Ethnic disparities in COVID-19: increased risk of infection or severe disease?

The coronavirus disease 2019 (COVID-19; caused by SARS-CoV-2) pandemic has affected the healthcare system on a global scale, and we utilized the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2020 annual meeting to examine how COVID-19 might affect patients with psoriatic disease (PsD) and the clinicians who care for them. Pressing issues and concerns identified included whether having psoriasis increased the risk of acquiring COVID-19, vaccine safety, and the acceptability of telehealth. The general message from rheumatologists, dermatologists, infectious disease specialists, and patient research partners was that data did not suggest that having PsD or its treatment significantly increased risk of infection or more severe disease course, and that the telehealth experience was a success overall.

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Obesity is associated with severe disease and mortality in patients with coronavirus disease 2019 (COVID-19): a meta-analysis

BMC Public Health ◽

10.1186/s12889-021-11546-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zixin Cai ◽

Yan Yang ◽

Jingjing Zhang

Keyword(s):

Mechanical Ventilation ◽

Fixed Effects ◽

Web Of Science ◽

Meta Analysis ◽

Severe Disease ◽

Cochrane Library ◽

Risk Of Infection ◽

Icu Admission ◽

Increased Risk ◽

Nonobese Patients

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has led to global research to predict those who are at greatest risk of developing severe disease and mortality. The aim of this meta-analysis was to determine the associations between obesity and the severity of and mortality due to COVID-19. Methods We searched the PubMed, EMBASE, Cochrane Library and Web of Science databases for studies evaluating the associations of obesity with COVID-19. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random- or fixed-effects models. Meta-regression analyses were conducted to estimate regression coefficients. Results Forty-six studies involving 625,153 patients were included. Compared with nonobese patients, obese patients had a significantly increased risk of infection. (OR 2.73, 95% CI 1.53–4.87; I2 = 96.8%), hospitalization (OR 1.72, 95% CI 1.55–1.92; I2 = 47.4%), clinically severe disease (OR 3.81, 95% CI 1.97–7.35; I2 = 57.4%), mechanical ventilation (OR 1.66, 95% CI 1.42–1.94; I2 = 41.3%), intensive care unit (ICU) admission (OR 2.25, 95% CI 1.55–3.27; I2 = 71.5%), and mortality (OR 1.61, 95% CI 1.29–2.01; I2 = 83.1%). Conclusion Patients with obesity may have a greater risk of infection, hospitalization, clinically severe disease, mechanical ventilation, ICU admission, and mortality due to COVID-19. Therefore, it is important to increase awareness of these associations with obesity in COVID-19 patients.

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Comprehensive Testing Highlights Racial, Ethnic, and Age Disparities in the COVID-19 Outbreak: Epidemiological and Clinical Characteristic of Cases in Utah

10.1101/2020.05.05.20092031 ◽

2020 ◽

Cited By ~ 1

Author(s):

Sharia M Ahmed ◽

Rashmee U. Shah ◽

Margaret Bale ◽

Jordan B. Peacock ◽

Ben Berger ◽

...

Keyword(s):

Salt Lake ◽

Severe Disease ◽

Vital Signs ◽

Ethnic Disparities ◽

Population Level ◽

The United States ◽

Duration Of Symptoms ◽

University Of Utah ◽

Increased Risk ◽

Exposure Risks

AbstractThe United States (US), which is currently the epicenter for the COVID-19 pandemic, is a country whose demographic composition differs from that of other highly-impacted countries. US-based descriptions of SARS-CoV-2 infections have, for the most part, focused on patient populations with severe disease, captured in areas with limited testing capacity. The objective of this study is to compare characteristics of positive and negative SARS-CoV-2 patients, in a population primarily comprised of mild and moderate infections, identified from comprehensive population-level testing. Here, we extracted demographics, comorbidities, and vital signs from 20,088 patients who were tested for SARS-CoV-2 at University of Utah Health clinics, in Salt Lake County, Utah; and for a subset of tested patients, we performed manual chart review to examine symptoms and exposure risks. To determine risk factors for testing positive, we used logistic regression to calculate the odds of testing positive, adjusting for symptoms and prior exposure. Of the 20,088 individuals, 1,229 (6.1%) tested positive for SARS-CoV-2. We found that Non-White persons were more likely to test positive compared to non-Hispanic Whites (adjOR=1.1, 95% CI: 0.8, 1.6), and that this increased risk is more pronounced among Hispanic or Latino persons (adjOR=2.0, 95%CI: 1.3, 3.1). However, we did not find differences in the duration of symptoms nor type of symptom presentation between non-Hispanic White and non-White individuals. We found that risk of hospitalization increases with age (adjOR=6.9 95% CI: 2.1, 22.5 for age 60+ compared to 0-19), and additionally show that younger individuals (aged 019), were underrepresented both in overall rates of testing as well as rates of testing positive. We did not find major race/ethnic differences in hospitalization rates. In this analysis of predominantly non-hospitalized individuals tested for SARS-CoV-2, enabled by expansive testing capacity, we found disparities in both testing and SARS-CoV-2 infection status by race/ethnicity and by age. Further work on addressing racial and ethnic disparities, particularly among Hispanic/Latino communities (where SARS-CoV-2 may be spreading more rapidly due to increased exposure and comparatively reduced testing), will be needed to effectively combat COVID-19 in the US.

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Racial/Ethnic Disparities in COVID-19 Hospital Admissions

10.1101/2020.07.12.20152017 ◽

2020 ◽

Author(s):

Violeta Alvarez Retamales ◽

Oswaldo Madrid Suarez ◽

Odalys Estefania Lara-Garcia ◽

Suhayb Ranjha ◽

Ruby Maini ◽

...

Keyword(s):

Hospital Admission ◽

Hospital Admissions ◽

Severe Disease ◽

Ethnic Disparities ◽

Black Population ◽

Admission Data ◽

Asian Pacific Islander ◽

Increased Risk ◽

Asian Pacific ◽

Racial Ethnic

Importance: COVID-19 has affected millions of people worldwide. Furthermore, with its increasing incidence, more has been learned about the risk factors that can make certain groups more at risk of contracting the disease or have worse outcomes. We aim to identify any discrepancy in the hospitalization rate by race/ethnicity of patients who tested positive for COVID-19, and through this, analyze the risks of these groups in an effort to call out for attention to the circumstances that make them more vulnerable and susceptible to disease. Observations: Analysis indicates that patients identified as non-Hispanic White and Asian/Pacific Islander in hospital admission data are underrepresented in COVID-19 admissions. Patients identified as non-Hispanic Black, Hispanic/Latino, and American Indian have a disproportionate burden of hospital admissions, suggesting an increased risk of more severe disease. Conclusions and Relevance: There is a disproportionate rate of COVID-19 hospitalizations found among non-Hispanic Blacks. Further investigation is imperative to identify and remediate the reason(s) for increased vulnerability to COVID-19 infections requiring hospital admission. These efforts would likely reduce the COVID-19 morbidity and mortality in the non-Hispanic Black population.

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Obesity Is Associated with Severe Disease and Mortality in Patients with Coronavirus Disease 2019 (COVID-19)

10.21203/rs.3.rs-122534/v1 ◽

2020 ◽

Author(s):

Zixin Cai ◽

Yan Yang ◽

Jingjing Zhang

Keyword(s):

Fixed Effects ◽

Web Of Science ◽

Meta Analysis ◽

Severe Disease ◽

Cochrane Library ◽

Obese Patients ◽

Risk Of Infection ◽

Fixed Effects Models ◽

Increased Risk ◽

Nonobese Patients

Abstract Background: The coronavirus disease 2019 (COVID-19) pandemic has led to global research with the aim of predicting which people are at greatest risk of developing severe disease and dying. The aim of this meta-analysis was to determine the associations between obesity and the severity of and mortality due to COVID-19. Methods: We searched the PubMed, EMBASE, Cochrane Library and Web of Science databases for studies evaluating the associations of obesity with COVID-19 . Odd risks (ORs) and 95% confidence intervals (CIs) were calculated using random- or fixed-effects models. Results: Thirty-eight studies involving 621502 patients were included. Compared with nonobese patients, obese patients had a significantly increased risk of infection (OR 3.19, 95% CI 1.45-7.03; I2 = 98.3%), hospitalization (OR 1.77, 95% CI 1.61-1.95; I2 = 43.8%), clinically severe disease (OR 2.88, 95% CI 1.99-4.16; I2 = 49.9%), mechanical ventilation (OR 1.66, 95% CI1.42-1.94; I2 = 41.3%), intensive care unit (ICU) (OR 2.06, 95% CI1.49-2.85; I2 = 71.4%), and mortality (OR 1.48, 95% CI 1.18-1.85; I2 = 80.8%). Conclusion: Patients with obesity may have a greater risk of developing severe COVID-19 and dying. Therefore, it is important to increase awareness of these associations with obesity in COVID-19 patients.

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Faculty Opinions recommendation of CD4+CD28- T cell expansion in granulomatosis with polyangiitis (Wegener's) is driven by latent cytomegalovirus infection and is associated with an increased risk of infection and mortality.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718359875.793494224 ◽

2014 ◽

Author(s):

Florian Kern

Keyword(s):

T Cell ◽

Cell Expansion ◽

Cytomegalovirus Infection ◽

Granulomatosis With Polyangiitis ◽

Risk Of Infection ◽

Increased Risk ◽

T Cell Expansion

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1095. Investigation of Risk Factors Associated with Serious Bacterial, Viral and Invasive Fungal Infections in Hematologic Patients on Ibrutinib

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1281 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S576-S577

Author(s):

Thomas Holowka ◽

Harry Cheung ◽

Maricar F Malinis ◽

Sarah Perreault ◽

Iris Isufi ◽

...

Keyword(s):

Risk Factors ◽

Fungal Infections ◽

Antimicrobial Prophylaxis ◽

Hematologic Malignancy ◽

Invasive Fungal Infections ◽

Risk Of Infection ◽

Factors Associated ◽

Serious Infection ◽

Increased Risk ◽

Serious Infections

Abstract Background Ibrutinib is a tyrosine kinase inhibitor used to treat hematologic malignancies that may increase the risk of serious infection including invasive fungal infections (IFI). In a study of 378 patients with hematologic malignancy on ibrutinib, serious infection and IFI occurred in 11% and 4% respectively (Varughese et al. Clin Infect Dis). The primary aims of our study were to determine the incidence of serious infection and associated risk factors in patients on ibrutinib. Methods We performed a retrospective analysis of patients with hematologic malignancy prescribed ibrutinib for ≥ 1 week at Yale New Haven Hospital from 2014 to 2019 to identify serious infections defined as those requiring inpatient management. We collected demographic, clinical and oncologic data. Chi-squared tests were used to determine factors associated with an increased risk of infection. Results A total of 254 patients received ibrutinib including 156 with CLL, 89 with NHL and 9 with other leukemias. Among these, 21 underwent HSCT, 9 complicated by GVHD. There were 51 (20%) patients with serious infections including 45 (17.7%) bacterial, 9 (3.5%) viral and 5 (2%) IFI (1 pulmonary cryptococcosis, 4 pulmonary aspergillosis). Anti-mold prophylaxis was prescribed to 7 (2.8%) patients, none of whom developed IFI. Risk factors associated with serious infection included ECOG score ≥ 2 (OR 4.6, p < 0.001), concurrent steroid use (≥ 10 mg prednisone daily for ≥ 2 weeks; OR 3.0, p < 0.001), neutropenia (OR 3.6, p < 0.01), lymphopenia (OR 2.4, p < 0.05) and maximum ibrutinib dose of 560 mg (OR 2, p < 0.05). There was a dose dependent increase in infections based on number of chemotherapy regimens prior to ibrutinib initiation: 14.3% with 0, 19.7% with 1-2 and 28.7% with ≥ 3 prior treatments. Conclusion The incidence of serious infection in hematologic patients on ibrutinib was higher than previously reported (20% versus 11%) but the rate of IFI was lower (2% versus 4%). High ECOG score, leukopenia, steroids, and higher ibrutinib doses were associated with an increased risk for serious infection. Targeted antimicrobial prophylaxis should be considered for patients on ibrutinib with these risk factors. Improving functional status may also reduce the risk of infection in patients on ibrutinib. Disclosures All Authors: No reported disclosures

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Illness severity and risk of mental morbidities among patients recovering from COVID-19: a cross-sectional study in the Icelandic population

BMJ Open ◽

10.1136/bmjopen-2021-049967 ◽

2021 ◽

Vol 11 (7) ◽

pp. e049967

Author(s):

Karen Sól Saevarsdóttir ◽

Hildur Ýr Hilmarsdóttir ◽

Ingibjörg Magnúsdóttir ◽

Arna Hauksdóttir ◽

Edda Bjork Thordardottir ◽

...

Keyword(s):

Severe Disease ◽

Symptom Burden ◽

Cross Sectional Study ◽

Illness Severity ◽

University Education ◽

Adjusted Relative Risk ◽

Sectional Study ◽

Cross Sectional ◽

Symptoms Of Depression ◽

Increased Risk

ObjectiveTo test if patients recovering from COVID-19 are at increased risk of mental morbidities and to what extent such risk is exacerbated by illness severity.DesignPopulation-based cross-sectional study.SettingIceland.ParticipantsA total of 22 861 individuals were recruited through invitations to existing nationwide cohorts and a social media campaign from 24 April to 22 July 2020, of which 373 were patients recovering from COVID-19.Main outcome measuresSymptoms of depression (Patient Health Questionnaire), anxiety (General Anxiety Disorder Scale) and posttraumatic stress disorder (PTSD; modified Primary Care PTSD Screen for DSM-5) above screening thresholds. Adjusting for multiple covariates and comorbidities, multivariable Poisson regression was used to assess the association between COVID-19 severity and mental morbidities.ResultsCompared with individuals without a diagnosis of COVID-19, patients recovering from COVID-19 had increased risk of depression (22.1% vs 16.2%; adjusted relative risk (aRR) 1.48, 95% CI 1.20 to 1.82) and PTSD (19.5% vs 15.6%; aRR 1.38, 95% CI 1.09 to 1.75) but not anxiety (13.1% vs 11.3%; aRR 1.24, 95% CI 0.93 to 1.64). Elevated relative risks were limited to patients recovering from COVID-19 that were 40 years or older and were particularly high among individuals with university education. Among patients recovering from COVID-19, symptoms of depression were particularly common among those in the highest, compared with the lowest tertile of influenza-like symptom burden (47.1% vs 5.8%; aRR 6.42, 95% CI 2.77 to 14.87), among patients confined to bed for 7 days or longer compared with those never confined to bed (33.3% vs 10.9%; aRR 3.67, 95% CI 1.97 to 6.86) and among patients hospitalised for COVID-19 compared with those never admitted to hospital (48.1% vs 19.9%; aRR 2.72, 95% CI 1.67 to 4.44).ConclusionsSevere disease course is associated with increased risk of depression and PTSD among patients recovering from COVID-19.

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A novel box for aerosol and droplet guarding and evacuation in respiratory infection (BADGER) for COVID-19 and future outbreaks

Scientific Reports ◽

10.1038/s41598-021-82675-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hau D. Le ◽

Gordon A. Novak ◽

Kevin C. Janek ◽

Jesse Wang ◽

Khang N. Huynh ◽

...

Keyword(s):

Respiratory Infection ◽

Healthcare Providers ◽

Airborne Particles ◽

Risk Of Infection ◽

Indirect Contact ◽

Vacuum Suction ◽

Qualitative And Quantitative ◽

Additional Layer ◽

Increased Risk ◽

Design Construction

AbstractThe coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has infected millions and killed more than 1.7 million people worldwide as of December 2020. Healthcare providers are at increased risk of infection when caring for patients with COVID-19. The mechanism of transmission of SARS-CoV-2 is beginning to emerge as airborne spread in addition to direct droplet and indirect contact as main routes of transmission. Here, we report on the design, construction, and testing of the BADGER (Box for Aerosol and Droplet Guarding and Evacuation in Respiratory Infection), an affordable, scalable device that contains droplets and aerosol particles, thus minimizing the risk of infection to healthcare providers. A semi-sealed environment is created inside the BADGER, which is placed over the head of the patient and maintains at least 12-air changes per hour using in-wall vacuum suction. Multiple hand-ports enable healthcare providers to perform essential tasks on a patient’s airway and head. Overall, the BADGER has the potential to contain large droplets and small airborne particles as demonstrated by simulated qualitative and quantitative assessments to provide an additional layer of protection for healthcare providers treating COVID-19 and future respiratory contagions.

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