Failure of chronic hydroxychloroquine in preventing severe complications of COVID-19 in patients with rheumatic diseases

Abstract Objective To compare baseline characteristics, clinical presentations, and outcomes of patients with rheumatic conditions requiring hospitalization for COVID-19 who received chronic hydroxychloroquine to those who did not receive chronic hydroxychloroquine. Methods We identified all patients with a rheumatologic disease who were admitted with COVID-19 to two hospitals in New York City between March 3-April 30 2020. Patients who received chronic hydroxychloroquine prior to admission were matched 1:2 (±10 years of age) to patients who did not receive chronic hydroxychloroquine. We compared demographics, comorbidities, hydroxychloroquine dosages, concurrent medications, presentations, and outcomes between the groups. Results There were 14 patients receiving hydroxychloroquine and 28 matched control subjects. The median age of cases was 63 years (IQR 43–73) and 60 years (IQR 41–75) for controls. Control subjects had a higher prevalence of pulmonary diseases (42.8%), diabetes (35.7%), and obesity (35.7%) than their case counterparts (28.6%, 14.3%, and 7.1%, respectively). A higher proportion of case than control subjects (50% vs.s 25%) reported usage of prednisone for their rheumatic conditions prior to admission. Despite these differences in baseline characteristics, univariate logistic regression revealed no statistically significant differences in the need for mechanical ventilation (OR 1.5; 95% CI: 0.34–6.38) or in-hospital mortality (OR 0.77; 95% CI: 0.13–4.56). Conclusion Hydroxychloroquine therapy in individuals with rheumatic conditions was not associated with less severe presentations of COVID-19 among hospitalized patients compared with individuals with rheumatic conditions not receiving hydroxychloroquine.

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Coronavirus 2019 and People Living With Human Immunodeficiency Virus: Outcomes for Hospitalized Patients in New York City

Clinical Infectious Diseases ◽

10.1093/cid/ciaa880 ◽

2020 ◽

Vol 71 (11) ◽

pp. 2933-2938 ◽

Cited By ~ 6

Author(s):

Keith Sigel ◽

Talia Swartz ◽

Eddye Golden ◽

Ishan Paranjpe ◽

Sulaiman Somani ◽

...

Keyword(s):

New York ◽

Human Immunodeficiency Virus ◽

Mechanical Ventilation ◽

New York City ◽

York City ◽

Cumulative Incidence ◽

Clinical Characteristics ◽

Hiv Status ◽

Immunodeficiency Virus ◽

Race Ethnicity

Abstract Background There are limited data regarding the clinical impact of coronavirus disease 2019 (COVID-19) on people living with human immunodeficiency virus (PLWH). In this study, we compared outcomes for PLWH with COVID-19 to a matched comparison group. Methods We identified 88 PLWH hospitalized with laboratory-confirmed COVID-19 in our hospital system in New York City between 12 March and 23 April 2020. We collected data on baseline clinical characteristics, laboratory values, HIV status, treatment, and outcomes from this group and matched comparators (1 PLWH to up to 5 patients by age, sex, race/ethnicity, and calendar week of infection). We compared clinical characteristics and outcomes (death, mechanical ventilation, hospital discharge) for these groups, as well as cumulative incidence of death by HIV status. Results Patients did not differ significantly by HIV status by age, sex, or race/ethnicity due to the matching algorithm. PLWH hospitalized with COVID-19 had high proportions of HIV virologic control on antiretroviral therapy. PLWH had greater proportions of smoking (P < .001) and comorbid illness than uninfected comparators. There was no difference in COVID-19 severity on admission by HIV status (P = .15). Poor outcomes for hospitalized PLWH were frequent but similar to proportions in comparators; 18% required mechanical ventilation and 21% died during follow-up (compared with 23% and 20%, respectively). There was similar cumulative incidence of death over time by HIV status (P = .94). Conclusions We found no differences in adverse outcomes associated with HIV infection for hospitalized COVID-19 patients compared with a demographically similar patient group.

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Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study

BMJ ◽

10.1136/bmj.m1966 ◽

2020 ◽

pp. m1966 ◽

Cited By ~ 375

Author(s):

Christopher M Petrilli ◽

Simon A Jones ◽

Jie Yang ◽

Harish Rajagopalan ◽

Luke O’Donnell ◽

...

Keyword(s):

Heart Failure ◽

New York ◽

Mechanical Ventilation ◽

New York City ◽

Cohort Study ◽

Critical Illness ◽

Hospital Admission ◽

York City ◽

Hospice Care ◽

Male Sex

AbstractObjectiveTo describe outcomes of people admitted to hospital with coronavirus disease 2019 (covid-19) in the United States, and the clinical and laboratory characteristics associated with severity of illness.DesignProspective cohort study.SettingSingle academic medical center in New York City and Long Island.Participants5279 patients with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection between 1 March 2020 and 8 April 2020. The final date of follow up was 5 May 2020.Main outcome measuresOutcomes were admission to hospital, critical illness (intensive care, mechanical ventilation, discharge to hospice care, or death), and discharge to hospice care or death. Predictors included patient characteristics, medical history, vital signs, and laboratory results. Multivariable logistic regression was conducted to identify risk factors for adverse outcomes, and competing risk survival analysis for mortality.ResultsOf 11 544 people tested for SARS-Cov-2, 5566 (48.2%) were positive. After exclusions, 5279 were included. 2741 of these 5279 (51.9%) were admitted to hospital, of whom 1904 (69.5%) were discharged alive without hospice care and 665 (24.3%) were discharged to hospice care or died. Of 647 (23.6%) patients requiring mechanical ventilation, 391 (60.4%) died and 170 (26.2%) were extubated or discharged. The strongest risk for hospital admission was associated with age, with an odds ratio of >2 for all age groups older than 44 years and 37.9 (95% confidence interval 26.1 to 56.0) for ages 75 years and older. Other risks were heart failure (4.4, 2.6 to 8.0), male sex (2.8, 2.4 to 3.2), chronic kidney disease (2.6, 1.9 to 3.6), and any increase in body mass index (BMI) (eg, for BMI >40: 2.5, 1.8 to 3.4). The strongest risks for critical illness besides age were associated with heart failure (1.9, 1.4 to 2.5), BMI >40 (1.5, 1.0 to 2.2), and male sex (1.5, 1.3 to 1.8). Admission oxygen saturation of <88% (3.7, 2.8 to 4.8), troponin level >1 (4.8, 2.1 to 10.9), C reactive protein level >200 (5.1, 2.8 to 9.2), and D-dimer level >2500 (3.9, 2.6 to 6.0) were, however, more strongly associated with critical illness than age or comorbidities. Risk of critical illness decreased significantly over the study period. Similar associations were found for mortality alone.ConclusionsAge and comorbidities were found to be strong predictors of hospital admission and to a lesser extent of critical illness and mortality in people with covid-19; however, impairment of oxygen on admission and markers of inflammation were most strongly associated with critical illness and mortality. Outcomes seem to be improving over time, potentially suggesting improvements in care.

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Factors associated with hospitalization and critical illness among 4,103 patients with Covid-19 disease in New York City

10.1101/2020.04.08.20057794 ◽

2020 ◽

Cited By ~ 108

Author(s):

Christopher M. Petrilli ◽

Simon A. Jones ◽

Jie Yang ◽

Harish Rajagopalan ◽

Luke O’Donnell ◽

...

Keyword(s):

New York ◽

Mechanical Ventilation ◽

New York City ◽

Critical Illness ◽

Decision Tree ◽

York City ◽

Adverse Outcomes ◽

Maximum Information ◽

Factors Associated ◽

Markers Of Inflammation

AbstractBackgroundLittle is known about factors associated with hospitalization and critical illness in Covid-19 positive patients.MethodsWe conducted a cross-sectional analysis of all patients with laboratory-confirmed Covid-19 treated at an academic health system in New York City between March 1, 2020 and April 2, 2020, with follow up through April 7, 2020. Primary outcomes were hospitalization and critical illness (intensive care, mechanical ventilation, hospice and/or death). We conducted multivariable logistic regression to identify risk factors for adverse outcomes, and maximum information gain decision tree classifications to identify key splitters.ResultsAmong 4,103 Covid-19 patients, 1,999 (48.7%) were hospitalized, of whom 981/1,999 (49.1%) have been discharged, and 292/1,999 (14.6%) have died or been discharged to hospice. Of 445 patients requiring mechanical ventilation, 162/445 (36.4%) have died. Strongest hospitalization risks were age ≥75 years (OR 66.8, 95% CI, 44.7-102.6), age 65-74 (OR 10.9, 95% CI, 8.35-14.34), BMI>40 (OR 6.2, 95% CI, 4.2-9.3), and heart failure (OR 4.3 95% CI, 1.9-11.2). Strongest critical illness risks were admission oxygen saturation <88% (OR 6.99, 95% CI 4.5-11.0), d-dimer>2500 (OR 6.9, 95% CI, 3.2-15.2), ferritin >2500 (OR 6.9, 95% CI, 3.2-15.2), and C-reactive protein (CRP) >200 (OR 5.78, 95% CI, 2.6-13.8). In the decision tree for admission, the most important features were age >65 and obesity; for critical illness, the most important was SpO2<88, followed by procalcitonin >0.5, troponin <0.1 (protective), age >64 and CRP>200.ConclusionsAge and comorbidities are powerful predictors of hospitalization; however, admission oxygen impairment and markers of inflammation are most strongly associated with critical illness.

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COVID-19 infections and outcomes in patients with multiple myeloma in New York City: a cohort study from five academic centers

10.1101/2020.06.09.20126516 ◽

2020 ◽

Cited By ~ 2

Author(s):

Malin Hultcrantz ◽

Joshua Richter ◽

Cara Rosenbaum ◽

Dhwani Patel ◽

Eric Smith ◽

...

Keyword(s):

Risk Factors ◽

New York ◽

Multiple Myeloma ◽

Mechanical Ventilation ◽

New York City ◽

Immune System ◽

Plasma Cell ◽

York City ◽

Mortality Rates ◽

Plasma Cell Disorders

AbstractImportanceNew York City is a global epicenter for the SARS-CoV-2 outbreak with a significant number of individuals infected by the virus. Patients with multiple myeloma have a compromised immune system, due to both the disease and anti-myeloma therapies, and may therefore be particularly susceptible to coronavirus disease 2019 (COVID-19); however, there is limited information to guide clinical management.ObjectiveTo assess risk factors and outcomes of COVID-19 in patients with multiple myeloma.DesignCase-series.SettingFive large academic centers in New York City.ParticipantsPatients with multiple myeloma and related plasma cell disorders who were diagnosed with COVID-19 between March 10th, 2020 and April 30th, 2020.ExposuresClinical features and risk factors were analyzed in relation to severity of COVID-19.Main Outcomes and MeasuresDescriptive statistics as well as logistic regression were used to estimate disease severity reflected in hospital admissions, intensive care unit (ICU) admission, need for mechanical ventilation, or death.ResultsOf 100 multiple myeloma patients (male 58%; median age 68, range 41-91) diagnosed with COVID-19, 74 (74%) were admitted; of these 13 (18%) patients were placed on mechanical ventilation, and 18 patients (24%) expired. None of the studied risk factors were significantly associated (P>0.05) with adverse outcomes (ICU-admission, mechanical ventilation, or death): hypertension (N=56) odds ratio (OR) 2.3 (95% confidence interval [CI] 0.9-5.9); diabetes (N=18) OR 1.1 (95% CI 0.3-3.2); age >65 years (N=63) OR 2.0 (95% CI 0.8-5.3); high dose melphalan with autologous stem cell transplant <12 months (N=7) OR 1.2 (95% CI 0.2-7.4), IgG<650 mg/dL (N=42) OR=1.2 (95% CI 0.4-3.1). In the entire series of 127 patients with plasma cell disorders, hypertension was significantly associated with the combined end-point (OR 3.4, 95% CI 1.5-8.1).Conclusions and RelevanceAlthough multiple myeloma patients have a compromised immune system due to both the disease and therapy; in this largest disease specific cohort to date of patients with multiple myeloma and COVID-19, compared to the general population, we found risk factors for adverse outcome to be shared and mortality rates to be within the higher range of officially reported mortality rates.

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684 Contribution of Pulmonary Diseases to COVID-19 Mortality in a Diverse Community of New York City

SLEEP ◽

10.1093/sleep/zsab072.682 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A267-A267

Author(s):

Giardin Jean-Louis ◽

Azizi Seixas ◽

Jaime Ramos Cejudo ◽

Ricardo Osorio ◽

George Avirappattu ◽

...

Keyword(s):

New York ◽

New York City ◽

Sleep Apnea ◽

Household Income ◽

Sociodemographic Factors ◽

Pulmonary Diseases ◽

Peripheral Artery ◽

Mortality Risks ◽

Male Sex ◽

Artery Disease

Abstract Introduction New York City has been one of the largest epicenters of the COVID-19 pandemic. This provided a wealth of data to examine the characteristics of COVID-19 patients in this multi-ethnic city, while assessing the contributions of cardio-metabolic burden and pulmonary conditions as potential “at-risk” conditions for COVID-19. We assessed the relative contribution of common upper and lower airway pulmonary diseases in determining the likelihood of COVID-19-related mortality independent of other medical conditions, health risks, and sociodemographic factors. Methods We analyzed data from one of the largest US-based case series of patients with COVID-19, captured from an academic health network in NYC. A total of 11,512 hospitalized patients (March 2-May 24, 2020) were tested with 4,446 (38.62%) receiving a positive diagnosis for COVID-19. EHR queries yielded age at time of testing, sex, race/ethnicity aggregated as non-Hispanic black, Asian and Hispanic referenced to non-Hispanic white; cardio-metabolic conditions (hypertension, hyperlipidemia, diabetes, obesity, peripheral artery disease, and coronary artery disease); pulmonary disease (e.g., COPD, sleep apnea, or asthma); autoimmune disease; and cancer. Mortality was based on the patient state (alive or deceased) at the moment of discharge. We included only patients who had been discharged alive or had expired. Anaconda Python 3.7 was used to perform all analyses. Results Among patients testing positive, 959 (21.57%) died of COVID-19-related complications at the hospital. Multivariate-adjusted Cox proportional hazards modeling showed mortality risks were strongly associated with greater age (HR=1.05; 95%CI:1.04–1.05), ethnic minority (HR=1.26; 95%CI:1.10–1.44), low household income (HR=1.29; 95%CI:1.11, 1.49), and male sex (HR=0.85; 95%CI:0.74, 0.97). Higher mortality risks were also associated with a history of COPD (HR=1.27; 95%CI:1.02–1.58), obesity (HR=1.19; 95%CI:1.04–1.37) and peripheral artery disease (HR=1.33; 95%CI:1.05–1.69). We observed a significantly higher rate of COVID-19 cases (43.8% vs 39.6%, p<0.05) among patients with sleep apnea (7.72%). However, they did not have a significantly higher mortality rate (13.0% vs 11.8%, NS), although they experienced a longer hospital stay (7.1±7.7 vs 6.1±7.5, p<0.01). Conclusion Patients with COPD had the highest odds of COVID-19 mortality. Sociodemographic factors including increased age, male sex, low household income, ethnic minority status were also independently associated with greater mortality risks. Support (if any) K07AG052685, R01MD007716, R01HL142066, K01HL135452, R01HL152453

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Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study

10.1101/2020.04.15.20067157 ◽

2020 ◽

Cited By ~ 10

Author(s):

Matthew J. Cummings ◽

Matthew R. Baldwin ◽

Darryl Abrams ◽

Samuel D. Jacobson ◽

Benjamin J. Meyer ◽

...

Keyword(s):

New York ◽

Mechanical Ventilation ◽

New York City ◽

Hospital Mortality ◽

Critically Ill ◽

York City ◽

Clinical Course ◽

Invasive Mechanical Ventilation ◽

Critically Ill Adults ◽

Ill Adults

AbstractBackgroundNearly 30,000 patients with coronavirus disease-2019 (COVID-19) have been hospitalized in New York City as of April 14th, 2020. Data on the epidemiology, clinical course, and outcomes of critically ill patients with COVID-19 in this setting are needed.MethodsWe prospectively collected clinical, biomarker, and treatment data on critically ill adults with laboratory-confirmed-COVID-19 admitted to two hospitals in northern Manhattan between March 2nd and April 1st, 2020. The primary outcome was in-hospital mortality.Secondary outcomes included frequency and duration of invasive mechanical ventilation, frequency of vasopressor use and renal-replacement-therapy, and time to clinical deterioration following hospital admission. The relationship between clinical risk factors, biomarkers, and in-hospital mortality was modeled using Cox-proportional-hazards regression. Each patient had at least 14 days of observation.ResultsOf 1,150 adults hospitalized with COVID-19 during the study period, 257 (22%) were critically ill. The median age was 62 years (interquartile range [IQR] 51-72); 170 (66%) were male. Two-hundred twelve (82%) had at least one chronic illness, the most common of which were hypertension (63%; 162/257) and diabetes mellitus (36%; 92/257). One-hundred-thirty-eight patients (54%) were obese, and 13 (5%) were healthcare workers. As of April 14th, 2020, in-hospital mortality was 33% (86/257); 47% (122/257) of patients remained hospitalized. Two-hundred-one (79%) patients received invasive mechanical ventilation (median 13 days [IQR 9-17]), and 54% (138/257) and 29% (75/257) required vasopressors and renal-replacement-therapy, respectively. The median time to clinical deterioration following hospital admission was 3 days (IQR 1-6). Older age, hypertension, chronic lung disease, and higher concentrations of interleukin-6 and d-dimer at admission were independently associated with in-hospital mortality.ConclusionsCritical illness among patients hospitalized with COVID-19 in New York City is common and associated with a high frequency of invasive mechanical ventilation, extra-pulmonary organ dysfunction, and substantial in-hospital mortality.

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COVID-19-Associated Critical Illness—Report of the First 300 Patients Admitted to Intensive Care Units at a New York City Medical Center

Journal of Intensive Care Medicine ◽

10.1177/0885066620946692 ◽

2020 ◽

Vol 35 (10) ◽

pp. 963-970 ◽

Cited By ~ 6

Author(s):

Sudham Chand ◽

Sumit Kapoor ◽

Deborah Orsi ◽

Melissa J. Fazzari ◽

Tristan G. Tanner ◽

...

Keyword(s):

United States ◽

New York ◽

Mechanical Ventilation ◽

New York City ◽

Intensive Care ◽

Critical Illness ◽

Mortality Rate ◽

York City ◽

Medical Center ◽

The United States

Background: The first confirmed case of novel coronavirus (2019-nCoV) infection in the United States was reported from the state of Washington in January, 2020. By March, 2020, New York City had become the epicenter of the outbreak in the United States. Methods: We tracked all patients with confirmed coronavirus-19 (COVID-19) infection admitted to intensive care units (ICU) at Montefiore Medical Center (Bronx, NY). Data were obtained through manual review of electronic medical records. Patients had at least 30 days of follow-up. Results: Our first 300 ICU patients were admitted March 10 through April 11, 2020. The majority (60.7%) of patients were men. Acute respiratory distress syndrome (ARDS) was documented in 91.7% of patients; 91.3% required mechanical ventilation. Prone positioning was employed in 58% of patients and neuromuscular blockade in 47.8% of mechanically-ventilated patients. Neither intervention was associated with decreased mortality. Vasopressors were required in 77.7% of patients. Acute kidney injury (AKI) was present on admission in 40.7% of patients, and developed subsequently in 36.0%; 50.9% of patients with AKI received renal replacement therapy (RRT). Overall 30-day mortality rate was 52.3%, and 55.8% among patients receiving mechanical ventilation. In univariate analysis, higher mortality rate was associated with increasing age, male sex, hypertension, obesity, smoking, number of comorbidities, AKI on presentation, and need for vasopressor support. A representative multivariable model for 30-day mortality is also presented, containing patient age, gender, body mass index, and AKI at admission. As of May 11, 2020, 2 patients (0.7%) remained hospitalized. Conclusions: Mortality in critical illness associated with COVID-19 is high. The majority of patients develop ARDS requiring mechanical ventilation, vasopressor-dependent shock, and AKI. The variation in mortality rates reported to date likely reflects differences in the severity of illness of the evaluated populations.

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Severe Clinical Outcomes Among Adults Hospitalized With Respiratory Syncytial Virus Infections, New York City, 2017-2019

Public Health Reports ◽

10.1177/00333549211041545 ◽

2021 ◽

pp. 003335492110415

Author(s):

Connor R. Goldman ◽

William D. Sieling ◽

Luis R. Alba ◽

Raul A. Silverio Francisco ◽

Celibell Y. Vargas ◽

...

Keyword(s):

Older Adults ◽

New York ◽

Mechanical Ventilation ◽

New York City ◽

Risk Factor ◽

Respiratory Syncytial Virus ◽

York City ◽

Rsv Infection ◽

Syncytial Virus ◽

Residential Living

Objectives Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults. We assessed severe clinical outcomes among hospitalized adults that were associated with RSV infections. Methods We performed a nested retrospective study in 3 New York City hospitals during 2 respiratory viral seasons, October 2017–April 2018 and October 2018–April 2019, to determine the proportion of patients with laboratory-confirmed RSV infection who experienced severe outcomes defined as intensive care unit (ICU) admission, mechanical ventilation, and/or death. We assessed factors associated with these severe outcomes and explored the effect of RSV-associated hospitalizations on changes in the living situations of surviving patients. Results Of the 403 patients studied (median age, 69 years), 119 (29.5%) were aged ≥80. Severe outcomes occurred in 19.1% of patients, including ICU admissions (16.4%), mechanical ventilation (12.4%), and/or death (6.7%). Patients admitted from residential living facilities had a 4.43 times higher likelihood of severe RSV infection compared with patients who were living in the community with or without assistance from family or home health aides. At discharge, 56 (15.1%) patients required a higher level of care than at admission. Conclusions RSV infection was associated with severe outcomes in adults. Living in a residential facility at admission was a risk factor for severe outcomes and could be a proxy for frailty rather than an independent risk factor. Our data support the development of prevention strategies for RSV infection in older populations, especially older adults living in residential living facilities.

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Baseline Characteristics of Workers at Ten New York City Employers Recruited for a Private-Public Research Collaborative

Journal of Occupational and Environmental Medicine ◽

10.1097/jom.0b013e31815cbad0 ◽

2008 ◽

Vol 50 (2) ◽

pp. 190-201 ◽

Cited By ~ 2

Author(s):

Ron Z. Goetzel ◽

Daria Luisi ◽

Ronald J. Ozminkowski ◽

Enid Chung Roemer ◽

Sabira Taher

Keyword(s):

New York ◽

New York City ◽

York City ◽

Public Research ◽

Baseline Characteristics

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Association of substance use disorders and drug overdose with adverse COVID-19 outcomes in New York City: January–October 2020

Journal of Public Health ◽

10.1093/pubmed/fdaa241 ◽

2020 ◽

Author(s):

Bennett Allen ◽

Omar El Shahawy ◽

Erin S Rogers ◽

Sarah Hochman ◽

Maria R Khan ◽

...

Keyword(s):

New York ◽

New York City ◽

Substance Use ◽

Drug Overdose ◽

York City ◽

Alcohol Use Disorder ◽

Hospital System ◽

Increased Risk ◽

History Of ◽

Baseline Characteristics

ABSTRACT Background Evidence suggests that individuals with history of substance use disorder (SUD) are at increased risk of COVID-19, but little is known about relationships between SUDs, overdose and COVID-19 severity and mortality. This study investigated risks of severe COVID-19 among patients with SUDs. Methods We conducted a retrospective review of data from a hospital system in New York City. Patient records from 1 January to 26 October 2020 were included. We assessed positive COVID-19 tests, hospitalizations, intensive care unit (ICU) admissions and death. Descriptive statistics and bivariable analyses compared the prevalence of COVID-19 by baseline characteristics. Logistic regression estimated unadjusted and sex-, age-, race- and comorbidity-adjusted odds ratios (AORs) for associations between SUD history, overdose history and outcomes. Results Of patients tested for COVID-19 (n = 188 653), 2.7% (n = 5107) had any history of SUD. Associations with hospitalization [AORs (95% confidence interval)] ranged from 1.78 (0.85–3.74) for cocaine use disorder (COUD) to 6.68 (4.33–10.33) for alcohol use disorder. Associations with ICU admission ranged from 0.57 (0.17–1.93) for COUD to 5.00 (3.02–8.30) for overdose. Associations with death ranged from 0.64 (0.14–2.84) for COUD to 3.03 (1.70–5.43) for overdose. Discussion Patients with histories of SUD and drug overdose may be at elevated risk of adverse COVID-19 outcomes.

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