorders of Family Members of Patients Admitted to the Intensive Care Unit With COVID-19
Jama Internal Medicine, April 2022; doi:10.1001/jamainternmed.2022.1118
Importance The psychological symptoms associated with having a family member admitted to the intensive care unit (ICU) during the COVID-19 pandemic are not well defined.
Objective To examine the prevalence of symptoms of stress-related disorders, primarily posttraumatic stress disorder (PTSD), in family members of patients admitted to the ICU with COVID-19 approximately 90 days after admission.
Design, Setting, and Participants This prospective, multisite, mixed-methods observational cohort study assessed 330 family members of patients admitted to the ICU (except in New York City, which had a random sample of 25% of all admitted patients per month) between February 1 and July 31, 2020, at 8 academic-affiliated and 4 community-based hospitals in 5 US states.
Exposure Having a family member in the ICU with COVID-19.
Main Outcomes and Measures Symptoms of PTSD at 3 months, as defined by a score of 10 or higher on the Impact of Events Scale 6 (IES-6).
Results A total of 330 participants (mean [SD] age, 51.2 [15.1] years; 228 [69.1%] women; 150 [52.8%] White; 92 [29.8%] Hispanic) were surveyed at the 3-month time point. Most individuals were the patients’ child (129 [40.6%]) or spouse or partner (81 [25.5%]). The mean (SD) IES-6 score at 3 months was 11.9 (6.1), with 201 of 316 respondents (63.6%) having scores of 10 or higher, indicating significant symptoms of PTSD. Female participants had an adjusted mean IES-6 score of 2.6 points higher (95% CI, 1.4-3.8; P < .001) than male participants, whereas Hispanic participants scored a mean of 2.7 points higher compared with non-Hispanic participants (95% CI, 1.0-4.3; P = .002). Those with graduate school experience had an adjusted mean score of 3.3 points lower (95% CI, 1.5-5.1; P < .001) compared with those with up to a high school degree or equivalent. Qualitative analyses found no substantive differences in the emotional or communication-related experiences between those with high vs low PTSD scores, but those with higher scores exhibited more distrust of practitioners.
Conclusions and Relevance In this cohort study, symptoms of PTSD among family members of ICU patients with COVID-19 were high. Hispanic ethnicity and female gender were associated with higher symptoms. Those with higher scores reported more distrust of practitioners.
Gatti et al
Clinical outcome in solid organ transplant recipients affected by COVID-19 compared to general population: a systematic review and meta-analysis
CONTENUTO E COMMENTO: Revisione sistematica e metanalisi degli outcome di pazienti con COVID-19 sottoposti a trapianto di organo solido, a confronto con la popolazione generale di trapiantati senza infezione : nessun eccesso di mortalità fra gli infetti, ma aumentato rischio di ricovero in Rianimazione e di insufficienza renale acuta.
Englum, B.R.; et al.
Impact of the COVID-19 pandemic on diagnosis of new cancers: A national multicenter study of the Veterans Affairs Healthcare System
CONTENUTO E COMMENTO: Studio sugli effetti del COVID-19 sulla diagnostica delle 4 principali neoplasie negli stati uniti (prostata, polmone, vescica e colon-retto). Si evidenzia nel 2020 una riduzione del numero delle procedure, specialmente le colonscopie, ma anche altre procedure invasive come le biopsie prostatiche e le cistoscopie, necessarie per la diagnosi delle relative neoplasie. Insieme al calo del numero di procedure si osserva una riduzione del numero di diagnosi.
Le conseguenze di questo trend negativo e dunque il ritardo diagnostico potrebbe portare ad un incremento della mortalità.
Grave C, et al.
Myocardial infarction throughout 1 year of the COVID-19 pandemic: French nationwide study of hospitalization rates, prognosis and 90-day mortality rates
Arch Cardiovasc Dis,
COMMENTO: Questo studio nazionale francese è il primo a indagare su tassi di ricovero per infarto nel corso del 2020 e ad esaminare le tendenze a livello nazionale nelle riammissioni e la mortalità per tutte le cause nei 90 giorni dopo il ricovero per infarto miocardico. C'è stato una significativa diminuzione dei ricoveri per infarto in Francia, come in molti paesi, durante la prima ondata della pandemia di COVID-19 all'inizio del 2020, soprattutto negli over-85 e negli NSTEMI. In questi ultimi si osserva un aumento di rotture cardiache e tassi di disturbi del ritmo e della conduzione che potrebbe essere correlato a maggiori ritardi nella gestione o alla selezione dei casi più gravi di NSTEMI, tuttavia senza un aumento dei tassi di mortalità. Uno dei limiti di questo studio è che non viene indagato il tasso di decessi tra coloro che sono deceduti a casa, senza arrivare all’attenzione dei sanitari. Resteranno da valutare le complicanze croniche di questo fenomeno.
Liu Y, et al.
Dilemma and solutions of treatment delay in cancer patients during the COVID-19 pandemic: A single-center, prospective survey
Asia Pac J Clin Oncol, https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajco.13724
CONTENUTO E COMMENTO: Il COVID-19 ha posto di fronte ai sanitari un’enorme sfida nella gestione dei malati di cancro. In questo studio, tra i vari risultati emerge quanto i pazienti oncologici abbiano un forte senso di autoprotezione e un grande desiderio di cura. Purtroppo durante il periodo di studio (corrispondente al periodo iniziale della pandemia) un ritardo nel trattamento oncologico di oltre 1 settimana è stato registrato nel 41,8% (59/141) dei pazienti arruolati.
Ting Shi et al.
The Lancet Respiratory Medicine
Risk of COVID-19 hospital admission among children aged 5–17 years with asthma in Scotland: a national incident cohort study
The Lancet Respiratory Medicine, https://www.thelancet.com/action/showPdf?pii=S2213-2600%2821%2900491-4
CONTENUTO: Studio retrospettivo di coorte condotto in Scozia con l’obiettivo di identificare quali bambini tra i 5 e i 17 anni affetti da asma erano a maggiore rischio di malattia severa da COVID-19. Analizzando i dati di sorveglianza raccolti tra marzo 2020 e luglio 2021 dei bambini con asma (circa 60mila), di questi il 6.8% ha avuto un’infezione da SARS-Cov-2. Il tasso di ricovero ospedaliero dovuto a COVID-19 era più alto nei bambini con asma scarsamente controllata (che avevano cioè un precedente ricovero o avevano effettuato.
COMMENTO: Lavoro interessante che offre l’opportunità di sottolineare alcuni punti chiave sul tema asma e COVID-19 in età pediatrica.
- Le patologie respiratorie croniche e l’asma non rappresentano un fattore di rischio per insorgenza di infezione di SARS-CoV-2 o per una maggiore gravità della malattia anche se i ricoveri ospedalieri aumentano nei casi di asma severa magari in fase di scarso controllo; le patologie allergiche sembrano svolgere un ruolo protettivo.
- In corso di pandemia da SARS-CoV-2 i soggetti asmatici non hanno motivo di sospendere le terapie in atto, per evitare riacutizzazione di sintomi e prevenire recidive. Per patologie più gravi come l’asma allergico grave persistente, l’orticaria cronica spontanea e la DA grave, l’AIFA ha consentito di prolungare la durata dei piani terapeutici per i farmaci biologici.
- Per ridurre il rischio di contagio in ambiente ospedaliero, è stato proposto di implementare l’utilizzo della telemedicina con consulti medici periodici (contatti telefonici o videochiamate).
- In merito alla vaccinazione dei soggetti in età pediatrica affetti da asma, questi dovrebbero essere considerati fragili, ovvero avere un accesso prioritario per la vaccinazione solo in caso di asma severo o refrattario ai trattamenti.
OnCovid Study Group
Time-Dependent COVID-19 Mortality in Patients With Cancer: An Updated Analysis of the OnCovid Registry
CONTENUTO : Case series multicentrica su pazienti con diagnosi di infezione da SARS-CoV-2 e neoplasia solida o ematologica inseriti nel registro europeo OnCovid, con l’obiettivo di valutare l’andamento di gravità clinica e mortalità da COVID-19 nei pazienti oncologici nel corso della pandemia.Lo studio dimostra che i pazienti diagnosticati durante la prima ondata (febbraio-giugno 2020) presentavano un rischio di mortalità a 14 giorni e a 3 mesi significativamente maggiore rispetto ai pazienti diagnosticati durante la seconda ondata (luglio 2020-febbraio 2021).
COMMENTO: Questo studio di ampie dimensioni (perché condotto sul registro europeo OnCovid) e di tipo multicentrico, ha valutato l’impatto in termini prognostici (gravità clinica e malattia) dell’infezione da SARS-CoV-2 e la presenza di una neoplasia d’organo o ematologica. Quanto emerge è che l’impatto negativo di questa infezione, è risultata maggiore nel corso della prima ondata rispetto alle altre, il che è più che comprensibile dal momento che le strutture sanitarie di tutta Europa sono state per così dire travolte dalla comparsa di questa nuova infezione/malattia.
Horiuchi S, et al.
Immune memory from SARS-CoV-2 infection in hamsters provides variant-independent protection but still allows virus transmission
CONTENUTO : Studio su modello animale esplorante la risposta immunitaria in seguito a re-infezione da diverse varianti. Tale esperimento dimostra che, in caso di re-infezione, la risposta cellulare B e T di tipo adattativo si rivela efficace nel controllare l’infezione, a prescindere dalla variante, ma non riesce a bloccare la trasmissione del virus sia su animali « naive » che su animali sieroconvertiti.
COMMENTO :Questo lavoro sperimentale conferma quello che già è stato dimostrato nell’uomo, e cioè che le risposte dell’immunità adattativa dei linfociti B e T specifici per SARS-CoV-2, generata in seguito ad una precedente infezione, proteggono molto bene dalla malattia severa (che porta a volte a morte) determinata da una reinfezione con diverse varianti SARS-CoV-2, ma non dalla reinfezione se i topi venivano sottoposti ad un ulteriore « challenge » di infezione. Se trasliamo questi dati nelle strategie vaccinali nell’uomo, essi supportano la necessità della terza dose per incrementare la risposta immunitaria protettiva specifica che permetta il controllo delle infezioni da parte delle varianti e la susseguente memoria a lunog termine.
Causey K et al
Estimating global and regional disruptions to routine childhood vaccine coverage during the COVID-19 pandemic in 2020: a modelling study
The Lancet, July 2021; DOI: 10.1016/S0140-6736(21)01337-4
COMMENTO : Background : The COVID-19 pandemic and efforts to reduce SARS-CoV-2 transmission substantially affected health services worldwide. To better understand the impact of the pandemic on childhood routine immunisation, we estimated disruptions in vaccine coverage associated with the pandemic in 2020, globally and by Global Burden of Disease (GBD) super-region.
Methods : For this analysis we used a two-step hierarchical random spline modelling approach to estimate global and regional disruptions to routine immunisation using administrative data and reports from electronic immunisation systems, with mobility data as a model input. Paired with estimates of vaccine coverage expected in the absence of COVID-19, which were derived from vaccine coverage models from GBD 2020, Release 1 (GBD 2020 R1), we estimated the number of children who missed routinely delivered doses of the third-dose diphtheria-tetanus-pertussis (DTP3) vaccine and first-dose measles-containing vaccine (MCV1) in 2020.
Findings : Globally, in 2020, estimated vaccine coverage was 76·7% (95% uncertainty interval 74·3–78·6) for DTP3 and 78·9% (74·8–81·9) for MCV1, representing relative reductions of 7·7% (6·0–10·1) for DTP3 and 7·9% (5·2–11·7) for MCV1, compared to expected doses delivered in the absence of the COVID-19 pandemic. From January to December, 2020, we estimated that 30·0 million (27·6–33·1) children missed doses of DTP3 and 27·2 million (23·4–32·5) children missed MCV1 doses. Compared to expected gaps in coverage for eligible children in 2020, these estimates represented an additional 8·5 million (6·5–11·6) children not routinely vaccinated with DTP3 and an additional 8·9 million (5·7–13·7) children not routinely vaccinated with MCV1 attributable to the COVID-19 pandemic. Globally, monthly disruptions were highest in April, 2020, across all GBD super-regions, with 4·6 million (4·0–5·4) children missing doses of DTP3 and 4·4 million (3·7–5·2) children missing doses of MCV1. Every GBD super-region saw reductions in vaccine coverage in March and April, with the most severe annual impacts in north Africa and the Middle East, south Asia, and Latin America and the Caribbean. We estimated the lowest annual reductions in vaccine delivery in sub-Saharan Africa, where disruptions remained minimal throughout the year. For some super-regions, including southeast Asia, east Asia, and Oceania for both DTP3 and MCV1, the high-income super-region for DTP3, and south Asia for MCV1, estimates suggest that monthly doses were delivered at or above expected levels during the second half of 2020.
Interpretation : Routine immunisation services faced stark challenges in 2020, with the COVID-19 pandemic causing the most widespread and largest global disruption in recent history. Although the latest coverage trajectories point towards recovery in some regions, a combination of lagging catch-up immunisation services, continued SARS-CoV-2 transmission, and persistent gaps in vaccine coverage before the pandemic still left millions of children under-vaccinated or unvaccinated against preventable diseases at the end of 2020, and these gaps are likely to extend throughout 2021. Strengthening routine immunisation data systems and efforts to target resources and outreach will be essential to minimise the risk of vaccine-preventable disease outbreaks, reach children who missed routine vaccine doses during the pandemic, and accelerate progress towards higher and more equitable vaccination coverage over the next decade.
Patel SY et al
Diabetes Care and Glycemic Control During the COVID-19 Pandemic in the United States
JAMA, July 2021; doi:10.1001/jamainternmed.2021.3047
COMMENTO: There were 1 357 029 and 1 364 522 adults with diabetes in the 2019 and 2020 cohorts, respectively, with similar baseline characteristics. In 2019, 0.3% of cohort had 1 or more telemedicine visit, compared with 29.1% of the 2020 cohort during the pandemic period.
Seagle EE et al
The landscape of candidemia during the COVID-19 pandemic
CID, June 2021; doi.org/10.1093/cid/ciab562
COMMENTO : Background : The COVID-19 pandemic has resulted in unprecedented healthcare challenges, and COVID-19 has been linked to secondary infections. Candidemia, a fungal healthcare-associated infection, has been described in patients hospitalized with severe COVID-19. However, studies of candidemia and COVID-19 co-infection have been limited in sample size and geographic scope. We assessed differences in patients with candidemia with and without a COVID-19 diagnosis.
Methods : We conducted a case-level analysis using population-based candidemia surveillance data collected through the Centers for Disease Control and Prevention’s Emerging Infections Program during April–August 2020 to compare characteristics of candidemia patients with and without a positive test for COVID-19 in the 30 days before their Candida culture using chi-square or Fisher exact tests.
Results : Of the 251 candidemia patients included, 64 (25.5%) were positive for SARS-CoV-2. Liver disease, solid organ malignancies, and prior surgeries were each >3 times more common in patients without COVID-19 co-infection, whereas intensive care unit-level care, mechanical ventilation, having a central venous catheter, and receipt of corticosteroids and immunosuppressants were each >1.3 times more common in patients with COVID-19. All cause in-hospital fatality was two times higher among those with COVID-19 (62.5%) than without (32.1%).
Conclusions : One quarter of candidemia patients had COVID-19. These patients were less likely to have certain underlying conditions and recent surgery commonly associated with candidemia and more likely to have acute risk factors linked to COVID-19 care, including immunosuppressive medications. Given the high mortality, it is important for clinicians to remain vigilant and take proactive measures to prevent candidemia in patients with COVID-19.
Lepak AJ et al
Association of Changes in Seasonal Respiratory Virus Activity and Ambulatory Antibiotic Prescriptions With the COVID-19 Pandemic
JAMA, June 2021 ; DOI: 10.1001/jamainternmed.2021.2621
COMMENTO: The COVID-19 pandemic led to numerous measures to mitigate the spread of SARS-CoV-2, including cancellations of gatherings, closure of businesses and schools, social distancing, wearing face masks, and other hygiene measures.1 These may have unintended positive associations with reducing other respiratory infections. As antibiotics are frequently inappropriately prescribed for viral respiratory diseases,2 we hypothesized that a decreased respiratory virus incidence would be associated with reduced ambulatory antibiotic orders.
Solomon MD et al
Changes in Patterns of Hospital Visits for Acute Myocardial Infarction or Ischemic Stroke During COVID-19 Surges
JAMA, June 2021; doi:10.1001/jama.2021.8414
COMMENTO : In contrast to the initial COVID-19 surgeduring March to April 2020 in the US and to recent data from the UK, no significant declines in AMI hospitalization or stroke alerts were observed during the largest and mostre centsurge duringOctober 2020 to January 2021 in KPNC. A modest decline was observed for stroke alertsduring the summer COVID-19 surge but quickly rebounded.
Wu CT et al
SARS-CoV-2 infects human pancreatic β-cells and elicits β-cell impairment
Cell Metabolism, May 2021 ; doi.org/10.1016/j.cmet.2021.05.013
COMMENTO : Emerging evidence points towards an intricate relationship between the pandemic of coronavirus disease 2019 (COVID-19) and diabetes. While pre-existing diabetes is associated with severe COVID-19, it is unclear if COVID-19 severity is a cause or consequence of diabetes. To mechanistically link COVID-19 to diabetes, we tested whether insulin-producing pancreatic β-cells can be infected by SARS-CoV-2 and cause β-cell depletion. We found that the SARS-CoV-2 receptor, ACE2 and related entry factors (TMPRSS2, NRP1, TRFC) are expressed in β-cells, with selectively high expression of NRP1. We discovered that SARS-CoV-2 infects human pancreatic β-cells in patients who succumbed to COVID-19 and selectively infects human islet β-cells in vitro. We demonstrated SARS-CoV-2 infection attenuates pancreatic insulin levels and secretion, and induces β-cell apoptosis, each rescued by NRP1 inhibition. Phosphoproteomic pathway analysis of infected islets indicates apoptotic β-cell signaling, similar to that observed in Type 1 diabetes (T1D). In summary, our study shows SARS-CoV-2 can directly induce β-cell killing.
Bodilsen J et al
Hospital admission and mortality rates for non-covid diseases in Denmark during covid-19 pandemic: nationwide population based cohort study
BMJ, May 2021 ; doi.org/10.1136/bmj.n1135
COMMENTO: Objective To determine the incidence of hospital admissions and associated mortality rates for non-covid medical conditions during the covid-19 pandemic.
Design Nationwide, population based cohort study.
Setting Denmark from 13 March 2019 to 27 January 2021.
Participants All Danish residents >1 year of age.
Main outcomes measures Population based healthcare registries that encompass the entire Danish population were used to compare hospital admission and mortality rates during the covid-19 pandemic (from 11 March 2020 to 27 January 2021) with the prepandemic baseline data (from 13 March 2019 to 10 March 2020). Hospital admissions were categorised as covid-19 when patients were assigned a diagnosis code for covid-19 within five days of admission. All patients were followed until migration, death, or end of follow-up, whichever came first. Rate ratios for hospital admissions were computed using Poisson regression and were directly standardised using the Danish population on 1 January 2019 as reference. 30 day mortality rate ratios were examined by Cox regression, adjusted for age and sex, and covid-19 diagnosis was used as a competing risk.
Results 5 753 179 residents were identified during 567.8 million person weeks of observation, with 1 113 705 hospital admissions among 675 447 people. Compared with the prepandemic baseline period (mean hospital admission rate 204.1 per 100 000/week), the overall hospital admission rate for non-covid-19 conditions decreased to 142.8 per 100 000/week (rate ratio 0.70, 95% confidence interval 0.66 to 0.74) after the first national lockdown, followed by a gradual return to baseline levels until the second national lockdown when it decreased to 158.3 per 100 000/week (0.78, 0.73 to 0.82). This pattern was mirrored for most major diagnosis groups except for non-covid-19 respiratory diseases, nervous system diseases, cancer, heart failure, sepsis, and non-covid-19 respiratory infections, which remained lower throughout the study period. Overall 30 day mortality rates were higher during the first national lockdown (mortality rate ratio 1.28, 95% confidence interval 1.23 to 1.32) and the second national lockdown (1.20, 1.16 to 1.24), and these results were similar across most major diagnosis groups. For non-covid-19 respiratory diseases, cancer, pneumonia, and sepsis, the 30 day mortality rate ratios were also higher between lockdown periods.
Conclusions Hospital admissions for all major non-covid-19 disease groups decreased during national lockdowns compared with the prepandemic baseline period. Additionally, mortality rates were higher overall and for patients admitted to hospital with conditions such as respiratory diseases, cancer, pneumonia, and sepsis. Increased attention towards management of serious non-covid-19 medical conditions is warranted.
Natori Y et al
When is it Safe to perform Abdominal Transplantation in patients with prior SARS-CoV-2 infection: A Case Series
Clinical Transplantation, May 2021 ; DOI: 10.1111/ctr.14370
COMMENT0: BACKGROUND: The Coronavirus disease 2019(COVID-19) pandemic has negatively impacted worldwide organ transplantation. However, there is limited information on recipients transplanted after SARS-CoV-2 infection. A full understanding of this scenario is required, as transplantation is a lifesaving procedure and COVID-19 remains an ongoing threat. METHODS: Abdominal organ transplant recipients diagnosed with COVID-19 prior to transplantation were identified by chart review and clinical data was collected. The primary outcome was the transplant outcome including graft loss, rejection and death, and reactivation of infection posttransplant. RESULTS: We identified 14 patients who received abdominal organ transplants after symptomatic PCR confirmed SARS-CoV-2 infection; four patients had a positive PCR at the time of admission for transplantation. The median time of follow-up was 79 (22-190) days. One recipient with negative PCR before transplant tested positive 9 days after transplant. One of 14 transplanted patients developed disseminated mold infection and died 86 days after transplant. During follow-up, only one patient developed rejection; thirteen patients had favorable graft outcomes. CONCLUSIONS: We were able to perform abdominal transplantation for patients with COVID-19 before transplant, even with positive PCR at the time of transplant. Larger studies are needed to determine the time to safe transplant after SARS-CoV-2 infection.
Lei H et al
Higher mortality in lung cancer patients with COVID-19? A systematic review and meta-analysis
Lung Cancer, May 2021; doi.org/10.1016/j.lungcan.2021.05.002
COMMENTO : OBJECTIVE: Given that the coronavirus disease 2019 (COVID-19) mainly spreads through the respiratory system and is associated with severe pulmonary complications, lung cancer patients may have worse outcomes than those with other tumors. There is no confirmed evidence about the mortality comparison between COVID-19 patients with lung cancer and other tumors. We performed a systematic review and pooled analysis to provide precise estimates of the mortality rate of COVID-19 patients with lung cancer and othertumors. MATERIALS AND METHODS: Our study systemically included and reviewed 13 studies on the characteristics of COVID-19 patients with lung cancer published up to November 1, 2020. The primary endpoint was all-cause mortality. We also compared the all-cause mortality rates in China and other regions as a secondary endpoint. The mortality rate was assessed with a fixed-effects model, which was used to derive the pooled mortality and 95 % con fi dence interval (CI). RESULTS: Thirteen studies from different countries, involving 1,229 patients with both COVID-19 and cancer, were selected for the pooled analysis. A total of 343 deaths were recorded in this population: 86 for lung cancers and 257 for other tumors. The mortality rate varies from 18 % to 60 % for patients with lung cancer and COVID-19 and 10%-41% for other tumor patients with COVID-19. The overall meta-analysis did not show a significant mortality difference for the lung cancer and other tumor subgroups (OR = 1.47, 95 %CI = 0.98-2.20, p = 0.06, I(2) = 23 %). Nevertheless, in regions other than China, the pooled mortality of lung cancer patients with COVID-19 was 42 %, which was significantly higher than that of other tumors (24 %) (OR = 2.73, 95 % CI = 1.54-4.86, p = 0.0006, I(2) = 16 %). CONCLUSION: Appropriate and aggressive preventive measures should be implemented to reduce the risk of COVID-19 in patients with cancer and optimally manage those who contract the infection.
Salto-Alejandre S et al
Risk factors for unfavorable outcome and impact of early post-transplant infection in solid organ recipients with COVID-19: A prospective multicenter cohort study
PloS One, April 2021 ; doi.org/10.1371/journal.pone.0250796
COMMENTO: The aim was to analyze the characteristics and predictors of unfavorable outcomes in solid organ transplant recipients (SOTRs) with COVID-19. We conducted a prospective observational cohort study of 210 consecutive SOTRs hospitalized with COVID-19 in 12 Spanish centers from 21 February to 6 May 2020. Data pertaining to demographics, chronic underlying diseases, transplantation features, clinical, therapeutics, and complications were collected. The primary endpoint was a composite of intensive care unit (ICU) admission and/or death. Logistic regression analyses were performed to identify the factors associated with these unfavorable outcomes. Males accounted for 148 (70.5%) patients, the median age was 63 years, and 189 (90.0%) patients had pneumonia. Common symptoms were fever, cough, gastrointestinal disturbances, and dyspnea. The most used antiviral or host-targeted therapies included hydroxychloroquine 193/200 (96.5%), lopinavir/ritonavir 91/200 (45.5%), and tocilizumab 49/200 (24.5%). Thirty-seven (17.6%) patients required ICU admission, 12 (5.7%) suffered graft dysfunction, and 45 (21.4%) died. A shorter interval between transplantation and COVID-19 diagnosis had a negative impact on clinical prognosis. Four baseline features were identified as independent predictors of intensive care need or death: advanced age, high respiratory rate, lymphopenia, and elevated level of lactate dehydrogenase. In summary, this study presents comprehensive information on characteristics and complications of COVID-19 in hospitalized SOTRs and provides indicators available upon hospital admission for the identification of SOTRs at risk of critical disease or death, underlining the need for stringent preventative measures in the early post-transplant period.
Haffner MR et al
Postoperative In-Hospital Morbidity and Mortality of Patients With COVID-19 Infection Compared With Patients Without COVID-19 Infection
JAMA, April 2021; doi:10.1001/jamanetworkopen.2021.5697
COMMENTO : A total of 5470 surgical patients with positive COVID-19 test results were matched with 5470 surgical patients with negative COVID-19 test results during the same study period. Among all hospitals, there were more than double the number of deaths reported in the cohort of patients with COVID-19 (811 [14.8%]) compared with the cohort of patients without COVID-19 (388 [7.1%]) (P < .001). The rates of complications listed in the Vizient Clinical Data Base (818 [15.0%] vs 760 [13.9%]; P = .11) and median length of stay (10.0 [interquartile range (IQR), 1.3-36.4] vs 10.7 [IQR, 1.0-558.0] days; P = .86) did not differ significantly between the 2 groups. However, hospital-acquired conditions (110 [2.0%] vs 46 [0.8%]; P < .001) and patient safety indicators (183 [3.3%] vs 129 [2.4%]; P = .002) were higher in patients with COVID-19.
Within each hospital ownership type (public, private, nonprofit), more deaths occurred in the group with COVID-19 compared with the group without COVID-19 in public hospitals (146 [15.8%] vs 46 [4.8%]; P < .001) and nonprofit hospitals (631 [14.7%] vs 326 [7.5%]; P < .001), but not in private hospitals (34 [14.1%] vs 16 [9.4%]; P = .15). Among surgical patients with COVID-19, there were no differences in mortality rates, complications listed in the Vizient Clinical Data Base, hospital-acquired conditions, or patient safety indicators among public, private, or nonprofit hospitals.
Pasquel FJ et al
Characteristics of and Mortality Associated With Diabetic Ketoacidosis Among US Patients Hospitalized With or Without COVID-19
JAMA, March 2021 ; doi:10.1001/jamanetworkopen.2021.1091
COMMENTO: Diabetic ketoacidosis (DKA) is a life-threatening, acute complication of diabetes. Despite an increase in DKA hospitalization rates, the age-adjusted DKA in-hospital case-fatality rate has declined over time. However, with the advent of coronavirus disease 2019 (COVID-19), a suspected increase in the frequency and severity of DKA has been hypothesized because of the potential diabetogenic effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To further characterize patients with DKA with and without COVID-19, we analyzed individual-level inpatient data from multiple US hospitals.
Huls A et al
Medical vulnerability of individuals with down syndrome to severe COVID-19 – data from the trisomy 21 research society and the UK ISARIC4C survey
EClinicalMedicine – The Lancet, February 2021; doi.org/10.1016/j.eclinm.2021.100769
COMMENTO : Background : Health conditions, immune dysfunction, and premature aging associated with trisomy 21 (Down syndrome, DS) may impact the clinical course of COVID-19.
Methods : The T21RS COVID-19 Initiative launched an international survey for clinicians or caregivers on patients with COVID-19 and DS. Data collected between April and October 2020 (N=1046) were analysed and compared with the UK ISARIC4C survey of hospitalized COVID-19 patients with and without DS.
Findings : The mean age of COVID-19 patients with DS in the T21RS survey was 29 years (SD = 18). Similar to the general population, the most frequent signs and symptoms of COVID-19 were fever, cough, and shortness of breath. Joint/muscle pain and vomiting or nausea were less frequent (p < 0.01), whereas altered consciousness/confusion were more frequent (p < 0.01). Risk factors for hospitalization and mortality were similar to the general population with the addition of congenital heart defects as a risk factor for hospitalization. Mortality rates showed a rapid increase from age 40 and were higher in patients with DS (T21RS DS versus non-DS patients: risk ratio (RR) = 3.5 (95%-CI=2.6;4.4), ISARIC4C DS versus non-DS patients: RR = 2.9 (95%-CI=2.1;3.8)) even after adjusting for known risk factors for COVID-19 mortality.
Interpretation : Leading signs/symptoms of COVID-19 and risk factors for severe disease course are similar to the general population. However, individuals with DS present significantly higher rates of medical complications and mortality, especially from age 40.
Neuroimmunology Brazilian Study Group Focused on COVID-19 and MS
Incidence and clinical outcome of Coronavirus disease 2019 in a cohort of 11,560 Brazilian patients with multiple sclerosis
Multiple Sclerosis Journal, 2 Febrary 2021; DOI: 10.1177/1352458520978354
COMMENTO: Background:Little information is available regarding the incidence and clinical outcome of the SARS-CoV2 infection in patients with multiple sclerosis (pwMS).
Objective:To determine the incidence, clinical outcome, and impact of COVID-19 on pwMS.
Methods:This observational study was prospectively performed on a cohort of pwMS (N = 11,560) followed up by 47 out of 51 Brazilian MS referral centers that registered pwMS with COVID-19 at the REDONE platform from 13 March to 4 June 2020.
Results:The incidence of COVID-19 for pwMS patients was 27.7/10,000 patients and for the general population was 29.2/10,000 inhabitants. A total of 94 (77 women) pwMS patients, aged 40 ± 10.25 years, presenting 9.9 ± 8.6 years of MS disease duration, developed the COVID-19, most of them (87%) exhibited the mild form of the disease. Eighty (96%) patients maintained the use of MS disease-modifying treatment (DMT) during COVID-19 pandemic and 14 patients were not in use of DMTs.
Conclusion:Incidence of COVID-19 in Brazilian pwMS was not different from those observed for the general Brazilian population. Most pwMS exhibited mild COVID-19, despite the maintenance of the underlying MS treatment.
COVID-19 measures also suppress flu—for now
Science, 15 January 2021; DOI: 10.1126/science.371.6526.224
COMMENTO: Influenza forecasters are a cautious bunch. Flu cases can spike in late winter after months of low infection rates, making experts reluctant to predict a mild season too soon. But many are ready to declare that COVID-19 control measures have dramatically tamped down the flu and other respiratory viruses that would normally be ripping through the Northern Hemisphere.
Sharma A et al
Clinical characteristics and outcomes of COVID-19 in haematopoietic stem-cell transplantation recipients: an observational cohort study
The Lancet, 19 January 2021; doi.org/10.1016/S2352-3026(20)30429-4
COMMENTO: Background : Haematopoietic stem-cell transplantation (HSCT) recipients are considered at high risk of poor outcomes after COVID-19 on the basis of their immunosuppressed status, but data from large studies in HSCT recipients are lacking. This study describes the characteristics and outcomes of HSCT recipients after developing COVID-19.
Methods : In response to the pandemic, the Center for International Blood and Marrow Transplant Research (CIBMTR) implemented a special form for COVID-19-related data capture on March 27, 2020. All patients—irrespective of age, diagnosis, donor type, graft source, or conditioning regimens—were included in the analysis with data cutoff of Aug 12, 2020. The main outcome was overall survival 30 days after a COVID-19 diagnosis. Overall survival probabilities were calculated using Kaplan-Meier estimator. Factors associated with mortality after COVID-19 diagnosis were examined using Cox proportional hazard models.
Findings : 318 HSCT recipients diagnosed with COVID-19 were reported to the CIBMTR. The median time from HSCT to COVID-19 diagnosis was 17 months (IQR 8–46) for allogeneic HSCT recipients and 23 months (8–51) for autologous HSCT recipients. The median follow-up of survivors was 21 days (IQR 8–41) for allogeneic HSCT recipients and 25 days (12–35) for autologous HSCT recipients. 34 (18%) of 184 allogeneic HSCT recipients were receiving immunosuppression within 6 months of COVID-19 diagnosis. Disease severity was mild in 155 (49%) of 318 patients, while severe disease requiring mechanical ventilation occurred in 45 (14%) of 318 patients—ie, 28 (15%) of 184 allogeneic HSCT recipients and 17 (13%) of 134 autologous HSCT recipients. At 30 days after the diagnosis of COVID-19, overall survival was 68% (95% CI 58–77) for recipients of allogeneic HSCT and 67% (55–78) for recipients of autologous HSCT. Age 50 years or older (hazard ratio 2·53, 95% CI 1·16–5·52; p=0·020); male sex (3·53; 1·44–8·67; p=0·006), and development of COVID-19 within 12 months of transplantation (2·67, 1·33–5·36; p=0·005) were associated with a higher risk of mortality among allogeneic HSCT recipients, and a disease indication of lymphoma was associated with a higher risk of mortality compared with plasma cell disorder or myeloma (2·41, [1·08–5·38]; p=0·033) in autologous HSCT recipients.
Interpretation : Recipients of autologous and allogeneic HSCT who develop COVID-19 have poor overall survival. These data emphasise the need for stringent surveillance and aggressive treatment measures in HSCT recipients who develop COVID-19.