Obese COVID-19 patients at risk for respiratory failure but not hospital death

A retrospective cohort study of 1,687 COVID-19 patients at two New York City hospitals published yesterday in the Annals of Internal Medicine revealed that 31% were obese, and obese patients were at higher risk of respiratory failure.

Researchers at Weill Cornell Medicine studied the electronic medical record data of adults hospitalized with the novel coronavirus from Mar 3 to May 15 for outpatient body mass index (BMI) measurements recorded within 3 months after hospitalization. They defined obesity as a BMI of 30 or higher, and 31.1% of patients fit that category, with 5.4% of all patients being morbidly obese.

Most obese patients were younger than those with healthy BMIs. The fully adjusted risk of dying was highest for underweight patients, lowest for overweight patients, and progressively rose with greater obesity, but overall obesity did not raise the risk of in-hospital death. The fully adjusted hazard ratio for respiratory failure was lowest among normal-weight patients, advancing with increasing BMIs. The risk associated with obesity did not differ significantly across age, sex, or race.

The authors concluded that "obesity was an independent risk factor for respiratory failure but not for in-hospital mortality. Our findings, at least in part, explain the extensive use of invasive mechanical ventilation reported in the United States, where the prevalence of obesity exceeds 40%."

The researchers said that obesity could increase risk of COVID-19 complications through several mechanisms:

• Fat-storage cells cause inflammation and increase the risk of blood clots and an overreaction of the immune system.
• Obesity impairs lung function, leading to severe respiratory distress and failure.
• Obesity increases the risk of lung injury by altering energy production in cells in the outer layer of the lungs.

Communities should consider their prevalence of obesity when planning their COVID-19 response, the authors said.
Jul 6 Ann Intern Med research letter

Study: Only 1 of 335 plane passengers likely infected with COVID-19 on board

An epidemiologic study published yesterday in Travel Medicine and Infectious Disease suggests that only 1 of 335 passengers on a flight from Singapore to Hangzhou, China, in late January was likely infected with COVID-19 while on board.

Chinese researchers collected the travelers' demographic information and illness descriptions before, during, and after the flight. Sixteen of 335 passengers (4.8%) were infected with COVID-19, and all but one of them had a history of exposure to the novel coronavirus before departure. That passenger had been seated near four infected passengers from Wuhan for about 1 hour and did not wear his face mask appropriately during the flight.

The attack rate was significantly higher among passengers who had departed from Wuhan, China, than among those who departed from other places.

"COVID-19 transmission may have occurred during the flight," the authors wrote. "However, the majority of the cases in the flight-associated outbreak could not be attributed to transmission on the flight but were associated with exposure to the virus in Wuhan or to infected members in a single tour group."
Jul 6 Travel Med Infect Dis abstract

Zika-exposed infants have wide variety of neurologic abnormalities

A study today in JAMA Network Open shows that children exposed to Zika virus prenatally suffer a wide array of neurologic issues, even when they did not display microcephaly, the most severe birth outcome linked to Zika.

The study was conducted on 219 children with prenatal exposure to Zika seen at a pediatric hospital in Rio de Janeiro, Brazil. The children ranged in age from 6 to 42 months and were exposed during the 2015-16 Zika epidemic. Children were evaluated monthly for the first 6 months of life, then every 3 months until the age of 4.

Fifty-three of the children had congenital microcephaly (MC), or a smaller-than-normal head, and the rest had normocephaly (NC). Although children with NC had fewer neurologic issues than those with MC, 68% displayed some sort of neurologic abnormality, including 29.3% with abnormal brain imaging results and 38.7% with abnormal tone.

The authors also found that NC children with smaller head circumferences (HCs) had increased neurocognitive delays.

"Although many children with NC were not born with an obvious congenital birth defect, neurodevelopmental abnormalities were found in 36% of the children who later underwent Bayley-III assessments. These results illustrate that antenatal ZIKV exposure may be associated with a wide clinical spectrum, with children exhibiting a variety of manifestations and outcomes," the authors concluded.

In a commentary on the study in the same journal, Sarah B. Mulkey, MD, PhD, of the Prenatal Pediatrics Institute at Children's National Hospital in Washington, DC, wrote that the HC finding "provides a practical tool to help determine risk for adverse clinical outcomes in a ZIKV-exposed infant at birth that can be widely used in a variety of follow-up settings."
Jul 7 JAMA Netw Open study
Jul 7 JAMA Netw Open commentary

WHO committee extends polio public health emergency

The World Health Organization (WHO) polio emergency committee met for the 25th time on Jun 23 to discuss the latest polio developments and recommended that the international risk of poliovirus spread still remains a public health emergency of international concern (PHEIC) under the International Health Regulations. Director-General Tedros Adhanom Ghebreyesus, PhD, accepted the group's recommendations on Jul 3.

Among the group's concerns are that the increased number of wild poliovirus type 1 (WPV1) cases in Afghanistan and Pakistan in 2019 have continued into 2020. However, Nigeria was recently declared free of WPV1. The committee also raised concerns about multiple circulating vaccine-derived polio outbreaks in four WHO regions: African, Eastern Mediterranean, South East Asian, and Western Pacific.

In his remarks to the group, Tedros said the COVID-19 pandemic has significantly affected public health programs, including polio, and that the risk of international spread has probably increased. He also noted that a novel oral polio vaccine type 2, which will be made available for emergency use, is expected to help stop the cycles of using monovalent oral poliovirus type 2 (OPV2) vaccine to combat outbreaks, only to have OPV2 seed new outbreaks.

Along with the PHEIC recommendation, the group also tweaked its list of temporary measures for affected countries. WHO emergency committees typically meet every 3 months or more often as needed.
Jun 23 WHO statement