This page will be updated on 28 February. In the meantime, check new papers at https://covidreference.com/top10.
Williams R. Coronavirus Brain Breach. Biomedical Picture of the Day, posted 8 January. Link: http://www.bpod.mrc.ac.uk/archive/2021/2/8
This image shows the virus responsible for COVID-19, SARS-CoV-2 (red), in the act of infecting and killing human brain cells, with dead cells shown in green. The cells aren’t those of a patient’s brain of course, which would be impossible… | Continue reading at http://www.bpod.mrc.ac.uk/archive/2021/2/8.
Haarhaus M, Santos C, Haase M, et al. Risks prediction of COVID-19 incidence and mortality in a large multi-national haemodialysis cohort: Implications for management of the pandemic in outpatient haemodialysis settings. Clin Kidney J 2021, published 5 February. Full-text: https://doi.org/10.1093/ckj/sfab037
Outcomes in 38.256 hemodialysis (HD) patients from a multi-national dialysis cohort between March 3rd and July 3rd 2020. During the observational period, 1259 patients (3,3%) acquired COVID-19. Of these, 62% were hospitalized or died. Mortality was 22% among COVID-19 patients.
Sultanian P, Lundgren P, Strömsöe A, et al. Cardiac arrest in COVID-19: characteristics and outcomes of in- and out-of-hospital cardiac arrest. A report from the Swedish Registry for Cardiopulmonary Resuscitation. Eur Heart J. 2021 Feb 5:ehaa1067. PubMed: https://pubmed.gov/33543259. Full-text: https://doi.org/10.1093/eurheartj/ehaa1067
Pedram Sultanian and colleagues studied out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) of all patients reported to the Swedish Registry for Cardiopulmonary Resuscitation from 1 January to 20 July 2020. During the pandemic phase, COVID-19 was involved in at least 10% of all OHCAs and 16% of IHCAs, and, among COVID-19 cases, 30-day mortality was increased 3,4-fold in OHCA and 2,3-fold in IHCA.
Möhn N, Konen FF, Pul R, et al. Experience in Multiple Sclerosis Patients with COVID-19 and Disease-Modifying Therapies: A Review of 873 Published Cases. J Clin Med. 2020 Dec 16;9(12):4067. PubMed: https://pubmed.gov/33339436. Full-text: https://doi.org/10.3390/jcm9124067
Patients without disease modifying therapies (DMTs), with previous cardiovascular diseases, or with a severe degree of disability may be at a higher risk of severe COVID-19. In this review of 873 published cases, immunosuppressive therapy itself did not appear to be a substantial risk factor. The authors argue that it might be reasonable to assume that these therapies could be protective, either directly by mitigating the cytokine storm, or indirectly by reducing the disease activity of MS.
Accili D. Can COVID-19 cause diabetes? Nat Metab 2021 published 11 January. Full-text: https://doi.org/10.1038/s42255-020-00339-7
Whether a separate entity of post-COVID-19 diabetes possibly associated with lasting β-cell damage also exists is not yet clear.
Marjot T, Moon AM, Cook JA, et al. Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: An international registry study. J Hepatol. 2020 Oct 6:S0168-8278(20)33667-9. PubMed: https://pubmed.gov/33035628. Full-text: https://doi.org/10.1016/j.jhep.2020.09.024
No comment needed. The key messages presented at the beginning of the paper:
- Patients with cirrhosis experience high rates of hepatic decompensation and death following SARS-CoV-2 infection.
- Mortality increased in stepwise fashion according to Child-Pugh class.
- Other risk factors for death included advancing age and alcohol-related liver disease.
- Mortality risk was higher in patients with advanced cirrhosis than propensity-score-matched controls without liver disease.
- The majority of deaths in patients with cirrhosis were from COVID-19-related lung disease.
Fernandez-Ruiz R, Paredes J, Niewold TB. COVID-19 in patients with Systemic Lupus Erythematosus: Lessons learned from the inflammatory disease. Transl Res. 2020 Dec 19:S1931-5244(20)30302-9. PubMed: https://pubmed.gov/33352298. Full-text: https://doi.org/10.1016/j.trsl.2020.12.007
The authors review the literature to date on COVID-19 in patients with systemic lupus erythematosus (SLE) and provide an in-depth review of current research in the area, including immune pathway activation, epidemiology, clinical features, outcomes, and the psychosocial impact of the pandemic in patients with SLE.
Hoffmann C, Casado JL, Härter G, et al. Immune deficiency is a risk factor for severe COVID-19 in people living with HIV. HIV Med. 2020 Dec 27. PubMed: https://pubmed.gov/33368966. Full-text: https://doi.org/10.1111/hiv.13037
In people living with HIV (PLWH), immune deficiency is a possible risk factor for severe COVID‐19, even in the setting of HIV virologic suppression. There is no evidence for a protective effect of PIs or tenofovir alafenamide. This is the result of a multi-center cohort study which evaluated risk factors for morbidity and mortality of COVID‐19 in PLWH infected with SARS‐CoV‐2 in three countries. Patients with severe COVID‐19 had a lower current CD4 T cell count and a lower CD4 T cell nadir, compared with patients with mild‐to‐moderate COVID‐19. In a multivariate analysis, the only factor associated with risk for severe COVID‐19 was a current CD4+ T cell count of < 350/µl (adjusted odds ratio 2.85, 95% confidence interval 1.26‐6.44, p = 0.01). The only factor associated with mortality was a low CD4 T cell nadir.
Shields AM, Burns SO, Savic S, Richter AG; UK PIN COVID-19 consortium. COVID-19 in patients with primary and secondary immunodeficiency: the United Kingdom experience. J Allergy Clin Immunol. 2020 Dec 15:S0091-6749(20)32406-4. PubMed: https://pubmed.gov/33338534. Full-text: https://doi.org/10.1016/j.jaci.2020.12.620
In comparison to the general population, adult patients with primary immunodeficiency (PID) and symptomatic secondary immunodeficiency (SID) display greater morbidity and mortality from COVID-19. This is the result of a study that enrolled 100 patients by 1 July 2020, 60 with PID, 7 with other inborn errors of immunity including autoinflammatory diseases and C1 inhibitor deficiency and 33 with SID.
Guillet H, Gallet R, Pham V, et al. Clinical spectrum of ischaemic arterial diseases associated with COVID-19: a series of four illustrative cases. Eur Heart J 2020, published 25 December. Full-text: https://doi.org/10.1093/ehjcr/ytaa488
Henri Guillet et al. from Hôpital Henri Mondor, Paris, describe four different cases of COVID-19 infection with ischemic arterial events: a myocardial infarction with high thrombus load, ischemic stroke on spontaneous thrombosis of the aortic valve, floating thrombus with mesenteric, splenic and renal infarction, and acute limb ischemia.
Allen B, El Shahawy O, Rogers ES, et al. Association of substance use disorders and drug overdose with adverse COVID-19 outcomes in New York City: January–October 2020, Journal of Public Health. J Pub Health 2020, published 26 December. Full-text: https://doi.org/10.1093/pubmed/fdaa241
What do you know about the relationships between substance use disorders (SUDs), overdose and COVID-19 severity and mortality? Patients with histories of SUD and drug overdose could face disproportionate risk of critical COVID-19 illness, is the answer by Bennett Allen et al. However, the authors concede that they cannot assure whether the outcomes were due to COVID-19 or unrelated because they adjusted for few comorbidities. In particular, due to missing data, body mass index was not assessed.
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.
Goodman KE, Magder LS, Baghdadi JD, et al. Impact of Sex and Metabolic Comorbidities on COVID-19 Mortality Risk Across Age Groups: 66,646 Inpatients Across 613 U.S. Hospitals. Clin Infect Dis 2020, December 19. Full-text: https://doi.org/10.1093/cid/ciaa1787
Among 66.646 (6,5%) admissions with a COVID-19 diagnosis across 613 US hospitals, 12.388 (18,6%) died in-hospital. In multivariable analysis, male sex was independently associated with 30% higher mortality risk (aRR, 1.30, 95% CI: 1.26 – 1.34). Of note, diabetes without chronic complications was not a risk factor at any age (aRR 1.01, 95% CI: 0.96 – 1.06), and hypertension without chronic complications was only a risk factor in younger people (20-39 year-olds) (aRR, 1.68, 95% CI: 1.17 – 2.40). Diabetes with chronic complications, hypertension with chronic complications, and obesity were risk factors in most age groups, with highest relative risks among 20-39 year-olds (respective aRRs 1.79, 2.33, 1.92; p ≤ 0.002).
Hyrich KL, Machado PM. Rheumatic disease and COVID-19: epidemiology and outcomes. Nat Rev Rheumatol December 18, 2020. Full-text: https://doi.org/10.1038/s41584-020-00562-2
According to this brief review, many questions about COVID-19 in patients with rheumatic diseases remain unanswered. These patients, when analyzed as a combined group, might have a slightly increased risk of death, although the role of disease activity and treatment was not taken into account in most studies. Chronic use of glucocorticoids at moderate or high doses is associated with hospitalization for severe COVID-19. Treatment with cytokine inhibitors could reduce the risk of SARS-CoV-2 infection, although the mechanisms of this protective effect are not clear.
ERA-EDTA Council, ERACODA Working Group. Chronic kidney disease is a key risk factor for severe COVID-19: a call to action by the ERA-EDTA. Nephrology Dialysis Transplantation December 19 2020. Full-text: https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfaa314/6041849
The OpenSAFELY project analysed factors associated with COVID-19 deaths in 17 million patients. The picture that arose differs significantly from initial reports. For example, hypertension is not an independent risk factor for COVID-19 death, but renal disease very much is. Dialysis (aHR 3.69), organ transplantation (aHR 3.53) and CKD (aHR 2.52 for patients with eGFR < 30 mL/min/1.73 m2) represent three of the four co-morbidities associated with the highest mortality risk from COVID-19. The risk associated with CKD Stages 4 and 5 is higher than the risk associated with diabetes mellitus (aHR range 1.31–1.95, depending upon glycemic control) or chronic heart disease (aHR 1.17). This article defines essential action points, among which is advocating the inclusion of CKD patients in clinical trials, testing the efficacy of drugs and vaccines to prevent severe COVID-19.
Morales DR, Conover MM, You SC, et al. Renin–angiotensin system blockers and susceptibility to COVID-19: an international, open science, cohort analysis. Lancet Digital Health December 17, 2020. Full-text: https://doi.org/10.1016/S2589-7500(20)30289-2
In this multicenter cohort study following more than 1,3 million patients with hypertension from the USA and Spain, no clear association of increased risk of COVID-19 diagnosis, hospital admission, or subsequent complications was seen with the outpatient use of ACEI or ARB. These findings support recent recommendations that patients should not halt their ACEI or ARB therapy despite previously posited mechanisms of increased COVID-19 risk. Furthermore, the marginal difference between ACEIs and ARBs does not warrant class switching to reduce COVID-19 susceptibility.
Vijenthira A, Gong IY, Fox TA. Outcomes of patients with hematologic malignancies and COVID-19: a systematic review and meta-analysis of 3377 patients. Blood December 17, 2020, 136 (25): 2881–2892. Full-text: https://doi.org/10.1182/blood.2020008824
Systemic review and meta-analysis of 34 adult and 5 pediatric studies (3377 patients) from Asia, Europe, and North America (14 of 34 adult studies included only hospitalized patients). Adult patients with hematologic malignancy and COVID-19 found a 34% risk of death, whereas pediatric patients had a 4% risk of death. Patients on systemic anticancer therapy had a similar risk of death to patients on no treatment.
Agrawal M, Brenner EJ, Zhang X, et al. Characteristics and Outcomes of IBD Patients with COVID-19 on Tofacitinib Therapy in the SECURE-IBD Registry. Inflammatory Bowel Diseases 16 December 2020. Full-text: https://doi.org/10.1093/ibd/izaa303
Tofacitinib is a Janus kinase inhibitor (JAKi) approved for the treatment of ulcerative colitis (UC) and other immune-mediated diseases. As many JAKis, it is also evaluated in COVID-19 trials. Manasi Agrawal and colleagues here describe characteristics and outcomes of COVID-19 in 37 patients with IBD treated with tofacitinib compared with other medications in the SECURE-IBD registry. Overall, they found no difference in COVID-19 outcomes between the two groups. Good to see: though tofacitinib at the higher dose has been associated with venous thromboembolism, none of the tofacitinib-treated patients in this cohort experienced thrombotic complications.
Huskamo HA, Busch AB, Uscher-Pines, et al. Treatment of Opioid Use Disorder Among Commercially Insured Patients in the Context of the COVID-19 Pandemic. JAMA December 15. 2020; 324(23):2440-2442. Full-text: https://doi.org/10.1001/jama.2020.21512
During the first 3 months of the pandemic, among patients already receiving OUD medication, there was no decrease in medication fills or clinician visits.
Liondan CE, Mankad K, Ram D. Neuroimaging manifestations in children with SARS-CoV-2 infection: a multinational, multicentre collaborative study. Lancet Child Adol December 15, 2020. Full-text: https://doi.org/10.1016/S2352-4642(20)30362-X
An international call for cases of children with encephalopathy related to SARS-CoV-2 infection and abnormal neuroimaging findings was made. In total, 38 cases from 8 different countries reviewed by a central neuroradiology panel. The most common imaging patterns were post-infectious immune-mediated acute disseminated encephalomyelitis-like changes of the brain (16 patients), myelitis (eight patients), and neural enhancement (13 patients).
Keddi S, Pakpoor J, Mousele C, et al. Epidemiological and cohort study finds no association between COVID-19 and Guillain-Barré syndrome. Brain 2020, published 14 December. Full-text: https://doi.org/10.1093/brain/awaa433
Some reports of Guillain-Barré syndrome (GBS) have emerged during the coronavirus disease 2019 (COVID-19) pandemic. Here, Michael Lunn, Stephen Keddie and colleagues from University College London Hospitals NHS Foundation Trust studied the epidemiology of GBS cases reported to the UK National Immunoglobulin Database from 2016 to 2019 and compared it to cases reported during the COVID-19 pandemic. The result: GBS incidence has fallen during the pandemic, which may be the influence of lockdown measures reducing transmission of GBS inducing pathogens such as Campylobacter jejuni and respiratory viruses.
Lee SC, Son KJ, Han CH, et al. Impact of comorbid asthma on severity of coronavirus disease (COVID-19). Sci Rep 10, 21805 (2020). Full-text: https://doi.org/10.1038/s41598-020-77791-8
Asthma may not be a risk factor for poor prognosis of COVID-19. In a nationwide retrospective cohort study, Seon Cheol Park, Sang Chul Lee and colleagues from South Korea selected 7272 adult COVID-19 patients, 686 of whom had a history of asthma. After adjusting for age, sex, and the Charlson comorbidity score, asthma was not a significant risk factor for respiratory failure or mortality among all COVID-19 patients (odds ratio [OR] = 0,99, p = 0,997 and OR = 1,06, p = 0,759). Only a history of acute exacerbation in the previous year before COVID-19 was a significant risk factors for death (OR = 2,63, P = 0,043).
Culha MG, Demir O, Sahin O, et al. Sexual attitudes of healthcare professionals during the COVID-19 outbreak. Int J Impot Res 2020. Full-text: https://doi.org/10.1038/s41443-020-00381-9
Sporadic episodes of sexual dysfunction? Don’t worry, it’s COVID. The reassuring news has just been published by Mehmet Gökhan Çulha and colleagues in a short summary of an online survey among 185 healthcare professionals. Sexual desire, weekly sexual intercourse/masturbation number, foreplay time, sexual intercourse time – everything decreased. When factors affecting sexual dysfunction were analyzed as univariate and multivariate, sexual dysfunction was shown to be significantly more common in males and alcohol users. Time to put the bottle aside and get vaccinated.
Colombier S, Mahendiran T, Niclauss L, Kirsch M. Cardiac arrest and COVID-19: inflammation, angiotensin-converting enzyme 2, and the destabilization of non-significant coronary artery disease—a case report. European Heart Journal 2020, published 12 December. Full-text: https://doi.org/10.1093/ehjcr/ytaa475
The authors describe the case of a 60-year-old COVID-19 patient whose inaugural presentation was a refractory cardiac arrest secondary to the destabilization of known, non-significant coronary artery disease. This case illustrates several potential mechanisms that are thought to drive the cardiac complications seen in COVID-19.
Diller GP, Gatzoulis MA, Broberg CS, et al. Coronavirus disease 2019 in adults with congenital heart disease: a position paper from the ESC working group of adult congenital heart disease, and the International Society for Adult Congenital Heart Disease. Eur Heart J 2020, published 12 December. Full-text: https://doi.org/10.1093/eurheartj/ehaa960
In this position paper, the authors discuss the impact of COVID-19 on ACHD patients, focusing on pathophysiology, risk stratification for work, self-isolation, hospitalization, impact on pregnancy, psychosocial health, and longer-term implications for the provision of ACHD care.
Palumbo MV, Rambur B, McKenna LP. Living at Home with Dementia Now More Complicated with COVID-19. Health Social Work 2020, published 13 December. Full-text: https://doi.org/10.1093/hsw/hlaa029
Living at home with dementia is complicated, even more so during the SARS-CoV-2 pandemic. In this article Mary Val Palumbo, Betty Rambur and Lori P McKenna describe that unpredictability is heightened; that grief associated with dementia progression because of relationship changes, loss of emotional support, decreased financial support, increased dependency, and loss of future plans has intensified; and that fear of contracting the virus has exacerbated stress for single, largely homebound family caregivers.
Bhaskaran K, Rentsch CT, MacKenna B, et al. HIV infection and COVID-19 death: a population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform. Lancet HIV 2020, published 11 December. Full-text: https://doi.org/10.1016/S2352-3018(20)30305-2
Should people with HIV in the UK be at increased risk of COVID-19 mortality? This would be the suggestion of a retrospective cohort study by Ben Goldacre, Krishnan Bhaskaran and colleagues who analyzed the data of 17 282 905 adults, of whom 27 480 (0·16%) had HIV recorded. 14,882 COVID-19 deaths occurred during the study period, with 25 among people with HIV. People living with HIV had higher risk of COVID-19 death than those without HIV after adjusting for age and sex: hazard ratio (HR) 2·90 (95% CI 1·96–4·30; p<0·0001). In a comment, Laura Waters and Anton Pozniak urge for caution in interpretating the results of this study. (Waters LJ, Pozniak AL. COVID-19 death in people with HIV: interpret cautiously. Lancet HIV 2020, published 11 December. Full-text: https://doi.org/10.1016/S2352-3018(20)30332-5.) They emphasize a low absolute mortality of less than 0·1% and recall that 23 (92%) of 25 people with HIV who died had comorbidities.
Fancourt D, Steptoe A, Feifei Bu. Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England: a longitudinal observational study. Lancet Psychiatry 2020, published 9 December. Full-text: https://doi.org/10.1016/S2215-0366(20)30482-X
Several studies suggest that mental health deteriorated in many countries before and during lockdowns. The authors show that the highest levels of depression and anxiety occurred in the early stages of lockdown but declined fairly rapidly, possibly because individuals adapted to circumstances.
FAI2R / SFR / SNFMI / SOFREMIP / CRI / IMIDIATE consortium and contributors. Severity of COVID-19 and survival in patients with rheumatic and inflammatory diseases: data from the French RMD COVID-19 cohort of 694 patients. Ann Rheum Dis. 2020 Dec 2:annrheumdis-2020-218310. PubMed: https://pubmed.gov/33268442. Full-text: https://doi.org/10.1136/annrheumdis-2020-218310
Large French database, including patients with inflammatory rheumatic and musculoskeletal diseases (iRMD). Of 694 adults, 438 (63%) developed mild (not hospitalized), 169 (24%) moderate (hospitalized non-ICU) and 87 (13%) severe (ICU/deceased) disease. In multivariable imputed analyses, the variables associated with severe infection were age, male gender, hypertension and higher BMI. Use of corticosteroids (OR=1.97), mycophenolate mofetil (OR=6.6) and rituximab (OR=4.21) were also risk factors.
Trapani S, Masiero L, Puoti F, et al. Incidence and outcome of SARS-CoV-2 infection on solid organ transplantation recipients: A nationwide population-based study. Am J Transplant. 2020 Dec 5. PubMed: https://pubmed.gov/33278850. Full-text: https://doi.org/10.1111/ajt.16428
Registry case data from Italy: the cumulative incidence of SARS-CoV-2 infection in solid organ transplantation recipients (SOTRs) is three times higher than that estimated for the Italian population, highlighting that SOTRs are more at risk of infection than non-SOTRs. The 30- and 60-day cumulative incidence of mortality of COVID+ SOTRs was twice as high when compared to non-SOTRs.
Gulersen M, Staszewski C, Grayver E, et al. Coronavirus Disease 2019 (COVID-19)-Related Multisystem Inflammatory Syndrome in a Pregnant Woman. Obstet Gynecol. 2020 Dec 3. PubMed: https://pubmed.gov/33278275. Full-text: https://doi.org/10.1097/AOG.0000000000004256
Case report of a woman at 28 weeks gestation, diagnosed with COVID-19 4 weeks prior, and admitted with chest pain. Evaluation indicated myocarditis and marked elevations of inflammatory markers consistent with multisystem inflammatory syndrome in adults. Treatment with intravenous immunoglobin and corticosteroids was associated with a favorable outcome.
Fernandez CE, Franz CK, Ko JH, et al. Imaging Review of Peripheral Nerve Injuries in Patients with COVID-19. Radiology. 2020 Dec 1:203116. PubMed: https://pubmed.gov/33258748. Full-text: https://doi.org/10.1148/radiol.2020203116
Peripheral nerve injury can occur in COVID-19 patients secondary to post-infectious inflammatory neuropathy, prone positioning-related stretch/compression injury, systemic neuropathy, or nerve entrapment from hematoma. MR neurography and high-resolution ultrasound are excellent diagnostic tools for peripheral nerve injury. For COVID-19 patients and survivors with neuromuscular complications, imaging of peripheral nerves can aid medical decision-making, rehabilitative care, and patient/family counseling.
Yu B, Li C, Sun Y, et al. Insulin treatment is associated with increased mortality in patients with COVID-19. Cell Metabolism November 23, 2020. Full-text: https://doi.org/10.1016/j.cmet.2020.11.014
Oops! In this retrospective study on 689 patients with COVID-19 and Type 2 diabetes from Wuhan, China, insulin treatment was associated with a significant increase in mortality (27.2% vs. 3.5%; adjusted HR, 5.38). Further analysis showed that insulin treatment was associated with enhanced systemic inflammation and aggravated injuries of vital organs. However, this was a retrospective observation which could not establish a causal effect relationship between insulin treatment and high mortality. Moreover, there were significant differences in several baseline characteristics and laboratory indices at admission (for examples, SpO2, NT-proBNP and albumin), which may contribute to the different severity and outcome observed in patients treated with insulin.
Shah GL, DeWolf S, Lee YJ, et al. Favorable outcomes of COVID-19 in recipients of hematopoietic cell transplantation. J Clin Invest. 2020 Nov 16:141777. PubMed: https://pubmed.gov/32897885. Full-text: https://doi.org/10.1172/JCI141777
Gunjan L. Shah from Memorial Sloan Kettering Cancer Center and colleagues retrospectively investigated 77 patients with SARS-CoV-2 who were recipients of cellular therapy (Allo, 35; Auto, 37; CAR T, 5; median time from cellular therapy, 782 days). Overall survival at 30 days was 78%. Mortality was largely driven by patients with active malignancy, especially relapsed leukemia, in whom the goals of care were affected both by COVID-19 severity and the decision to forgo anti-cancer treatment during an active infection. Immune profiling revealed reductions and rapid recovery in lymphocyte populations across lymphocyte subsets. Many patients were able to recover from COVID-19 infection and mount an antibody response with similar overall survival to the general hospitalized population.
Luo X, Liao Q, Shen Y, et al. Vitamin D Deficiency Is Inversely Associated with COVID-19 Incidence and Disease Severity in Chinese People. The Journal of Nutrition 13 November 2020. Full-text: https://doi.org/10.1093/jn/nxaa332
Vitamin D might have beneficial potential due to its immunomodulatory and anti-inflammatory properties. But is a deficiency associated with disease severity? Perhaps. In this cross-sectional study, 335 COVID-19 patients admitted to the Wuhan Tongji Hospital were retrospectively analyzed. A vitamin D deficiency (< 30 nmol/L) was significantly associated with COVID-19 severity (OR 2.7). Prospective studies have to confirm these results.
Lim S, Bae JH, Kwon HS, et al. COVID-19 and diabetes mellitus: from pathophysiology to clinical management. Nat Rev Endocrinol (2020). Full-text: https://doi.org/10.1038/s41574-020-00435-4
Patients with diabetes mellitus are at increased risk of severe COVID-19. The authors discuss potential pathogenetic links between COVID-19 and diabetes mellitus; tight control of glucose levels; explain that insulin and dipeptidyl peptidase 4 inhibitors can be used safely in patients with diabetes mellitus and COVID-19; and caution that metformin and sodium–glucose co-transporter 2 inhibitors might need to be withdrawn in patients at high risk of severe disease.
Taquet M, Luciano S, Geddes JR, et al. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62,354 COVID-19 cases in the USA. Lancet Psychiatry November 09, 2020. Full-text: https://doi.org/10.1016/S2215-0366(20)30462-4
Survivors of COVID-19 appear to be at increased risk of psychiatric sequelae. Here, Maxime Taquet and colleagues used a global federated network that captures anonymized data from electronic health records in 54 health care organizations in the US, totaling 69.8 million patients and 62,354 patients diagnosed with COVID-19. In patients with no previous psychiatric history, a diagnosis of COVID-19 was associated with increased incidence of a first psychiatric diagnosis in the following 14 to 90 days compared with six other health events (i.e., hazard ratio [HR] 2.1 vs influenza). The HR was greatest for anxiety disorders, insomnia, and dementia. The incidence of a first diagnosis of dementia in the 14 to 90 days after COVID-19 diagnosis was 1.6% in people older than 65 years. A psychiatric diagnosis in the previous year was associated with a higher incidence of COVID-19 diagnosis (relative risk 1.65).
Li L, Li F, Fortunati F, et al. Association of a Prior Psychiatric Diagnosis With Mortality Among Hospitalized Patients With Coronavirus Disease 2019 (COVID-19) Infection. JAMA Netw Open September 30, 2020; 3(9):e2023282. Full-text: https://doi.org/10.1001/jamanetworkopen.2020.23282
Among a total of 1685 patients who were hospitalized with COVID-19, 473 (28%) received psychiatric diagnoses prior to hospitalization. After controlling for demographic characteristics, other medical comorbidities, and hospital location, the risk of death remained significantly greater among patients with a psychiatric disorder (hazard ratio, 1.5; 95% CI, 1.1-1.9; P = .003). Reasons are unclear. Psychiatric symptoms may arise as a marker of systemic pathophysiologic processes such as inflammation, that may, in turn, predispose to mortality. Similarly, psychiatric disorders may augment systemic inflammation and compromise the function of the immune system, while psychotropic medications may also be associated with mortality risk. Or is there confounding?
Toor J, Adams ER, Aliee M, et al. Predicted Impact of COVID-19 on Neglected Tropical Disease Programs and the Opportunity for Innovation. Clin Infect Dis. 2020 Sep 28:ciaa933. PubMed: https://pubmed.gov/32984870. Full-text: https://doi.org/10.1093/cid/ciaa933
Due to the COVID-19 pandemic, many key neglected tropical disease (NTD) activities have been postponed. However, disruption will vary amongst the diseases and there are ways to mitigate the impact and accelerate progress towards the ambitious WHO 2030 goals.
Agren D. Understanding Mexican health worker COVID-19 deaths. Lancet 2020, published 19 September. Full-text: https://doi.org/10.1016/S0140-6736(20)31955-3
More health workers seem to have died in Mexico than anywhere else. Why? Limited specialized equipment of poor quality. Working conditions, workplace safety, job continuity (contracts) have all also been cited. Mexico also keeps “a very disaggregated register of the numbers on health worker deaths.”
Dandachi D, Geiger G, Montgomery MW, et al. Characteristics, Comorbidities, and Outcomes in a Multicenter Registry of Patients with HIV and Coronavirus Disease-19. Clin Inf Dis 2020 Sep 9. Full-text: https://doi.org/10.1093/cid/ciaa1339.
Among 286 HIV-infected patients who were included by US healthcare providers, mortality rates were 9.4% (27/286) overall, 16.5% (27/164) among those hospitalized, and 51.5% (24/47) among those admitted to an ICU. Older age, chronic lung disease, and hypertension were associated with severe outcomes. A lower CD4 count (< 200 cells/mm³) was associated with the primary and secondary endpoints. There was no association between the antiretroviral regimen or lack of viral suppression and predefined outcomes.
Fraser J, Mousley J, Testro A, Smibert OC, Koshy AN. Clinical Presentation, Treatment, and Mortality Rate in Liver Transplant Recipients With Coronavirus Disease 2019: A Systematic Review and Quantitative Analysis. Transplant Proc. 2020 Jul 30:S0041-1345(20)32634-8. PubMed: https://pubmed.gov/32891405. Full-text: https://doi.org/10.1016/j.transproceed.2020.07.012
A systematic search was performed for articles published up to June 15, 2020, revealing 223 liver transplant recipients with COVID-19 in 15 studies. Immunosuppression was modified in 32.8% of recipients. The case fatality rate was 19.3%. Dyspnea on presentation, diabetes mellitus, and age 60 years or older were significantly associated with increased mortality (P ≤ 0.01) with a trend to a higher mortality rate observed in those with hypertension and those receiving corticosteroids at the time of COVID-19 diagnosis.
Rodgers GP, Gibbons GH. Obesity and Hypertension in the Time of COVID-19. JAMA 2020, published 9 September. Full-text: https://doi.org/10.1001/jama.2020.16753
If you are interested in US prevalence and trends for obesity and controlled hypertension from 1999 through 2018, read this editorial about the following two papers:
Ogden CL, Fryar CD, Martin CB, et al. Trends in obesity prevalence by race and Hispanic origin—1999-2000 to 2017-2018. JAMA 2020, published 9 September. Full-text: https://doi.org/10.1001/jama.2020.14590
Muntner P, Hardy ST, Fine LJ, et al. Trends in blood pressure control among US adults with hypertension, 1999-2000 to 2017-2018. JAMA 2020, published 9 September. Full-text: https://doi.org/10.1001/jama.2020.14545
Meltzer DO, Best TJ, Zhang H, et al. Association of Vitamin D Status and Other Clinical Characteristics With COVID-19 Test Results. JAMA Netw Open September 3, 2020;3(9):e2019722. Full-text: https://doi.org/10.1001/jamanetworkopen.2020.19722
Is treatment for vitamin D deficiency associated with reductions in the risk of COVID-19? Maybe. In this retrospective cohort study of 489 patients who had a vitamin D level measured in the year before COVID-19 testing, the relative risk of testing positive for COVID-19 was 1.77 times greater for patients with likely deficient vitamin D status compared with patients with likely sufficient vitamin D status. However, as with all retrospective studies, be aware of confounding: vitamin D deficiency may be a consequence associated with a range of chronic health conditions or behavioral or environmental factors that increase COVID-19 risk.
Mato AR, Roeker LE, Lamanna N, et al. Outcomes of COVID-19 in patients with CLL: a multicenter international experience. Blood September 3, 2020, 136 (10): 1134–1143. Full-text: https://ashpublications.org/blood/article/136/10/1134/461426/Outcomes-of-COVID-19-in-patients-with-CLL-a
Among 198 CLL patients diagnosed with symptomatic COVID-19 across 43 international centers, the overall case fatality rate was 33%, although 25% remain admitted. Watch-and-wait and treated subgroups had similar rates of admission, ICU admission, intubation and mortality. Of note, CLL-directed treatment with Bruton tyrosine kinase inhibitors (BTKis, have been proposed as a potential treatment for COVID-19) at COVID-19 diagnosis did not impact survival, though BTKis were held during the COVID-19 course for most patients.
Keller N, Chantrel F, Krummel T. Impact of first-wave COronaVIrus disease 2019 infection in patients on haemoDIALysis in Alsace: the observational COVIDIAL study. Nephrology Dialysis Transplantation, September 2, 2020. Volume 35, Issue 8, August 2020, Pages 1338–1411. Full-text: https://doi.org/10.1093/ndt/gfaa170
Prospective observational study conducted in eight HD facilities in Alsace, France. Among 1,346 HD patients, 123 tested positive for COVID-19. Case fatality rate was 24%. While patients presented severe forms of the disease, they often displayed atypical symptoms, with the CRP level being highly associated with risk of death.
Piñana JL, Xhaard A, Tridello G, et al. Seasonal human coronaviruses respiratory tract infection in recipients of allogeneic hematopoietic stem cell transplantation. J Infect Dis. 2020 Aug 29:jiaa553. PubMed: https://pubmed.gov/32860509. Full-text: https://doi.org/10.1093/infdis/jiaa553
In this retrospective multicenter study, which included 402 allo-HCT recipients (adults and children) with upper and/or lower respiratory tract disease (RTD) caused by seasonal HCoV diagnosed through multiplex PCR assays 2012-2019, a significant morbidity was found. HCoV infection frequently required hospitalization (18%), oxygen administration (13%) and ICU admission (3%). Three-month overall mortality after HCoV detection was 7% in the full cohort and 16% in those with lower RTD. Three conditions were identified with higher mortality in recipients with lower RTD: low absolute lymphocyte counts, corticosteroids and, not suprisingly, ICU admission.
Webb GJ, Marjot T, Cook JA, et al. Outcomes following SARS-CoV-2 infection in liver transplant recipients: an international registry study. Lancet Gastroenterol Hepatol 2020, published 28 August. Full-text: https://doi.org/10.1016/S2468-1253(20)30271-5
No increased risk of death for patients with liver transplants. In this multicenter cohort study, Gwilym Webb et al. collected data on 151 adult liver transplant recipients from 18 countries and 627 patients who had not undergone liver transplantation. After adjusting for age, sex, creatinine concentration, obesity, hypertension, diabetes, and ethnicity, liver transplantation did not significantly increase the risk of death in patients with SARS-CoV-2 infection. However, ICU admission (43 [28%] vs 52 [8%], p<0·0001) and invasive ventilation (30 [20%] vs 32 [5%], p < 0·0001) were more frequent in the liver transplant cohort.
Almario CV, Chey WD, Spiegel BMR. Increased Risk of COVID-19 Among Users of Proton Pump Inhibitors. Am J Gastroenterol. 2020 Aug 25. PubMed: https://pubmed.gov/32852340 . Full-text: https://doi.org/10.14309/ajg.0000000000000798
Do PPIs increase the odds for acquiring SARS-CoV-2 infection? Maybe. Using an online survey of 53,130 participants (3,386 with a positive test), Christopher V Almario and colleagues found that individuals using PPIs either once daily (aOR 2.15; 95% CI, 1.90-2.44) or twice daily (aOR 3.67; 95% CI, 2.93-4.60) had significantly increased odds for reporting a positive COVID-19 test when compared with those not taking PPIs. Individuals taking histamine-2 receptor antagonists were not at elevated risk. However, before you stop your PPI: please consider that like all observational studies, this study is very susceptible to confounding (for example, people suffering from other comorbidities may be more likely to take PPIs). Moreover, people participating in this survey were not representative of the general population. Let’s keep an eye out for more data.
Cheng X, Liu YM, Li H, et al. Metformin Use Is Associated with Increased Incidence of Acidosis but not Mortality in Individuals with COVID-19 and Pre-existing Type 2 Diabetes. Cell Metabol August 20, 2020. Full-text: https://doi.org/10.1016/j.cmet.2020.08.013
Retrospective cohort study of 1,213 hospitalized individuals with COVID-19 and pre-existing type 2 diabetes (T2D). Metformin use was significantly associated with a higher incidence of acidosis, particularly in cases with severe COVID-19, but not with 28-day COVID-19-related mortality. Furthermore, metformin use was significantly associated with reduced heart failure and inflammation. These findings provide some evidence in support of continuing metformin treatment in individuals with COVID-19 and pre-existing T2D, but acidosis and kidney function should be carefully monitored.
Ellul MA, Benjamin L, Singh B, et al. Neurological associations of COVID-19. Lancet Neurol 2020;19:767-83. PubMed: https://pubmed.gov/32622375. Full-text: https://doi.org/10.1016/S1474-4422(20)30221-0
Recognition of neurological disease associated with SARS-CoV-2 in patients whose respiratory infection is mild or asymptomatic may prove challenging, especially if primary COVID-19 illness occurred weeks earlier. Tom Solomon and colleagues navigate you through the neurological complications of COVID-19 in this ‘Rapid (15 pages) Review”.
Fifi JT, Mocco J. COVID-19 related stroke in young individuals. Lancet Neurol 2020;19:713-715. Full-text: https://doi.org/10.1016/S1474-4422(20)30272-6
SARS-CoV-2 infection may cause thrombotic vascular events. In patients presenting with large vessel stroke during the COVID-19 pandemic, COVID-19 patients were significantly younger, with a mean age of 59 years, than patients who tested negative for SARS-CoV-2, who had a mean age of 74 years. Johanna Fifi and J Mocco recommend that, in otherwise healthy, young patients who present with stroke during the pandemic, the diagnosis of COVID-19 should be thoroughly investigated.
Lee J, Foote MB, Lumish M, et al. Chemotherapy and COVID-19 Outcomes in Patients With Cancer. J Clin Oncol 2020, August 14, 2020. Full-text: https://ascopubs.org/doi/full/10.1200/JCO.20.01307
Among a total of 309 patients with cancer and concurrent COVID-19 at the Memorial Sloan Kettering Cancer Center, cytotoxic chemotherapy administered within 35 days of a COVID-19 diagnosis was not significantly associated with a severe or critical COVID-19 event (HR, 1.10; 95% CI, 0.73 to 1.60). However, patients with active hematologic or lung malignancies, peri–COVID-19 lymphopenia, or baseline neutropenia had worse COVID-19 outcomes. Findings remained consistent in a multivariate model and in multiple sensitivity analyses.
Boettler T, Marjot T, Newsome N, et al. Impact of COVID-19 on the care of patients with liver disease: EASL-ESCMID position paper after 6 months of the pandemic. J Hepatol 2020, Aug 4. Full-text: https://doi.org/10.1016/j.jhepr.2020.100169
High COVID-19 mortality rates have been reported in patients with pre-existing chronic liver disease and cirrhosis: this excellent review serves as an update on the previous position paper summarizing the evidence for liver disease involvement during COVID-19 and also provide some recommendations on how to return to routine care.
Solomon MD, McNulty EJ, Rana JS, et al. The Covid-19 Pandemic and the Incidence of Acute Myocardial Infarction. N Engl J Med 2020; 383:691-693, August 13, 2020. Full-text: https://doi.org/10.1056/NEJMc2015630
Using data from Kaiser Permanente Northern California, a large health care delivery system with 255 clinics providing care for more than 4.4 million persons throughout Northern California, Mathew Solomon and colleagues show that the weekly rates of hospitalization for acute myocardial infarction decreased by up to 48% during the COVID-19 period. Decreases were similar among patients with NSTEMI (incidence rate ratio, 0.51) and those with STEMI (0.60). Of note, demographic characteristics, hemodynamic measures on admission, initial and peak troponin I values, and the burden of other examined co-existing conditions were similar in patients who presented during the COVID-19 period and in those who presented before the first case of COVID-19 occurred.
Solomon DA, Sherman AC, Kanjilal S. Influenza in the COVID-19 Era. Jama 2020, published 14 August. Full-text: https://doi.org/10.1001/jama.2020.14661
In some years and in some countries, the annual influenza epidemic can result in tens of thousands in deaths. Now clinicians face a second respiratory virus associated with morbidity and mortality several-fold higher than that of influenza. In this short Insight article, Daniel Solomon and colleagues stress the importance of widespread implementation of seasonal influenza vaccination and preservation of non-pharmacologic interventions (such as mandatory face coverings in public, closure of schools and retail spaces, and restrictions on movement) until community immunity is achieved through an effective SARS-CoV-2 vaccine and/or natural infection.
Passamonti F, Cattaneo C, Arcaini L, et al. Clinical characteristics and risk factors associated with COVID-19 severity in patients with haematological malignancies in Italy: a retrospective, multicentre, cohort study. Lancet Haematol 2020, published 13 August. Full-text: DOI:https://doi.org/10.1016/S2352-3026(20)30251-9
In this 74-author study from Italy, Francesco Passamonti and colleagues report a retrospective study which included patients with a diagnosis of a hematological malignancy between 25 February and 18 May, 2020, with laboratory-confirmed and symptomatic COVID-19. 198 (37%) of 536 patients died. Progressive disease status, diagnosis of acute myeloid leukemia, indolent non-Hodgkin lymphoma, aggressive non-Hodgkin lymphoma or plasma cell neoplasms were associated with worse overall survival. See also the comment by Samuel Rubinstein and Jeremy Warner: COVID-19 and haematological malignancy: navigating a narrow strait. Lancet Haematol 2020, published 13 August. Full-text: https://doi.org/10.1016/S2352-3026(20)30252-0
Holman N, Knighton P, Kar P, et al. Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study. Lancet Diabetes Endocrinol 2020, published 13 August. Full-text: https://doi.org/10.1016/S2213-8587(20)30271-0
Barron E, Bakhai C, Kar P, et al. Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study. Lancet Diabetes Endocrinol 2020, published 13 August. Full-text: https://doi.org/10.1016/S2213-8587(20)30272-2
A double hit by Jonathan Valabhji and colleagues! In the first paper (Holman et al.), the authors did a population-based cohort study of people with diabetes in the UK. Between 16 February and 11 May 2020, 1,604 people with type 1 diabetes and 36,291 people with type 2 diabetes died from all causes. Of these deaths, 464 in people with type 1 diabetes and 10,525 in people with type 2 diabetes were defined as COVID-19 related, of which 289 (62.3%) and 5,833 (55.4%), respectively, occurred in people with a history of cardiovascular disease or with renal impairment (eGFR < 60 mL/min per 1.73 m2). Increased COVID-19-related mortality also corresponded with glycemic control and body mass index.
In the second paper (Barron et al.), the authors did a whole-population study assessing risks of in-hospital death with COVID-19 between 1 March and 11 May 2020. Among the 23,698 in-hospital COVID-19-related deaths, a third occurred in people with diabetes: 7,434 (31.4%) in people with type 2 diabetes, 364 (1.5%) in those with type 1 diabetes, and 69 (0.3%) in people with other types of diabetes.
Tartof SY, Qian L, Hong V, et al. Obesity and Mortality Among Patients Diagnosed With COVID-19: Results From an Integrated Health Care Organization. Ann Intern Med. 2020 Aug 12. PubMed: https://pubmed.gov/32783686. Full-text: https://doi.org/10.7326/M20-3742
In this retrospective cohort study, Sara Tartof and colleagues determined the adjusted effect of body mass index (BMI), associated comorbidities, sociodemographic factors, and other factors on risk for death due to COVID-19. Compared with patients with a BMI of 18.5 to 24 kg/m2, those with BMIs of 40 to 44 kg/m2 and greater than 45 kg/m2 had relative risks of 2.68 and 4.18, respectively. This risk was most striking among those aged 60 years or younger and men. The authors found no increased risk for death associated with Black or Latino race/ethnicity or other sociodemographic characteristics. See also the comment by David Kass: COVID-19 and Severe Obesity: A Big Problem? Ann Intern Med. 2020 Aug 12. PubMed: https://pubmed.gov/32783685. Full-text: https://doi.org/10.7326/M20-5677
Rivinius R, Kaya Z, Schramm R, et al. COVID-19 among heart transplant recipients in Germany: a multicenter survey. Clin Res Cardiol. 2020 Aug 11. PubMed: https://pubmed.gov/32783099. Full-text: https://doi.org/10.1007/s00392-020-01722-w
A multicenter survey of all heart transplant centers in Germany evaluating the current status of COVID-19 among adult heart transplant recipients. Eight of 21 patients (38.1%) displayed a severe course needing invasive mechanical ventilation, seven of whom died.
Inciarte A, Gonzalez-Cordon A, Rojas J, et al. Clinical characteristics, risk factors, and incidence of symptomatic COVID-19 in adults living with HIV: a single-center, prospective observational study. AIDS. 2020 Aug 7. PubMed: https://pubmed.gov/32773471. Full-text: https://doi.org/10.1097/QAD.0000000000002643
53 out of 5683 (0.9% confidence interval 0.7-1.2%) PLWH in Barcelona were diagnosed with COVID-19. Clinical presentation, severity rate, and mortality were not dependent on any HIV-related or antiretroviral-related factor. COVID-19 standardized incidence rate was lower in PLWH than in the general population.
Restivo DA, Centonze D, Alesina A, Marchese-Ragona R. Myasthenia Gravis Associated With SARS-CoV-2 Infection. Ann Intern Med 2020, published 10 August. Full-text: https://www.acpjournals.org/doi/10.7326/L20-0845
Myasthenia gravis is an autoimmune disease in which antibodies bind to acetylcholine receptors (AChRs) or to functionally related molecules in the post-synaptic membrane at the neuromuscular junction. Now Domenico Restivo and colleagues describe 3 patients without previous neurologic or autoimmune disorders who were diagnosed with myasthenia gravis within 5 to 7 days after fever onset related to COVID-19. The authors speculate that antibodies directed against SARS-CoV-2 proteins might cross-react with AChR subunits.
Williams RD II, Shah A, Tikkanen R, et al. Do Americans face greater mental health and economic consequences from covid-19? Comparing the US with other high-income countries. Commonwealth Fund 2020, published 6 August. Full-text: https://www.commonwealthfund.org/publications/issue-briefs/2020/aug/americans-mental-health-and-economic-consequences-COVID19
One-third of U.S. adults reported experiencing stress, anxiety, and great sadness that was difficult to cope with by themselves, a significantly higher proportion than in other countries. Over 30 percent of Americans faced negative economic impacts due to the pandemic, significantly more than in the comparison high-income countries. Can the US do more regarding mental health, an existing concern before COVID-19? See also the comment by Janice Hopkins Tanne: Mental health and economic problems are worse in US than in other rich nations. BMJ 2020, Aug 6;370:m3110. PubMed: https://pubmed.gov/32764109. Full-text: https://doi.org/10.1136/bmj.m3110
Velez JCQ, Caza T, Larsen CP. COVAN is the new HIVAN: the re-emergence of collapsing glomerulopathy with COVID-19. Nat Rev Nephrol2020, published 4 August. Full-text: https://doi.org/10.1038/s41581-020-0332-3
Is COVAN the new HIVAN? Collapsing glomerulopathy was first characterized in the setting of HIV infection and termed HIV-associated nephropathy (HIVAN). In recent months, five case reports of collapsing glomerulopathy akin to those seen during the HIV epidemic have been published describing cases of collapsing glomerulopathy in association with SARS-CoV-2 infection. All of these cases were in patients of African ethnicity. Juan Carlos Velez and co-authors propose the term COVID-19-associated nephropathy (COVAN) to be used to describe this specific entity.
Rugge M, Zorzi M, Guzzinati S. SARS-CoV-2 infection in the Italian Veneto region: adverse outcomes in patients with cancer. Nat Cancer 2020, published 31 July. Full-text: https://doi.org/10.1038/s43018-020-0104-9
Massimo Rugge, Manuel Zorzi and Stefano Guzzinati describe 9,275 patients with SARS-CoV-2 infection (CV2+ve), 723 of whom (7.8%) had a cancer diagnosis. The proportion of patients hospitalized was higher among patients with cancer (56.6% versus 34.4% among other patients), and so was the proportion of deaths (14.7% versus 4.5%). The risk of adverse outcomes of SARS-CoV-2 infection was significantly higher for patients with cancer versus those without, particularly for males and older people. Breast cancer and hematological cancers were associated with a higher risk of both hospitalization and death. Lung cancer was associated with a fourfold risk of death due to SARS-CoV-2 infection. The authors insist that the clinical importance of these results warrants further investigation.
Steardo L Jr, Steardo L, Verkhratsky A. Psychiatric face of COVID-19. Transl Psychiatry 2020;10,261. Full-text: https://doi.org/10.1038/s41398-020-00949-5
Your weekend review – 8 pages and 176 references? Father and son Steardo and Alexei Verkhratsky from Catanzaro, Benevento and Manchester/Bilbao/Moscow, respectively, outline possible neuropsychiatric complications of COVID-19: depression, bipolar disorders, reactive psychosis, obsessive-compulsive disorder, epilepsy, post-traumatic stress disorder. The authors predict an increased incidence of mental pathologies as a result of wide-spread SARS-CoV-2 infection.
Nishiga M, Wang DW, Han Y et al. COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives. Nat Rev Cardiol 2020, published 20 July. Full-text: https://doi.org/10.1038/s41569-020-0413-9
Pre-existing cardiovascular disease is linked with higher morbidity and mortality in patients with COVID-19, whereas COVID-19 itself can induce myocardial injury, arrhythmia, acute coronary syndrome and venous thromboembolism. In this review, Masataka Nishiga, Joseph C. Wu and colleagues summarize the current understanding of the interaction between COVID-19 and the cardiovascular system.
Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiol 2020, published online July 27. Full-text: https://doi.org/10.1001/jamacardio.2020.3557
Are COVID-19 patients at risk of heart problems after surviving an illness? In a prospective observational cohort study, Eike Nagel and colleagues from the University of Frankfurt, Germany, evaluated cardiovascular magnetic resonance (CMR) images of 100 patients who were recovering from COVID-19 disease. A total of 78 patients (78%) had abnormal CMR findings, including raised myocardial native T1 (n = 73), raised myocardial native T2 (n = 60), myocardial late gadolinium enhancement (n = 32), and pericardial enhancement (n = 22). Endomyocardial biopsy in patients with severe findings revealed active lymphocytic inflammation. At the time of CMR, high-sensitivity troponin T was detectable (3 pg/mL or greater) in 71 patients recently recovered from COVID-19 (71%) and significantly elevated (13.9 pg/mL or greater) in 5 patients (5%). Of note, the median time interval between COVID-19 diagnosis and CMR was 71 (IQR: 64-92) days. The authors stress the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19.
Read also the editorial by Clyde W. Yancy and Gregg C. Fonarow: Coronavirus Disease 2019 (COVID-19) and the Heart—Is Heart Failure the Next Chapter? JAMA Cardiol 2020, published online July 27. Full-text: https://doi.org/doi:10.1001/jamacardio.2020.3575
Lindner D, Fitzek A, Bräuninger H, et al. Association of Cardiac Infection With SARS-CoV-2 in Confirmed COVID-19 Autopsy Cases. JAMA Cardiol 2020, published online July 27. Full-text: https://doi.org/10.1001/jamacardio.2020.3551
How much is COVID-19 associated with myocardial injury, possibly as the result of viral infection of the heart? Dirk Westermann and colleagues from the University Heart and Vascular Center in Hamburg, Germany, report on a series of 39 autopsies of patients with COVID-19 in whom pneumonia was the clinical cause of death in 35 of 39. SARS-CoV-2 was documented in 24 of 39 patients (61.5%) and viral load above 1000 copies per μg RNA in 16 of 39 patients (41.0%). A cytokine response panel consisting of 6 proinflammatory genes was increased in those 16 patients compared with 15 patients without any SARS-CoV-2 in the heart. In situ hybridization suggested that the most likely localization of SARS-CoV-2 was not in the cardiomyocytes but in interstitial cells or macrophages invading the myocardial tissue.
Read also the editorial by Clyde W. Yancy and Gregg C. Fonarow: Coronavirus Disease 2019 (COVID-19) and the Heart—Is Heart Failure the Next Chapter? JAMA Cardiol 2020, published online July 27. Full-text: https://doi.org/doi:10.1001/jamacardio.2020.3575
Karim QA, Karim SSA. COVID-19 affects HIV and tuberculosis care. Science 24 Jul 2020:Vol. 369, Issue 6502, pp. 366-368. Full-text: https://science.sciencemag.org/content/369/6502/366
Key resources that had been extensively built up over decades for the control of HIV and TB are now being redirected to control COVID-19 in various countries in Africa, particularly South Africa. Find out how HIV and TB prevention and treatment have been affected by the SARS-CoV-2 pandemic.
Léger D, Beck F, Fressard L, Verger P, Peretti-Watel P, COCONEL Group. Poor sleep associated with overuse of media during the COVID-19 lockdown. Sleep 2020, published 25 July. Full-text: https://doi.org/10.1093/sleep/zsaa125
This COCONEL survey was based on a permanent panel of 750,000 French individuals, authorized by the French National Agency for Data Protection (CNIL). Here, 1005 panelists answered the survey out of the 25,800 invitations mailed out in mid-April of 2020. Damien Leger and colleagues report that the prevalence of sleep problems during the lockdown was notably higher (73%) than that reported among the general population in France in 2017 (49%). Their comment: “Physicians usually recommend coping with sleep disorders by exercising, going outside, avoiding screen time, and having a regular schedule — all recommendations difficult to apply during lockdown.” A concise two-page read.
Yao Z, Chen J, Wang Q, et al. Three Patients with COVID-19 and Pulmonary Tuberculosis, Wuhan, China, January-February 2020. Emerg Infect Dis. 2020 Jul 15;26(11). PubMed: https://pubmed.gov/32667282. Full-text: https://doi.org/10.3201/eid2611.201536
Tham SM, Lim WY, Lee CK, et al. Four Patients with COVID-19 and Tuberculosis, Singapore, April-May 2020. Emerg Infect Dis. 2020 Jul 15;26(11). PubMed: https://pubmed.gov/32667283. Full-text: https://doi.org/10.3201/eid2611.202752
Two papers about three patients with COVID-19 and tuberculosis in Wuhan and four patients in Singapore. Clinicians treating at-risk populations should be aware of possible co-infection with M. tuberculosis and SARS-CoV-2 in patients with atypical radiographic features of COVID-19.
Mato AR, Roeker LE, Lamanna N, et al. Outcomes of COVID-19 in Patients with CLL: A Multicenter, International Experience. Blood. 2020 Jul 20:blood.2020006965. PubMed: https://pubmed.gov/32688395. Full-text: https://doi.org/10.1182/blood.2020006965
CLL patients have impaired humoral and cellular immune function. The authors describe the first large, disease-specific series in a defined cohort of hematologic cancer patients from 43 international centers. Of 198 CLL patients diagnosed with symptomatic COVID-19, 39% were treatment-naïve (“watch and wait”) while 61% received at least one CLL therapy. At a median follow-up of 16 days, the overall case fatality rate was 33%, while another 25% were still in hospital. Discover differences between “Watch and wait” and treated cohorts with regard to ICU admission, intubation, and mortality. CLL patients are at high risk of death.
Bilaloglu S, Aphinyanaphongs Y, Jones S, et al. Thrombosis in Hospitalized Patients With COVID-19 in a New York City Health System. JAMA. Published online July 20, 2020. Full-text: https://doi.org/10.1001/jama.2020.13372
The authors assessed the incidence of, and risk factors for, venous and arterial thrombotic events in patients with COVID-19 in 4 hospitals in New York City. Among 3334 consecutive patients, a thrombotic event occurred in 16.0%. 207 (6.2%) were venous (3.2% PE and 3.9% DVT) and 365 (11.1%) were arterial (1.6% ischemic stroke, 8.9% MI, and 1.0% systemic thromboembolism). All-cause mortality was 24.5% and was higher in those with thrombotic events (43.2% vs 21.0%). D-dimer level at presentation was independently associated with thrombotic events, consistent with early coagulopathy.
Sorry for being 40 days late to present this article published in June. As obesity is recognized as an independent risk factor for severe illness and death with COVID-19, a reminder of the players involved in the obesity pandemic is always helpful. The authors have a concise message: “Food industries around the world must immediately stop promoting, and governments must force reformulation of, unhealthy foods and drinks.” As food industries won’t stop promoting, governments must regulate them.
Apicella M, Campopiano MC, Mantuano M, et al. COVID-19 in people with diabetes: understanding the reasons for worse outcomes. Lancet Diabetes Endocrinol, 17 July 2020. Full-text: https://doi.org/10.1016/S2213-8587(20)30238-2
This review provides an assessment of prognostic factors in patients with diabetes and COVID-19. A poorer prognosis would be the consequence of the syndromic nature of diabetes: hyperglycemia, older age, comorbidities, and in particular hypertension, obesity, and cardiovascular disease. All would contribute to an increased risk.
Hogan AB, Jewel BL, Sherrard-Smith E, et al. Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study. Lancet July 13, 2020. Full-text: https://doi.org/10.1016/S2214-109X(20)30288-6
The collateral damage is just as great. Using established transmission models, data indicate that in countries with a high burden of malaria, HIV and tuberculosis, COVID-19 related disruptions in care could lead to a loss of life-years of over 5 years, that is of the same order of magnitude as the direct impact from COVID-19. The authors estimate that deaths due to HIV, tuberculosis, and malaria over 5 years could increase by up to 10% due to HIV (mainly due to treatment interruptions), 20% to TB (less timely diagnosis and treatment of new cases), and 36% to malaria (interruption of planned net campaigns), respectively.
Ikematsu H, Hayden FG, Kawaguchi K, et al. Baloxavir Marboxil for Prophylaxis against Influenza in Household Contacts. NEJM July 8, 2020. Full-text: https://doi.org/10.1056/NEJMoa1915341
How will we deal with influenza next winter? Baloxavir marboxil (baloxavir) is a prodrug of the cap-dependent endonuclease inhibitor baloxavir acid and was approved as a single-dose treatment for uncomplicated influenza A and B in Japan and in the US in 2018. Among 752 household contacts of 545 index patients (96% influenza A) virus infection, the percentage in whom clinical influenza developed was significantly lower in the baloxavir group than in the placebo group (1.9% vs. 13.6%).
Uyeki TM. Baloxavir for Postexposure Prophylaxis against Influenza in Households. NEJM July 8, 2020. Full-text: https://doi.org/10.1056/NEJMe2022702
This editorial discusses some caveats of the above trial, including resistance issues. Moreover, 73% of the household contacts received baloxavir or placebo rapidly – within 24 hours after the onset of illness. Last but not least, clinicians are reminded that the primary prevention of influenza is through annual influenza vaccination. We have to be prepared next winter.
Panepinto JA, Brandow A, Mucalo L, et al. Coronavirus disease among persons with sickle cell disease, United States, March 20–May 21, 2020. Emerg Infect Dis. 2020 Oct. Full-text: https://doi.org/10.3201/eid2610.202792
Sickle cell disease (SCD) disproportionately affects Black or African-American persons in the United States and can cause multisystem organ damage and reduced lifespan. Among 178 persons with SCD in the US who were reported to an SCD–coronavirus disease case registry, 122 (69%) were hospitalized and 13 (7%) died. According to the authors, this is alarming, given that the mean patient age was < 40 years. However, there may be bias toward more severe cases in this registry.
Tadic M, Cuspidi C, Grassi G, Mancia G. COVID-19 and arterial hypertension: Hypothesis or evidence? J Clin Hypertens (Greenwich). 2020 Jul 6. PubMed: https://pubmed.gov/32627330. Full-text: https://doi.org/10.1111/jch.13925
Hypertension has been proven to be more prevalent in patients with an adverse outcome. So far, there is no study that demonstrates the independent predictive value of hypertension on mortality in COVID-19 patients. This review summarizes the current knowledge about the relationship between hypertension and COVID‐19 and the role of hypertension on outcome in these patients.
Stanworth SJ, New HV, Apelseth TO, et al. Effects of the COVID-19 pandemic on supply and use of blood for transfusion. Lancet Hematology, July 03, 2020. Full-text: https://doi.org/10.1016/S2352-3026(20)30186-1
The pandemic has major implications for blood transfusion. There are uncertain patterns of demand, and transfusion institutions need to plan for reductions in donations and loss of crucial staff because of sickness and public health restrictions. This article provides a synthesis of the published literature and guidance during times of potential or actual shortage. However, a reduction in donor numbers has largely been matched by reductions in demand for transfusion.
Zhong J, Shen G, Yang H, et al. COVID-19 in patients with rheumatic disease in Hubei province, China: a multicentre retrospective observational study. Lancet Rheumatology July 03, 2020. Full-text: https://doi.org/10.1016/S2665-9913(20)30227-7
Patients with autoimmune rheumatic disease might be more susceptible. Within 42 families with at least one member suffering from a rheumatic disease, COVID-19 was diagnosed in 27 (63%) of 43 patients with a rheumatic disease and in 28 (34%) of 83 of their family members with no rheumatic disease (adjusted odds ratio 2.68, 95% CI 1.14–6.27). Patients with rheumatic disease who were taking hydroxychloroquine had a lower risk of COVID-19 infection than patients taking other disease-modifying anti-rheumatic drugs (OR 0.09, 0.01–0.94).
Armeni E, Aziz U, Qamar S, et al. Protracted ketonaemia in hyperglycaemic emergencies in COVID-19: a retrospective case series. Lancet Diabetol Endocrinol July 01, 2020. Full-text: https://doi.org/10.1016/S2213-8587(20)30221-7
COVID-19 is associated with hyperglycemic emergencies in COVID-19. In this case series of 35 patients from three hospitals in north London, UK, March 1–30, 2020, an over-representation of type 2 diabetes in patients presenting with diabetic ketoacidosis and long-lasting ketosis was observed. Findings suggest acute insulinopenia in patients with COVID-19 and with type 2 diabetes, which persisted up until the time of discharge in 30% of patients previously not insulin-treated. Moreover, the study sample, with almost half of patients of African background, had protracted ketonemia and ketoacidosis.
Del Amo J, Polo R, Moreno S, et al. Incidence and Severity of COVID-19 in HIV-Positive Persons Receiving Antiretroviral Therapy – A Cohort Study. Annals Int Med 2020, June 26. Full-text: https://doi.org/10.7326/M20-3689
Is there an effect of TDF? Of 77,590 HIV-positive persons receiving ART, 236 were diagnosed with COVID-19, 151 were hospitalized, 15 were admitted to the ICU, and 20 died. The risk for COVID-19 hospitalization was 20.3 (95% CI, 15.2 to 26.7) among patients receiving TAF/FTC, 10.5 (CI, 5.6 to 17.9) among those receiving TDF/FTC, 23.4 (CI, 17.2 to 31.1) among those receiving ABC/3TC, and 20.0 (CI, 14.2 to 27.3) for those receiving other regimens. However, residual confounding by comorbid conditions cannot be completely excluded.
Tison GH, Avram R, Kuhar P, et al. Worldwide Effect of COVID-19 on Physical Activity: A Descriptive Study. Ann Int Med 2020, June 29. Full-text: https://doi.org/10.7326/M20-2665
Big data: Using data from a popular health and wellness smartphone app (Argus), a rapid worldwide step count decrease was seen during the COVID-19 pandemic, with regional variability. Samples from different countries varied widely in the number of days after pandemic declaration that a 15% step count decrease was seen: Italy (5 days), Spain (9 days), France (12 days), India (14 days), the United States (15 days), the United Kingdom (17 days), Australia (19 days), and Japan (24 days).
Louapre C, Collongues N, Stankoff B, et al. Clinical Characteristics and Outcomes in Patients With Coronavirus Disease 2019 and Multiple Sclerosis. JAMA Neurol 2020, June 26. Full-text: https://doi.org/10.1001/jamaneurol.2020.2581
This registry-based cohort study from France has included 347 patients with MS with a confirmed or highly suspected diagnosis of COVID-19. In total, 73 patients (21.0%) had a COVID-19 severity score of 3 or more, and 12 patients (3.5%) died. Age, Expanded Disability Severity Scale score (EDSS; ranging from 0 to 10, with cutoffs at 3 and 6), and obesity were independent risk factors for severe COVID-19; there was no association found between exposure to disease-modifying therapies and severity.
Meca-Lallana V, Aguirre C, Beatrizdel Río, Cardeñoso L, Alarcon T, Vivancos J. COVID-19 in 7 multiple sclerosis patients in treatment with ANTI-CD20 therapies. Mult Scler Relat Disord. 2020 Jun 15;44:102306. PubMed: https://pubmed.gov/32585617. Full-text: https://doi.org/10.1016/j.msard.2020.102306
A small case series on patients with MS and COVID-19, treated with the anti-CD20 monoclonal antibodies (mAbs) ocrelizumab and rituximab. Although the severity of the clinical picture varied, patients’ development was good, indicating that B cells and immunoglobulin may not be absolutely necessary for viral elimination. Not all patients developed antibodies against SARS-CoV-2.
Sivaloganathan H, Ladikou EE, Chevassut T. COVID-19 mortality in patients on anticoagulants and antiplatelet agents. Br J Haematol. 2020 Jun 25. PubMed: https://pubmed.gov/32584423. Full-text: https://doi.org/10.1111/bjh.16968
Anticoagulants, or other antithrombotic agents such as antiplatelet drugs, might counteract the coagulopathic effects of COVID-19 resulting in improved outcomes. This small, matched-control study shows that this is probably not the case. Patients on aspirin (n=18), on clopidogrel (n=8), apixaban (n=12), warfarin (n=7) and some other drugs did not have a significantly different mortality risk to patients not taking these drugs. According to the authors, this could suggest these agents negate any potential increased mortality risk attributable to whichever disease the drugs had been prescribed, but further data on comorbidities is required to confirm this assertion.
Zhang XJ, Quin JJ, Cheng X, et al. In-hospital Use of Statins is Associated with a Reduced Risk of Mortality among Individuals with COVID-19. Cell Metabolism June 24, 2020. Full-text: https://doi.org/10.1016/j.cmet.2020.06.015
Retrospective study on 13,981 patients in Hubei Province, China, among which 1,219 received statins. Based on a Cox model with time-varying exposure and after propensity score-matching, 28-day all-cause mortality was 5.2% and 9.4% in the matched statin and non-statin groups, respectively. Randomized controlled trials involving statin treatment for COVID-19 are needed.
Robilotti EV, Babady NE, Mead PA, et al. Determinants of COVID-19 disease severity in patients with cancer. Nat Med June 24, 2020. Full-text: https://doi.org/10.1038/s41591-020-0979-0
Among 423 cases of symptomatic COVID-19 who were diagnosed at Memorial Sloan Kettering Cancer Center, 40% were hospitalized for COVID-19 and 12% died within 30 days. Age older than 65 years and treatment with immune checkpoint inhibitors (ICIs) were predictors for hospitalization and severe disease, whereas receipt of chemotherapy and major surgery were not.
Kent DG, Knapp DJ, Kannan N. Survey Says: “COVID-19 Lockdown Hits Young Faculty and Clinical Trials“. Stem Cells Rep June 22, 2020. Full-text: https://doi.org/10.1016/j.stemcr.2020.06.010
The survey was conducted from 6 to 15 April, 2020 and filled out by 762 researchers from 52 countries. It captured opinions from across all career stages on how COVID-19 has severely impacted laboratory research (i.e., 65% of laboratories were mostly or completely shut). From the crippling of ongoing and planned clinical trials across the full breadth of stem cell research to the devastating loss of productivity for those researchers near career transitions, the survey revealed some of the bleak truths on the impact of COVID-19 in the stem cell community.
Lange SJ, Ritchey MD, Goodman AB, et al. Potential Indirect Effects of the COVID-19 Pandemic on Use of Emergency Departments for Acute Life-Threatening Conditions — United States, January–May 2020. MMWR Morb Mortal Wkly Rep. ePub: 22 June 2020. Full-text: https://www.cdc.gov/mmwr/volumes/69/wr/mm6925e2.htm
National syndromic surveillance data has found that emergency department (ED) visits declined 42% during the early months of the pandemic. This report describes trends in ED visits for three acute life-threatening health conditions, immediately before and after declaration of the COVID-19 pandemic as a national emergency: in the 10 weeks following the declaration, ED visits declined 23% for heart attack, 20% for stroke, and 10% for hyperglycemic crisis. The substantial reduction might be explained by many pandemic-related factors including fear of exposure to COVID-19, unintended consequences of public health recommendations to minimize non-urgent health care, stay-at-home orders, or other reasons.
El-Sharkawi D, Iyengar S. Haematological Cancers and the risk of severe COVID-19: Exploration and critical evaluation of the evidence to date. Br J Haematol. 2020 Jun 19. PubMed: https://pubmed.gov/32559308. Full-text: https://doi.org/10.1111/bjh.16956
The authors review the evidence to date to see whether a history of hematological malignancy is associated with increased risk of COVID‐19. Results: Multivariable analysis does indicate that patients with hematological malignancy, especially those diagnosed recently, are at increased risk of death with COVID‐19 compared to the general population. The evidence that this risk is higher than for those with solid malignancies is conflicting. There is suggestive evidence from smaller cohort studies that those with myeloid malignancy may be at increased risk within the blood cancer population, but this needs to be confirmed through larger studies.
Ibáñez-Samaniego L, Bighelli F, Usón C, et al. Elevation of liver fibrosis index FIB-4 is associated with poor clinical outcomes in patients with COVID-19. J Infect Dis. 2020 Jun 21:jiaa355. PubMed: https://pubmed.gov/32563190. Full-text: https://doi.org/10.1093/infdis/jiaa355
In middle-aged patients with COVID-19, the FIB-4 index may have a relevant prognostic role. In a multivariate analysis, among other risk factors, a FIB-4 > 2.67 increased the risk of ICU admission significantly (OR 3.41; 95% CI 1.30-8.92).
Fosbøl EL, Butt JH, Østergaard L, et al. Association of Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use With COVID-19 Diagnosis and Mortality. JAMA June 19, 2020. Full-text: https://doi.org/10.1001/jama.2020.11301
ACE inhibitors are not harmful, even in Denmark (one of the countries with the best epidemiological data). In a retrospective cohort study of 4,480 (!) patients diagnosed as having COVID-19, prior ACEI/ARB use, compared with no use, was not significantly associated with mortality (adjusted hazard ratio, 0.83). In a nested case-control study of a cohort of 494,170 patients with hypertension, use of ACEI/ARB, compared with use of other antihypertensive medications, was not significantly associated with COVID-19 diagnosis (adjusted hazard ratio, 1.05).
Lai PH, Lancet EA, Weiden MD. Characteristics Associated With Out-of-Hospital Cardiac Arrests and Resuscitations During the Novel Coronavirus Disease 2019 Pandemic in New York City. JAMA Cardiol. Published online June 19, 2020. Full-text: https://doi.org/10.1001/jamacardio.2020.2488
In this population-based cross-sectional study of 5,325 patients with out-of-hospital cardiac arrests in New York City, the number undergoing resuscitation was 3-fold higher during the COVID-19 period compared with the similar period in 2019. The authors report 2,653 excess out-of-hospital cardiac arrests (90% of these excess cases resulted in out-of-hospital deaths).
Koopmann A, Ekaterini G, Falk K, et al. Did the General Population in Germany Drink More Alcohol during the COVID-19 Pandemic Lockdown? Alcohol and Alcoholism, June 19 20020. Full-text: https://doi.org/10.1093/alcalc/agaa058
Question of the day. Answer: Some did so, yes. Out of the 2,102 participants of this survey, 34.7% reported drinking “more or much more” alcohol since the begin of the lockdown. Binary logistic regression analyses showed that especially low educated subjects and subjects with higher levels of perceived stress due to the lockdown were at risk of consuming more alcohol during the lockdown.
Cappo A, Bellani G, Wintertin D, et al. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study. Lancet Resp Med June 19, 2020. Full-text: https://doi.org/10.1016/S2213-2600(20)30268-X
This prospective cohort study enrolled 56 patients with COVID-19-related pneumonia receiving supplemental oxygen or non-invasive continuous positive airway pressure. Prone positioning was feasible in most patients and effective in rapidly ameliorating blood oxygenation. The effect was maintained after resupination in half of the patients.
Arlet JB, de Luna G, Khimoud D, et al. Prognosis of patients with sickle cell disease and COVID-19: a French experience. Lancet Hematology 2020, June 18. Full-text: https://doi.org/10.1016/S2352-3026(20)30204-0
Results of this French cohort of 83 patients suggest that COVID-19, even if potentially severe, does not seem to carry an increased risk of morbidity or mortality in patients with sickle cell disease, as most patients worldwide have the SS/Sβ0 genotype and are younger than 45 years.
Zeidan AM, Poddu P, Patniak MM, et al. Special considerations in the management of adult patients with acute leukaemias and myeloid neoplasms in the COVID-19 era: recommendations from a panel of international experts. Lancet Hematology 2020, June 18. Full-text: https://doi.org/10.1016/S2352-3026(20)30205-2
This article summarise key changes related to service allocation, clinical and supportive care, clinical trial participation, and ethical considerations regarding the use of lifesaving measures for these patients. It also offers a consensus on clinical practice guidance for optimal care in both the university and community health-care settings.
Piccolo R, Bruzzese D, Mauro C, et al. Population Trends in Rates of Percutaneous Coronary Revascularization for Acute Coronary Syndromes Associated With the COVID-19 Outbreak. Circulation. 2020 Jun 16; 141(24): 2035–2037. Full-text: https://doi.org/10.1161/CIRCULATIONAHA.120.047457
This study investigated the association between the outbreak of COVID-19 and PCI rates for ACS (Acute Coronary Syndromes) in the Campania region, which, with 5.8 million residents, represents ≈10% of the Italian population. The outbreak was associated with a decline in the number of PCIs for ACS by 32%. In the last 2 weeks of the observational period, PCIs for ACS were reduced by 50%. In comparison with PCI volumes for the same time in 2019, the decline in PCI rates was of a similar magnitude (between 36% and 38%).
Garassino MC, Whisenant JG, Huang LC, et al. COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study. Lancet Oncol. 2020 Jun 12:S1470-2045(20)30314-4. PubMed: https://pubmed.gov/32539942. Full-text: https://doi.org/10.1016/S1470-2045(20)30314-4
Of 200 patients with COVID-19 and thoracic cancers (76% NSCLC) from eight countries were identified and included in the TERAVOLT registry, 152 (76%) were hospitalised and 66 (33%) died. Of note, in a multivariable analysis, only smoking history (OR 3.18, 95% CI 1.11-9.06) was associated with increased risk of death.
Furfaro F, Vuitton L, Fiorino G, et al. SFED recommendations for IBD endoscopy during COVID-19 pandemic: Italian and French experience. Nat Rev Gastroenterol Hepatol. 2020 Jun 11:1-10. PubMed: https://pubmed.gov/32528139. Full-text: https://doi.org/10.1038/s41575-020-0319-3
This perspective aims to provide a guide based on the Italian and French experience to better face the difficulties encountered by endoscopists during this pandemic. Some helpful recommendations regarding the use of personal protective equipment (both for patients and HCW) are proposed and different scenarios in endoscopic IBD management are evaluated to suggest when endoscopy could be rescheduled and replaced by alternative biomarkers.
Doglietto F, Vezzoli M, Gheza F, et al. Factors Associated With Surgical Mortality and Complications Among Patients With and Without Coronavirus Disease 2019 (COVID-19) in Italy. JAMA Surg. 2020 Jun 12. PubMed: https://pubmed.gov/32530453. Full-text: https://doi.org/10.1001/jamasurg.2020.2713
There is no good time for surgery: In this cohort study of 41 surgical patients with COVID-19 and 82 tightly matched control patients, significant differences were documented regarding rates of early mortality and complications (odds ratios 9.5 and 5.0, respectively), mainly pneumonia and thrombotic complications, were significantly associated with COVID-19, and different models identified COVID-19 as the first variable associated with surgical complications. These data suggest that, whenever possible, surgery should be postponed in patients with COVID-19.
Pinto BGG, Oliveira AER, Singh Y, et al. ACE2 Expression is Increased in the Lungs of Patients with Comorbidities Associated with Severe COVID-19. J Infect Dis. 2020 Jun 11:jiaa332. PubMed: https://pubmed.gov/32526012. Full-text: https://doi.org/10.1093/infdis/jiaa332
The authors analyzed over 700 lung transcriptome samples of patients with comorbidities associated with severe COVID-19 and found that ACE2 was highly expressed in these patients, compared to control individuals. Findings suggest that the higher expression of ACE2 in the lungs is associated with higher chances of developing a severe form of COVID-19, by facilitating SARS-CoV-2 entry into lung cells during the infection.
Belli LC, Duvoux C, Karam V, et al. COVID-19 in liver transplant recipients: preliminary data from the ELITA/ELTR registry. Lancet Gastroenterology & Hepatology, June 4, 2020. Full-text: https://doi.org/10.1016/S2468-1253(20)30183-7
First large analysis on liver transplant recipients. At a median follow-up of 18 days, 16/100 died from COVID-19. Of note, mortality was observed only in patients aged 60 years or older (16/73) and was more common in male recipients than in female recipients. Although not statistically significant, more patients who were transplanted at least 2 years earlier died than did those who received their transplant within the past 2 years (15/82, 18% vs 1/21, 5%).
Rubin EJ. Expression of Concern: Mehra MR et al. Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19. N Engl J Med 2020, June 2. Full-text: https://doi.org/10.1056/NEJMoa2007621
Ooops. They don’t trust their own authors (Mehra 2020). “Recently, substantive concerns have been raised about the quality of the information in that database”, editor Eric Rubin writes, washing NEJM’s hands in innocence. “We have asked the authors to provide evidence that the data are reliable. In the interim and for the benefit of our readers, we are publishing this Expression of Concern about the reliability of their conclusions.” Ok. Let’s wait and see what happens. But bad news because even in a journal like NEJM, bad data quality is possible.
Mehra MR, Desai SS, Kuy S, Henry TD, Patel AN. Cardiovascular disease, drug therapy, and mortality in Covid-19. N Engl J Med. Full-text: https://doi.org/10.1056/NEJMoa2007621
This was the original work of concern. Bad news that we cannot trust it. This was our comment: “The first study analyzed a total of 8,910 COVID-19 patients (from 169 hospitals located in 11 countries) for whom discharge status was availably by March 29 (Mehra 2020). A total of 515 (5.8%) died in the hospital. Factors independently associated with an increased risk of in-hospital death were an age greater than 65 years (odds ratio, 1.93), coronary artery disease (2.70), heart failure (2.48; 95% CI, 1.62 to 3.79), cardiac arrhythmia (1.95; 95% CI, 1.33 to 2.86), chronic obstructive pulmonary disease (2.96; 95% CI, 2.00 to 4.40), and current smoking (1.79; 95% CI, 1.29 to 2.47). No increased risk was found for the use of ACE inhibitors (0.33; 95% CI, 0.20 to 0.54) or the use of ARBs (1.23; 95% CI, 0.87 to 1.74). Of note, use of either ACE inhibitors or statins was associated with better survival. However, these associations should be considered with extreme caution as the study design cannot exclude the possibility of confounding.”
Shalev N, Scherer M, LaSota ED, et al. Clinical characteristics and outcomes in people living with HIV hospitalized for COVID-19. Clin Inf Dis 2020, May 30. Full-text: https://doi.org/10.1093/cid/ciaa635
31 people living with HIV (PLWH) were hospitalized for COVID-19. All patients were on antiretroviral therapy and virologically suppressed at the time of admission. One was mild (3%), 2 moderate (6.5%), 21 severe (60%) and 7 were critical (23%). At the time of analysis, 8 (25.8%) patients had died, 21 (67.7%) were alive and discharged and 2 (6.5%) were alive and hospitalized. Four deaths occurred in subjects over 65 years of age and 4 in patients between 50 and 65 years of age.
Tian J, Yuan X, Xiao J, et al. Clinical characteristics and risk factors associated with COVID-19 disease severity in patients with cancer in Wuhan, China: a multicentre, retrospective, cohort study. Lancet Oncology 2020, May 29. Full-text: https://10.1016/S1470-2045(20)30309-0
232 COVID-19 patients with cancer and were compared with 519 matched patients without cancer. Patients with cancer were more likely to have severe COVID-19 (64% versus 32%). Risk factors (of those well-known) for severe disease were advanced tumour stage (OR 2.60), elevated tumour necrosis factor α (1.22), elevated N-terminal pro-B-type natriuretic peptide (1.65).
COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet May 29, 2020. Full-text: https://doi.org/10.1016/S0140-6736(20)31182-X l (Important)
This large cohort includes 1128 patients who had surgery between Jan 1 and March 31, 2020, among them 835 (74%) emergency surgery and 280 (25%) elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26%) patients. 30-day mortality was 24% and pulmonary complications occurred in 577 (51%). In adjusted analyses, 30-day mortality was associated with male sex (Odds Ratio 1.75), age 70 years or older (2.30), ASA grades 3–5 versus grades 1–2 (2.35), malignant versus benign (1.55), emergency versus elective surgery (1.67), and major versus minor surgery (1.52).
Kuderer NM, Choueiri TK, Shah DP. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. Lancet May 28, 2020. Full-text: https://doi.org/10.1016/S0140-6736(20)31187-9
Cohort study from the USA, Canada, and Spain, analysing 928 cancer patients with COVID-19. Median age was 66 years (IQR 57–76) and the most prevalent malignancies were breast (21%) and prostate (16%). In total 121 (13%) patients had died. Beside general risk factors (age, male sex etc), independent factors associated with increased mortality were an ECOG status of 2 or higher and “active” cancer.
Vizcarra P, Pérez-Elías M, Quereda C, et al. Description of COVID-19 in HIV-infected individuals: a single-centre, prospective cohort. Lancet HIV. Published: May 28, 2020. Full-text: https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(20)30164-8/fulltext l (Important)
Single center study from Madrid, comparing 51 HIV+ patients with COVID-19 (35 confirmed cases) with 1,288 HIV patients without COVID-19. Six patients were critically ill and two died. There was no evidence that any specific antiretroviral drug (such as tenofovir or PIs) affected COVID-19 susceptibility or severity.
Geerts H, van der Graaf PH. Salvaging CNS Clinical Trials halted due to COVID-19. CPT Pharmacometrics Syst Pharmacol. 2020 May 28. PubMed: https://pubmed.gov/32468710. Full-text: https://doi.org/10.1002/psp4.12535
COVID-19 has halted many ongoing CNS clinical trials, especially in Alzheimer’s disease. While some of these trials will need to restart, others can re-start at different points with substantial protocol amendments. Authors propose the concept of mechanistic modeling-based virtual twin patients as a possible solution to harmonize the readouts from these complex and fragmented clinical datasets in a biologically relevant way.
Yahalom J, Dabaja BS, Ricardi U. ILROG emergency guidelines for radiation therapy of hematological malignancies during the COVID-19 pandemic. Blood 2020, 135 (21): 1829–1832. https://doi.org/10.1182/blood.2020006028
Realizing the need to reduce the exposure of patients and staff to potential infection with COVID-19, a task force makes recommendations for alternative radiation treatment schemes. The emphasis is on maintaining clinical efficacy and safety by increasing the dose per fraction while reducing the number of daily treatments.
Lupo-Stanghellini MT, Messina C, Marktel S, et al. Following-up allogeneic transplantation recipients during the COVID-19 pandemic. Lancet Haematol. 2020 May 22:S2352-3026(20)30176-9. PubMed: https://pubmed.gov/32450053. Full-text: https://doi.org/10.1016/S2352-3026(20)30176-9
The authors describe their way of taking care of the most vulnerable patient groups using telemedicine. They contacted 236/465 adult patients who received an allogeneic transplantation. Physicians felt confident about the management of patients using teleconsultations, and patients—reassured that they were not left alone while in quarantine—provided positive feedback on this approach.
Gartshteyn Y, Askanase AD, Schmidt NM, et al. COVID-19 and systemic lupus erythematosus: a case series. Published: May 26, 2020. Full-text: https://doi.org/10.1016/S2665-9913(20)30161-2
Of 18 SLE patients with COVID-19, most recovered. Previous intake of immunosuppressants before admission to hospital did not seem to influence the severity of infection.
Junejo M, Girometti N, McOwan A. HIV postexposure prophylaxis during COVID-19. May 25, 2020. Full-text: https://doi.org/10.1016/S2352-3018(20)30146-6
Weekly prescriptions of PEP at a large center in London dropped from a peak of 54 (from Feb 17–23, 2020) to four (from March 30–April 5, 2020) during lockdown. The most obvious explanation for this decline is that individuals are engaging in less condomless sex during lockdown. However, this might also reflect people’s reluctance to travel during this period, which would mean that individuals are not accessing the PEP they require.
Comment of the copy-editor: “And might also mean, that if they have less desire to travel, are hooking up less, and perhaps less sex is happening.”
Brenner EJ, Ungaro RC, Gearry RB, et al. Corticosteroids, but Not TNF Antagonists, Are Associated With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results From an International Registry. Gastroenterology 2020 May 18. Full-text: https://doi.org/10.1053/j.gastro.2020.05.032
An important and large study, analysing 525 patients with IBD from 33 countries. Thirty-seven patients (7%) had severe COVID-19, and 16 patients died (3% case fatality rate). Risk factors for severe COVID-19 among IBD patients included increasing age, ≥2 comorbidities, systemic corticosteroids (aOR 6.9, 95% CI 2.3-20.5), and sulfasalazine or 5-aminosalicylate use (aOR 3.1, 95% CI 1.3-7.7). Maintaining remission with steroid-sparing treatments will be important in managing patients with IBD through this pandemic. However, a causal relationship cannot be definitively established. Notably, TNF antagonist treatment was not associated with severe COVID-19.
Solomon MD, McNulty EJ, Rana JS, et al. The Covid-19 Pandemic and the Incidence of Acute Myocardial Infarction. NEJM 2020, May 19. Full-text: HTTPS://DOI.ORG/10.1056/NEJMc2015630
In a large diverse community setting in California, the incidence of hospitalization for acute myocardial infarction declined after March 4 by up to 48% more than would be expected on the basis of typical seasonal variation alone. Similar findings have been noted in northern Italy.
Review of the literature on thromboembolic events (TE) associated with COVID-19. The causation between the effects of ibuprofen and TE remains speculative. The role of ibuprofen on a vascular level remains unclear as well as whether ibuprofen is able to interact with SARS-CoV-2 through some mechanism. However, the authors recommend careful consideration to avoiding a high dosage of ibuprofen in subjects at particular risk of thromboembolic events.
Tschopp J, L´Huillier AG, Mombelli M, et al. First experience of SARS-CoV-2 infections in solid organ transplant recipients in the Swiss Transplant Cohort Study. Am J Transplant 2020 May 15. PubMed: https://pubmed.gov/32412159. Full-text: https://doi.org/10.1111/ajt.16062
Data from Switzerland. Overall, 21 patients were included with a median age of 56 years (10 kidney, 5 liver, 1 pancreas, 1 lung, 1 heart and 3 combined transplantations). Ninety‐five percent and 24% of patients required hospitalization and ICU admission, respectively. After a median of 33 days of follow‐up, 16 patients were discharged, 3 were still hospitalized and 2 patients died.
Mackey K, King VJ, Gurley S. Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults. A Living Systematic Review. Annals Internal Medicine 2020, May 15. Full-text: https://www.acpjournals.org/doi/10.7326/M20-1515
According to this review (data cut on May 4), evidence is of moderate certainty that ACEI and ARB use is not associated with a higher likelihood of receiving a positive SARS-CoV-2 test result. Evidence is of high certainty (14 observational studies, involving 23,565 adults) that neither medication is associated with more severe COVID-19 illness. Four registered randomized trials plan to evaluate ACEIs and ARBs for treatment of COVID-19. For more information, see our special from May 4: https://covidreference.com/top-10-may-4.
Latif F, Farr MA, Clerkin KJ, et al. Characteristics and Outcomes of Recipients of Heart Transplant With Coronavirus Disease 2019. JAMA Cardiol. 2020 May 13. PubMed: https://pubmed.gov/32402056. Full-text: https://doi.org/10.1001/jamacardio.2020.2159
Is there a higher mortality risk in heart transplanted patients? Probably yes. In this case series of 28 patients who had received a heart transplant in a large academic center (New York), 22 patients (79%) were hospitalized. At the end of the follow-up, 4 remained hospitalized and 7 (25%) had died.
Alqahtani JS, Oyelade T, Aldhahir AM, et al. Prevalence, Severity and Mortality associated with COPD and Smoking in patients with COVID-19: A Rapid Systematic Review and Meta-Analysis. PLoS One. 2020 May 11;15(5):e0233147. PubMed: https://pubmed.gov/32392262. Full-text: https://doi.org/10.1371/journal.pone.0233147
Time to quit smoking. Meta-analysis of 15 studies, including a total of 2,473 confirmed cases. COPD patients were at a higher risk of more severe disease (calculated RR 1.88). Current smokers were 1.45 times more likely to have severe complications compared to former and never smokers. Current smokers also had a higher mortality rate of 39%.
This paper offers some recommendations on the optimization of leukemia management during high-risk COVID-19 periods. Instead of reducing patient access to specialized cancer centers and modifying therapies to ones with unproven curative benefit, there is more rationale for less intensive yet effective therapies that may require fewer visits to the clinic or hospitalizations.
Härter G, Spinner CD, Roider J, at al. COVID-19 in people living with human immunodeficiency virus: a case series of 33 patients. Infection 2020, May 11. https://doi.org/10.1007/s15010-020-01438-z. Full-text https://link.springer.com/article/10.1007/s15010-020-01438-z. l (Important)
The first larger case series in HIV-infected patients. No excess morbidity and mortality was found among symptomatic COVID-19 cases. As the majority (22/33) was treated with tenofovir, including those developing severe or critical disease, data indicate no or only minimal clinical effect of tenofovir against SARS-CoV-2. Four patients also were on darunavir when they developed COVID-19 symptoms.
Xiong F, Tang H, Liu L, et al. Clinical Characteristics of and Medical Interventions for COVID-19 in Hemodialysis Patients in Wuhan, China. J Am Soc Nephrol. 2020 May 8. PubMed: https://pubmed.gov/32385130. Full-text: https://doi.org/10.1681/ASN.2020030354
First large (multicenter retrospective) study about epidemiologic and clinical characteristics of patients undergoing hemodialysis with COVID-19. There were 101 mild/moderate and 30 severe/critical cases. Of note, 28 (21%) were asymptomatic over the whole course of the disease and were diagnosed only by universal screening. Morbidity was around 2% and only 52% of patients experienced fever.
Chung SC, Providencia R, Sofat R, et al. Association between Angiotensin Blockade and Incidence of Influenza in the United Kingdom. NEJM May 8, 2020. Full-text: https://www.nejm.org/doi/full/10.1056/NEJMc2005396
Like SARS-CoV-2, influenza A viruses have been shown to use the ACE2 receptor. Using the linked electronic health care records of 5.6 million persons in the United Kingdom, authors have investigated the incidence of influenza among adults who received a prescription for an ACE inhibitor from 1998 through 2016. Main results: the use of ACE inhibitors and ARBs was associated with either no effect on the incidence of influenza or a lower incidence.
Zhu L, She ZG, Cheng X. Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes. Cell Metabolism, April 30, 2020. Full-text: https://www.cell.com/cell-metabolism/fulltext/S1550-4131(20)30238-2 l (Important)
Check your HbA1c! The hitherto largest retrospective study on the impact of type 2 diabetes (T2D) has carefully analyzed 7,337 cases of COVID-19 in Hubei Province, China, among them 952 with pre-existing T2D. The authors found that subjects with T2D required more medical interventions and had a significantly higher mortality (7.8% versus 2.7%; adjusted hazard ratio, 1.49) and multiple organ injury than the non-diabetic individuals. Well-controlled blood glucose was associated with markedly lower mortality (in-hospital death rate 1.1% versus 11.0%) compared to individuals with poorly controlled BG.
Piccolo R, Bruzzese D, Mauro C, et al. Population Trends in Rates of Percutaneous Coronary Revascularization for Acute Coronary Syndromes Associated with the COVID-19 Outbreak. Circulation. 2020 Apr 30. PubMed: https://pubmed.gov/32352318. Full-text: https://doi.org/10.1161/CIRCULATIONAHA.120.047457
Collateral damage of the current pandemic: data from Italy providing evidence that the outbreak of COVID-19 was associated with a decline by 32% in the number of percutaneous coronary intervention for acute coronary syndromes.
Stefanini GG, Montorfano M, Trabattoni D, et al. ST-Elevation Myocardial Infarction in Patients with COVID-19: Clinical and Angiographic Outcomes. Circulation. 2020 Apr 30. PubMed: https://pubmed.gov/32352306. Full-text: https://doi.org/10.1161/CIRCULATIONAHA.120.047525
STEMI may represent the first clinical manifestation of COVID-19. In 11 out of 28 patients (39%) with STEMI, a culprit lesion was not identifiable by coronary angiography. According to the authors, a dedicated diagnostic pathway should be delineated for COVID-19 patients with STEMI, aimed at minimizing patients’ procedural risks and healthcare providers’ risk of infection.
Yang G, Tan Z, Zhou L, et al. Effects Of ARBs And ACEIs On Virus Infection, Inflammatory Status And Clinical Outcomes In COVID-19 Patients With Hypertension: A Single Center Retrospective Study. Hypertension. 2020 Apr 29. PubMed: https://pubmed.gov/32348166. Full-text: https://doi.org/10.1161/HYPERTENSIONAHA.120.15143
The next retrospective study analysing COVID-19 patients with hypertension, argueing against deleterious effects of angiotensin II receptor blockers or angiotensin-converting enzyme inhibitors. Patients on these drugs (n=43) had significantly lower concentrations of CRP (p = 0.049) and procalcitonin (p = 0.008) than patients on other antihypertensive drugs (n = 83). Furthermore, trends toward lower proportions of critical diseases (9.3% vs 22.9%; p = 0.061) and death rates (4.7% vs 13.3%; p = 0.216) were observed.
Haberman R, Axelrad J, Chen A, et al. Covid-19 in Immune-Mediated Inflammatory Diseases – Case Series from New York. N Engl J Med. 2020 Apr 29. PubMed: https://pubmed.gov/32348641. Full-text: https://doi.org/10.1056/NEJMc2009567
Baseline use of biologics is not associated with worse COVID-19 outcomes. A case series of 86 patients with immune-mediated inflammatory disease (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, psoriasis, inflammatory bowel disease, or related conditions) and symptomatic COVID-19, among them 62 (72%) receiving biologics or Janus kinase (JAK) inhibitors. The percentage of patients who were receiving biologics or JAK inhibitors at baseline was higher among the ambulatory patients than among the hospitalized patients. In contrast, hospitalization rates were higher in patients treated with oral glucocorticoids, hydroxychloroquine and methotrexate.
Rangé G, Hakim R, Motreff P. Where have the STEMIs gone during COVID-19 lockdown? European Heart Journal – Quality of Care and Clinical Outcomes, April 29, 2020. Full-text: https://doi.org/10.1093/ehjqcco/qcaa034
Best paper title of the day. Using a French Registry, the authors found a spectacular drop of 25% for admission due to STEMI between March 2019 and March 2020. The steep decline was found for both acute (< 24hrs) and late presentation (> 24 hrs) STEMI. But where did they go? According to the authors, explanations may be patients’ fear of coming to the hospital or disturbing busy caregivers, especially in the case of mild STEMI clinical presentation. Other hypothetical reasons are reduced air pollution, better adherence to treatment, limited physical activity or absence of occupational stress during lockdown. When will we ever learn?
Baldi E, Sechi GM, Mare C, et al. Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy. N Engl J Med. 2020 Apr 29. PubMed: https://pubmed.gov/32348640. Full-text: https://doi.org/10.1056/NEJMc2010418
Avoiding hospitals, staying at home, dying of fear? Using data from the Lombardy Cardiac Arrest Registry for the provinces of Lodi, Cremona, Pavia, and Mantua during the first 40 days of the COVID-19 outbreak (February 21 through March 31, 2020), the authors found a 58% increase of out-of-hospital cardiac arrest compared to the same period in 2019.
De Filippo O, D’Ascenzo F, Angelini F, et al. Reduced Rate of Hospital Admissions for ACS during Covid-19 Outbreak in Northern Italy. N Engl J Med, April 28, 2020. Full-text: https://doi.org/10.1056/NEJMc2009166
The authors report a significant decrease in acute coronary syndrome-related hospitalization rates across several cardiovascular centers in northern Italy during the early days of the outbreak.
Castiglion V, Chiriacò M, Emdin M, et al. Statin therapy in COVID-19 infection. European Heart Journal Cardiovascular Pharmacotherapy, 2020, 29 April. Full-text: https://doi.org/10.1093/ehjcvp/pvaa042
Brief review: adjuvant treatment and continuation of pre-existing statin therapy could improve the clinical course of patients with COVID-19, either by their immunomodulatory action or by preventing cardiovascular damage.
Cai G, Bosse Y, Xiao F, Kheradmand F, Amos CI. Tobacco Smoking Increases the Lung Gene Expression of ACE2, the Receptor of SARS-CoV-2. Am J Respir Crit Care Med. 2020 Apr 24. PubMed: https://pubmed.gov/32329629. Full-text: https://doi.org/10.1164/rccm.202003-0693LE
Brand new information: smoking is not the best idea. However, this is particularly true in the current pandemic. Ever having smoked significantly and substantially increased pulmonary ACE2 expression by 25%. The significant smoking effect on ACE2 pulmonary expression may suggest an increased risk for viral binding and entry of SARS-CoV-2 in lungs of smokers.
Pereira MR, Mohan S, Cohen DJ, et al. COVID-19 in Solid Organ Transplant Recipients: Initial Report from the US Epicenter. Am J Transplant. 2020 Apr 24. PubMed: https://pubmed.gov/32330343. Full-text: https://doi.org/10.1111/ajt.15941
The first large cohort of COVID-19 in transplant recipients. Of 90 patients (median age 57 years), 46 were kidney recipients, 17 lung, 13 liver, 9 heart and 5 dual-organ transplants. Sixteen patients died (18% overall, 24% of hospitalized, 52% of ICU), indicating that transplant recipients appear to have more severe outcomes.
Single center experience with 36 kidney transplant recipients. Patients appear to have less fever as an initial symptom, lower CD3/4/8 cell counts and more rapid clinical progression: after 21 days, 10 died.
French JA, Brodie MJ, Caraballo R, et al. Keeping people with epilepsy safe during the Covid-19 pandemic. Neurology. 2020 Apr 23. PubMed: https://pubmed.gov/32327490. Full-text: https://doi.org/10.1212/WNL.0000000000009632
Some helpful recommendations on how to modify clinical care for people with epilepsy and what general advice can be given to these patients during this crisis.
Sriram K, Insel PA. Risks of ACE inhibitor and ARB usage in COVID-19: evaluating the evidence. Clin Pharmacol Ther. 2020 Apr 22. PubMed: https://pubmed.gov/32320478. Full-text: https://doi.org/10.1002/cpt.1863
Nice review. Data from 12 animal studies and from 12 human studies overwhelmingly imply that administration of ACEIs/ARBs does not increase ACE2 expression. Available evidence does not support the hypothesis that ACEI/ARB use increases ACE2 expression and the risk of complications from COVID-19. The authors conclude that patients being treated with ACEIs and ARBs should continue their use for approved indications.
Zhang P, Zhu L, Cai J, et al. Association of Inpatient Use of Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Mortality Among Patients With Hypertension Hospitalized With COVID-19. Circ Res. 2020 Apr 17. PubMed: https://pubmed.gov/32302265. Full-text: https://doi.org/10.1161/CIRCRESAHA.120.317134
Same idea: in this retrospective, multi-center study of 1128 adult patients with hypertension diagnosed with COVID-19, 188 patients taking ACEI/ARB were compared with 940 patients without using ACEI/ARB. Unadjusted mortality rate was lower in the ACEI/ARB group versus the non-ACEI/ARB group (3.7% vs. 9.8%). In a Cox model, after adjusting for age, gender, comorbidities, and in-hospital medications, the detected risk for all-cause mortality was lower in the ACEI/ARB group (adjusted HR 0.42; 95%CI, 0.19-0.92).
Sattar N, McInnes IB, McMurray JJV. Obesity a Risk Factor for Severe COVID-19 Infection: Multiple Potential Mechanisms. Circulation. 2020 Apr 22. PubMed: https://pubmed.gov/32320270. Full-text: https://doi.org/10.1161/CIRCULATIONAHA.120.047659
Brief review on obesity as a unifying risk factor for severe COVID-19 infection, reducing both protective cardiorespiratory reserve as well as potentiating the immune dysregulation. Possible patho-mechanisms are discussed.
Brojakowska A, Narula J, Shimony R, Bander J. Clinical Implications of SARS-Cov2 Interaction with Renin Angiotensin System. J Am Coll Cardiol. 2020 Apr 14. PubMed: https://pubmed.gov/32305401. Full-text: https://doi.org/10.1016/j.jacc.2020.04.028
Don’t stop your sartans or ACE inhibitors! The authors hypothesize that the benefits of treatment with renin-angiotensin system inhibitors in SARS-COV-2 may outweigh the risks and at the very least should not be withheld.
Kennedy NA, Jones GR, Lamb CA, et al. British Society of Gastroenterology guidance for management of inflammatory bowel disease during the COVID-19 pandemic. Gut. 2020 Apr 17. PubMed: https://pubmed.gov/32303607. Full-text: https://doi.org/10.1136/gutjnl-2020-321244
Making recommendations in the absence of data is not that easy. The authors have made heroic attempts to balance the risk of immune modifying drugs with the risk associated with active disease.
Daniels MJ, Cohen MG, Bavry AA, Kumbhani DJ. Reperfusion of STEMI in the COVID-19 Era – Business as Usual? Circulation. 2020 Apr 13. PubMed: https://pubmed.gov/32282225. Full-text: https://doi.org/10.1161/CIRCULATIONAHA.120.047122
In the current crisis with limited resources to protect the work force, fibrinolytic therapy (FT) may be considered for patients with myocardial infarction (STEMI). FT may even be preferred over primary percutaneous coronary intervention. Arguments for this strategy are summarized.
Zhong Z, Zhang Q, Xia H, et al. Clinical characteristics and immunosuppressants management of coronavirus disease 2019 in solid organ transplant recipients. Am J Transplant. 2020 Apr 13. PubMed: https://pubmed.gov/32282986. Full-text: https://doi.org/10.1111/ajt.15928
COVID-19 was observed in two transplant recipients (liver and kidney), with different treatments and prognoses. Both patients recovered.
Wang H, Li T, Barbarino P, et al. Dementia care during COVID-19. Lancet. 2020 Apr 11; 395(10231):1190-1191. PubMed: https://pubmed.gov/32240625. Full-text: https://doi.org/10.1016/S0140-6736(20)30755-8
Some thoughts on dementia care in this crisis.
Torres T, Puig L. Managing Cutaneous Immune-Mediated Diseases During the COVID-19 Pandemic. Am J Clin Dermatol. 2020 Apr 10. PubMed: https://pubmed.gov/32277351. Full-text: https://doi.org/10.1007/s40257-020-00514-2
Patients with cutaneous immune-mediated diseases (including psoriasis, atopic dermatitis, and hidradenitis suppurativa) may continue their treatment even during the COVID-19 outbreak, preventing disease flares. However, in patients with active COVID-19 infection, it is generally recommended to withhold immunosuppressive or biologic treatment.
Coles CE, Aristei C, Bliss J, et al. International Guidelines on Radiation Therapy for Breast Cancer During the COVID-19 Pandemic. Clin Oncol (R Coll Radiol). 2020 May;32(5):279-281. PubMed: https://pubmed.gov/32241520. Full-text: https://doi.org/10.1016/j.clon.2020.03.006
In order to reduce hospital visits to a minimum and to ease pressure on workforce, detailed guidelines on radiation therapy for breast cancer are given, mainly focussing on hypofractionation.
Dave M, Seoudi N, Coulthard P. Urgent dental care for patients during the COVID-19 pandemic. Lancet. 2020 Apr 3. PubMed: https://pubmed.gov/32251619. Full-text: https://doi.org/10.1016/S0140-6736(20)30806-0
Don’t forget the dentists! And test them with the same high priority as that of medical healthcare workers in hospitals!
Sun J, Aghemo A, Forner A, Valenti L. COVID-19 and liver disease. Liver Int. 2020 Apr 6. doi: https://doi.org/10.1111/liv.14470. [Epub ahead of print]
“Since December 2019, patients with unexplained pneumonia have been found in Wuhan, Hubei Province, China, which was caused by a novel coronavirus that had not been previously identified (1). Tentatively defined as 2019 novel coronavirus (2019-nCoV), the pathogen has now been named Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) (2), while the disease termed Coronavirus Disease 2019 (COVID-19).” This abstract was published on April 6, with references. In all seriousness. Come on guys, we all know that already! Is it to be feared that nobody will read your interesting mini-review on mechanisms and clinical implications of liver injury, unmet clinical needs and main research questions?
Is hypertension a true risk factor for severe COVID-19 courses? According to the authors, there is as yet (March 29) “no evidence” that hypertension is related to outcomes of COVID-19, or that ACE inhibitor or ARB use is harmful, or for that matter beneficial.
Pasha SB, Fatima H, Ghouri YA. Management of Inflammatory Bowel Diseases in the Wake of COVID-19 Pandemic. J Gastroenterol Hepatol. 2020 Apr 4. PubMed: https://pubmed.gov/32246874. Full-text: https://doi.org/10.1111/jgh.15056
Some thoughts on how to manage patients suffering from Inflammatory Bowel Diseases, regarding their ongoing immunosuppressive therapies which could render them more susceptible to acquire COVID-19 infection and develop severe courses.
Bavishi C, Maddox TM, Messerli FH. Coronavirus Disease 2019 (COVID-19) Infection and Renin Angiotensin System Blockers. JAMA Cardiol. 2020 Apr 3. PubMed: https://pubmed.gov/32242890. Full-text: https://doi.org/10.1001/jamacardio.2020.1282
This mini-review outlines the mechanisms by which RAAS inhibitors (ACEIs/ARBs) may be of benefit in COVID-19. Overview of the current recommendations for their use in infected patients. According to the authors, the biological plausibility of the salutary effects of RAAS inhibitors is intriguing and several trials of starting losartan in patients with COVID-19 are currently being planned.
Al-Shamsi HO, Alhazzani W, Alhuraiji A, et al. A Practical Approach to the Management of Cancer Patients During the Novel Coronavirus Disease 2019 (COVID-19) Pandemic: An International Collaborative Group. Oncologist. 2020 Apr 3. PubMed: https://pubmed.gov/32243668. Full-text: https://doi.org/10.1634/theoncologist.2020-0213
Detailed and important review for oncologists, addressing current challenges associated with managing cancer patients during theCOVID-19 pandemic.
Don’t forget or marginalize persons with substance use disorders during this crisis!
Fried JA, Ramasubbu K, Bhatt R, et al. The Variety of Cardiovascular Presentations of COVID-19. Circulation. 2020 Apr 3. PubMed: https://pubmed.gov/32243205. Full-text: https://doi.org/10.1161/CIRCULATIONAHA.120.047164
Four COVID-19 cases with cardiovascular presentations are described. In patients presenting with what appears to be a typical cardiac syndrome, COVID-19 infection should be in the differential during the current pandemic, even in the absence of fever or cough.
Meng J, Xiao G, Zhang J, et al. Renin-angiotensin system inhibitors improve the clinical outcomes of COVID-19 patients with hypertension. Emerg Microbes Infect. 2020 Dec;9(1):757-760. PubMed: https://pubmed.gov/32228222. Full-text: https://doi.org/10.1080/22221751.2020.1746200
First study arguing against any deleterious effect of RAAS inhibitors (ACE inhibitors or sartans) in COVID-19! Among 42 of 417 patients admitted to Shenzhen Hospital while on antihypertensive therapy, those receiving RAAS inhibitors had a lower rate of severe diseases than patients without (5/17 compared to 12/25) and a trend toward a lower level of IL-6 in peripheral blood.
Thoughts on how the pandemic affects treatment of patients with cancer and how it will hit the wider oncology community. Substantial changes for research, education, and collaboration are expected, including reduced international travel and increased remote networking and telemedicine.
Bousquet J, Akdis C, Jutel M, et al. Intranasal corticosteroids in allergic rhinitis in COVID-19 infected patients: An ARIA-EAACI statement. Allergy. 2020 Mar 31. PubMed: https://pubmed.gov/32233040. Full-text: https://doi.org/10.1111/all.14302
A joint statement of the European Academy of Allergology and Clinical Immunology, following the results of a questionnaire. Bottom line: Stopping intranasal steroids is not advised, until we know better.
Kaiser UB, Mirmira RG, Stewart PM. Our Response to COVID-19 as Endocrinologists and Diabetologists. J Clin Endocrin Metabol, 105, May 2020, published 31 March 2020, dgaa148, https://doi.org/10.1210/clinem/dgaa148
Thoughts on diabetes management, glucocorticoid use, pituitary or other neuroendocrine diseases.
CDC COVID-19 Response Team. Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 — United States, February 12–March 28, 2020. MMWR Morb Mortal Wkly Rep. ePub: 31 March 2020. Full-text: http://dx.doi.org/10.15585/mmwr.mm6913e2
No, the situation in the US does not differ from other countries. Among 7,162 patients with underlying health conditions or potential risk factors reported to the CDC, those with these conditions were more likely admitted to the hospital and to an ICU. And yes, “persons with underlying health conditions who have symptoms of COVID-19 should immediately contact their health care provider”.
Yao H, Chen JH, Xu YF. Patients with mental health disorders in the COVID-19 epidemic. Lancet Psychiatry. 2020 Apr;7(4):e21. Full-text: https://doi.org/10.1016/S2215-0366(20)30090-0
Don’t forget people with mental health conditions! A few thoughts on these patients who could be more substantially affected, resulting in relapses or worsening of an already existing mental health condition because of high susceptibility to stress compared with the general population.
Chen Q, Liang M, Li Y, et al. Mental health care for medical staff in China during the COVID-19 outbreak. Lancet Psychiatry. 2020 Apr;7(4):e15-e16. PubMed: https://pubmed.gov/32085839. Full-text: https://doi.org/10.1016/S2215-0366(20)30078-X
And don’t forget the staff! Some thoughts on how to maintain staff mental health during such a crisis.
Jin XH, Zheng KI, Pan KH, Xie YP, Zheng MH. COVID-19 in a patient with chronic lymphocytic leukaemia. Lancet Haematol. 2020 Apr;7(4):e351-e352. Full-text: https://doi.org/10.1016/S2352-3026(20)30074-0
Interesting case report on a patient with CLL. Clinical and biochemical features of COVID-19 might be partly masked by coexisting CLL. Longer incubation period was presumed.
Vaduganathan M, Vardeny O, Michel T, McMurray JV, Pfeffer MA, Solomon SD. Renin–Angiotensin–Aldosterone System Inhibitors in Patients with Covid-19. NEJM, March 30, 2020. Fulltext: https://www.nejm.org/doi/full/10.1056/NEJMsr2005760?
Fantastic review of an interdisciplinary expert panel on the use, risks and benefit of RAAS inhibitors (ACE inhibitors and sartans) in the COVID-19 era. Bottom line: We don’t know enough. Until further data are available, RAAS inhibitors can be continued.
A few new thoughts on HIV infection and COVID-19.
Zhu F, Cao Y, Xu S, Zhou M. Co-infection of SARS-CoV-2 and HIV in a patient in Wuhan city, China [published online ahead of print March 11, 2020]. J Med Virol. https://doi.org/10.1002/jmv.25732
First case report of patient with undiagnosed HIV infection (low CD4 counts), recovering from a coronavirus–related pneumonia. Argues against deleterious effect of HIV.