Epidemiology
Millán-Guerrero RO, Caballero-Hoyos R, Monárrez-Espino J. Poverty and survival from COVID-19 in Mexico. J Pub Health 2020, published 24 December. Full-text: https://doi.org/10.1093/pubmed/fdaa228
Individuals living in municipalities with extreme poverty had a 9% higher risk of dying than those living in municipalities classified as not poor. This is the result of a retrospective Mexican cohort study of nearly 250.000 COVID-19 patients. Mortality was 12,3% reaching 59,3% in patients with ≥ 1 co-morbidities. Combating extreme poverty needs to be a central preventive strategy.
Niu J, Rodriguez JA, Sareli C, et al. COVID-19 infection among first responders in Broward County, Florida, March–April 2020. Journal of Public Health 2020, published 24 December. Full-text: https://doi.org/10.1093/pubmed/fdaa231
Due to job-related exposures, first responders (FRs) are at a higher risk of SARS-CoV-2 infection than the general population. Here, Paula Eckardt, Jianli Niu and colleagues from Memorial Healthcare System, Hollywood, screened a total of 3375 FRs between March and April 2020. Overall, 289 (8,6%) were positive, with the highest rates among those aged 25-49 years. Of those testing positive, 235 (81,3%) were asymptomatic.
Transmission
Aydillo T, Gonzales-Reiche AS, Aslam S, et al. Shedding of Viable SARS-CoV-2 after Immunosuppressive Therapy for Cancer. N Engl J Med 2020, published 24 December. Full-text: https://doi.org/10.1056/NEJMc2031670
Patients with profound immunosuppression may shed viable SARS-CoV-2 for at least 2 months. This is the results of a study by Mini Kamboj, Teresa Aydillo and colleagues from Memorial Sloan Kettering Cancer Center, New York. The authors used cell cultures to detect viable virus in serially collected respiratory samples obtained from 18 recipients of hematopoietic stem cell transplants or chimeric antigen receptor (CAR) T cell therapy and 2 patients with lymphoma.
Treatment
Trump S, Lukassen S, Anker MS, et al. Hypertension delays viral clearance and exacerbates airway hyperinflammation in patients with COVID-19. Nat Biotechnol 2020, published 24 December. Full-text: https://doi.org/10.1038/s41587-020-00796-1
ACEI treatment in patients with SARS-CoV-2 infection and hypertension might warrant further investigation. This is the suggestion by Irina Lehmann, Saskia Trump and colleagues from Charité, Berlin, who combined clinical data (n = 144) and single cell sequencing data of airway samples (n = 48) with in vitro experiments. The authors observed a distinct inflammatory predisposition of immune cells in patients with hypertension that correlated with critical COVID-19 progression. ACEI treatment was associated with dampened COVID-19-related hyperinflammation and with increased cell intrinsic antiviral responses.
Severe COVID
Jorge A, D’Silva KM, Cohen A, et al. Temporal trends in severe COVID-19 outcomes in patients with rheumatic disease: a cohort study. Lancet Rheumatology 2020, published 23 December. Full-text: https://doi.org/10.1016/S2665-9913(20)30422-7
In this cohort study of patients with rheumatic and musculoskeletal diseases, Hyon Choi, April Jorge and colleagues from Massachusetts General Hospital compared 2811 patients who were diagnosed with COVID-19 during the first 90 days of the pandemic (early cohort) with 5729 patients diagnosed during the second 90 days of the pandemic (late cohort). The late cohort fared better: the risk of hospitalization, intensive care unit admission, mechanical ventilation, acute kidney injury, renal replacement therapy, and death was lower in the late cohort than in the early cohort. This finding is probably multifactorial, due to increased testing capacity allowing for detection of milder cases, improved supportive care, and improved treatments. The lesson for the future: use historical comparators cautiously in observational studies of new therapies for COVID-19!
Co-morbidities
McGurnaghan SJ, Weir A, Bishop J, et al. Risks of and risk factors for COVID-19 disease in people with diabetes: a cohort study of the total population of Scotland. Lancet Diabetes Endocrinol 2020, published 23 December. Full-text: https://doi.org/10.1016/S2213-8587(20)30405-8
Of the total Scottish population on March 1, 2020 (n = 5.463.300), the population with diabetes was 319.349 (5,8%), 1082 (0,3%) of whom developed fatal or critical care unit treated COVID-19 by July 31, 2020. In the population without diabetes, 4081 (0,1%) of 5.143.951 people developed fatal or critical care unit-treated COVID-19. As of July 31, the overall odds ratio (OR) for diabetes, adjusted for age and sex, was 1,395 compared with the risk in those without diabetes. The OR was 2,4 in type 1 diabetes and 1,4 in type 2 diabetes. Among people with diabetes, adjusted for age, sex, and diabetes duration and type, those who developed fatal or critical care unit-treated COVID-19 were more likely to be male, live in residential care or a more deprived area, have a COVID-19 risk condition, retinopathy, reduced renal function, or worse glycemic control, have had a diabetic ketoacidosis or hypoglycemia hospitalization in the past 5 years, be on more anti-diabetic and other medication (all p < 0.0001), and have been a smoker (p = 0.0011).
See also the comment by Stehouwer CDA. Observational research on severe COVID-19 in diabetes. Lancet Diabetes Endocrinol 2020, published 23 December. Full-text: https://doi.org/10.1016/S2213-8587(20)30432-0
Tisminetzky M, Delude C, Hebert T, et al. Multiple Chronic Conditions, and COVID-19: A literature review. J Gerontol 2020, published 24 December. Full-text: https://doi.org/10.1093/gerona/glaa320
Nothing new in this short review about the most frequent SARS-CoV-2 comorbidities: hypertension, diabetes mellitus, cardiovascular disease, chronic pulmonary disease, and chronic kidney disease. And: men had a higher risk of dying than women. But if you want a concise literature overview, here you go.
Collateral Effects
Silverman ME, Burgos L, Rodriguez ZI, et al. Postpartum mood among universally screened high and low socioeconomic status patients during COVID-19 social restrictions in New York City. Sci Rep 10, 22380 (2020). Full-text: https://doi.org/10.1038/s41598-020-79564-9
Post-partum depression, the most common complication of childbearing, is a prevalent, cross-cultural disorder. Even in the best environments, the period following childbirth represents a time of heightened stress and vulnerability for most, if not all, new parents. In this study of 516 post-partum patients, Michael Silverman et al. now demonstrate a differentiated response in the post-partum mood of those living in New York City during the COVID-19 pandemic… based on socioeconomic status! While those in areas with higher socioeconomic status (SES) demonstrated no change in post-partum mood after implementation of social restrictions in New York, those living in lower SES expressed improved mood over the same time period. Try to find out why.
Education
Tambyraja AL. New Order, New Hope. N Engl J Med 2020, published 24 December. Full-text: https://doi.org/10.1056/NEJMp2016142
In this Christmas Perspective, Andrew Tambyraja reminds us about traditional strengths in medicine: agility and patient focus, humility and the pursuit of the greater good.
Beyond Corona
Else H. Climate change and COVID-19 vaccines are among the themes set to shape research. Nature 2020, published 22 December. Full-text: https://www.nature.com/articles/d41586-020-03651-0
The science events to watch for in 2021: Climate comeback | COVID vaccines | Open access drive | Stem cell revamp | Crunch time for Alzheimer’s drug | Mars gets busy | Long-awaited telescope launch | Ripple effect
Copy-editor: Rob Camp