COVID-19 Scan for May 28, 2020

COVID-19 disparities
Autopsies of COVID-19 patients
Hypertension and COVID-19 severity

Racial disparities seen in Louisiana's COVID-19 patients

Yesterday in the New England Journal of Medicine a study of Louisiana COVID-19 patients showed major racial and ethnic differences in both hospitalization rates and in-hospital deaths.

The study analyzed outcomes from 3,481 patients seen in the Ochsner Health system between Mar 1 and Apr 11. Of those patients, 70.4% were black non-Hispanic, and 29.6% were white non-Hispanic. A total of 39.7% patients (1,382 patients) were hospitalized, 76.9% of whom were black.  Among the 326 patients who died from COVID-19, 70.6% were black, the authors said.

"More than one-third of admitted patients (474 patients) received care in an intensive care unit, among whom 80.2% were black patients. Among the 364 patients receiving mechanical ventilation, 81.6% were black," the authors said. "Although black patients represent 31% of the patients routinely cared for by Ochsner Health, they made up 76.9% of COVID-19–positive patients hospitalized within the health system."

According to the authors, black patients in Louisiana represent 59% of all COVID-19–related deaths in the state and 33% of the overall population. The authors said though socioeconomic factors must be considered for racial disparities, more studies are warranted to assess the immune response to this novel coronavirus with regard to racial and ethnic differences.
May 27 N Engl J Med study


Autopsies of African American COVID-19 patients show blood clots in lungs

A study yesterday in the Lancet Respiratory Medicine describes the autopsy findings of 10 African-American COVID-19 patients in New Orleans, noting the presence of small blood clots in the lungs that contributed to mortality.

The patients were men and women between the ages of 44 and 78, all with a history of at least one of the following comorbidities: high blood pressure, obesity, insulin-dependent type 2 diabetes, and chronic kidney disease. After the patients were hospitalized for COVID-19, chest x-rays for all of them showed acute respiratory distress syndrome.

The autopsies all showed diffuse alveolar damage, accompanied by thrombosed small vessels with significant associated hemorrhage, the authors wrote. "Thrombi were not grossly apparent in any other organs examined, including kidney, spleen, pancreas, and liver," they wrote. There was also a noted absence of secondary bacterial infections.

African Americans have died from COVID-19 infections at a higher rate than their white peers. In Louisiana, deaths in African Americans have made up 70% of COVID-19 fatalities.

"The key implications of our study include the discovery of a mechanism for severe pathology within the African American population, likely extendable to all persons with severe disease, and possibly a target for immediate therapeutic management," said senior author Richard Vander Heide, MD, PhD, director of pathology research at Louisiana State University Health New Orleans School of Medicine, in a press release. "The results may also be applicable to a broader demographic experiencing severe COVID-19 disease. Management of these patients should include therapy to target these pathologic mechanisms."
May 27 Lancet Resp Med study
May 27 Louisiana State University press release


Study strengthens link between high blood pressure worse COVID-19

Hypertension increases the risk of severe illness and death in patients with COVID-19 infections, Chinese researchers who analyzed 12 retrospective studies reported today in Epidemiology & Infection.

The scientists looked for reports in studies published through Mar 20 that included information about severe illnesses and deaths from COVID-19 along with clinical information about patients' hypertension. The 12 studies they focused on were from Wuhan and other parts of China and included 2,389 patients, 674 of them with severe illness.

Patients who had hypertension had a 2.27-fold higher risk of severe illness and a 3.48-fold higher risk of death compared with COVID-19 patients who didn't have hypertension, the group found. The association held true for patients both younger and older than age 50.

They noted that a similar connection has been reported for Middle East respiratory syndrome coronavirus (MERS-CoV), and though the mechanism isn't clear, one possibility is injury when virus surface spike proteins bind to angiotensin-converting enzyme 2 (ACE2) receptors, which may reduce protection against blood pressure increases.
May 28 Epidemiol Infect study

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