Inflammation linked to higher death risk, could shed light on COVID in men
A large study of German patients presented online at this week's European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Conference on Coronavirus Disease found that men have a 62% higher risk of death from COVID-19, possibly due to higher levels of inflammation.
The retrospective study followed 3,129 hospitalized adults from March through July in the LEOSS registry, an open-access database of clinical COVID-19 information established by the German Society of Infectious Diseases (DGI). Patient demographics and comorbidities were evaluated using the Charlson Comorbidity Index, which reflects the number of pre-existing conditions.
The researchers categorized COVID-19 into four phases: uncomplicated (asymptomatic or mild symptoms), complicated (need for supplemental oxygen), critical (need for life-supporting therapy) and recovery (improvement and discharge).
Men represented a higher proportion—male:female ratio of 1.48—of the mostly-hospitalized patients in the study, with male predominance even more pronounced in older age-groups. Researchers found no significant sex differences in comorbidities aside from higher rates of coronary artery disease—18% in men versus 10% in women—and smoking—14.5% versus 10.5%.
Men had longer mean hospital stays and were more likely to progress to critical condition, requiring intensive care unit (ICU) admission—30.6% versus 17.2%. Men also had significantly higher overall mortality—19.2% versus 12.9%—and COVID-19–attributable mortality—17.1% versus 10.3%. The study also found that men had significantly higher inflammatory markers, including interleukin-6, c-reactive protein, procalcitonin, and ferritin.
After the researchers adjusted for various factors, they found that being male proved to be an independent risk factor for a 62% increased risk of COVID-19 death.
In an ESCMID news release, the authors note, "Men have higher death rates as well as more frequent ICU admissions and longer hospital stays, that are all associated with higher inflammatory parameters during all phases of COVID-19. In our cohort, this effect was not explained by differences in comorbidities, age, or BMI between male and female patients."
Lead author Frank Hanses, MD, concludes, "We need further studies on what exactly makes men more vulnerable to COVID-19. We do not yet know which biological or possibly social factors lead to these marked differences."
Sep 23 ESCMID abstract
Sep 22 ESCMID news release
Demographics, government restrictions influence physical distancing
A Louisiana State University study analyzed cellphone data to track the evolution of stay-at-home behavior during the initial spread of COVID-19 from January to June in US counties. The PLOS One study used the amount of time spent at home as measured by cellphone tracking data as an indicator of stay-at-home behavior and as a proxy for physical (social) distancing.
Stay-at-home behavior increased ninefold from late January to late March, and then fell 50% by mid-June, the authors found. The analysis identified '"hot spots" and "cold spots" in counties in which distancing was low and high, respectively. The study revealed a significant degree of geographic clustering of distancing behavior, with implications for greater disease transmission in areas with low physical distancing and possible contagion between areas.
The authors point out the economic implications: "Clusters of low social distance counties with increasing incidence of disease may impede economic recovery, even in clusters of high social distance counties, because of the potential for contagion between low and high social distance county clusters."
Both demographic factors—population density, households with children, education, race and income—and governmental restrictions in the form of stay-at-home orders influenced the degree of distancing, the authors found. Over the course of the study, demographic factors explained a greater proportion of the differences in distancing behavior than did governmental restrictions. The authors conclude, "Persuading individuals to increase their social distancing voluntarily may provide a lower cost means to reducing disease incidence."
Rajesh Narayanan, PhD, MBA, said in a PLOS press release, "Cell phone location and mobility data reveal that social distancing in the U.S. during the Covid-19 pandemic was initially voluntary rather than a response to governmental jurisdictional restrictions. As the pandemic progressed, both effects reinforced each other, increasing social distancing far more than what could be explained by the sum of the individual effects."
Sep 22 PLOS One study
Sep 22 PLOS news release
UK study finds public health steps help protect homeless from COVID-19
In the first major study modeling SARS-CoV-2 transmission in homeless settings, researchers in England found that preventive measures reduced impacts of COVID-19 in homeless populations during the early days of the pandemic, from Feb to May 31, and have the potential to significantly reduce infection, death, hospital and intensive care unit (ICU) admission rates through early 2021.
The study, presented this week at the ESCMID Conference on Coronavirus Diseases and published in The Lancet, analyzed the effect of preventive policies such as specialized homeless accommodations and increased infection control measures in homeless settings on COVID-19 outcomes.
"People experiencing homelessness are vulnerable to COVID-19 due to the risk of transmission in shared accommodation and the high prevalence of comorbidities," study authors note.
The Lancet study found that preventive measures during the first wave may have avoided 21,092 infections, 266 deaths, 1,164 hospital admissions and 338 ICU admissions among the homeless. The authors wrote, "During the first wave of COVID-19 in England, our modelling suggests that people experiencing homelessness were protected by interventions in the general population, infection control in hostels, and closing of dormitory-style accommodation."
Projections for Jun 1 through Jan 31 of next year suggest that if preventive measures are continued, a further 1,754 infections, 31 deaths, 122 hospital admissions and 35 ICU admissions might be avoided. If preventive measures are lifted, there could be as many as 12,151 infections, 184 deaths, 733 hospital admissions and 213 ICU admissions, even with low disease incidence in the general population.
The study points to two key recommendations for reducing COVID-19 in homeless populations: close night shelters with dormitory-style sleeping quarters, and maintain strong infection control measures in hostels.
"COVID-19 outbreaks remain likely in these settings, even when incidence is low in the general population. Outbreaks can be prevented by providing stable single-room accommodation and by heightening infection control measures in homeless settings. These interventions can avoid large numbers of deaths," study authors concluded.
Sep 23 Lancet study
