COVID-19 Scan for May 20, 2021

COVID-19 long-haulers
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Nursing home COVID outbreaks
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COVID and vitamin D levels

1 in 7 adult COVID-19 patients requires care for new illness after infection

One in seven US adult COVID-19 patients developed at least one new illness requiring medical care after recovery from their infection in 2020, finds an observational study yesterday in BMJ.

The so-called COVID-19 "long-haulers" developed complications involving a range of organs and systems at least 3 weeks after infection. The complications affected the heart, kidneys, lungs, and liver, along with mental illnesses.

Researchers from OptumLabs at UnitedHealth Group in Minneapolis led the study, which consisted of mining health insurance records from Jan 1 to Oct 31, 2020, to identify 266,586 COVID-19 patients 18 to 65 years diagnosed as having at least 1 of 50 medical conditions as many as 6 months after infection. The patients were matched to two comparison cohorts without COVID-19 infection in 2019 or 2020 and one group diagnosed as having other viral lower respiratory tract infections.

Fourteen percent of adults infected with COVID-19 went on to require medical care for at least one new condition—5.0% more than in the 2020 comparison group and 1.7% more than in those who had a different viral respiratory infection. Also, the risk of specific conditions, including chronic respiratory failure, heart rhythm abnormalities, diabetes, fatigue, amnesia, and anxiety, was higher in the long-hauler group than in all comparison cohorts.

The absolute risk was low, at an excess 0.02 to 2.26 per 100 people in the 2020 comparison cohort. Patients at highest risk were 50 years and older and those with preexisting underlying illnesses or who were hospitalized for their infections.

In a BMJ press release, the authors said that the study suggests that as more people are infected with COVID-19, "the number of survivors with potential sequelae after COVID will continue to grow."

In a linked editorial, Elaine Maxwell, PhD, of the National Institute for Health Research in London, said that while it's unclear how long COVID-19 complications will continue after infection, they impose a burden on those affected, who may struggle to work or care for dependents. "Long COVID is also putting a strain on healthcare services, which have been already decimated by the pandemic," she said. "Identifying risk factors would facilitate triage and faster access to specialist care."
May 19 BMJ study, press release, and editorial

 

GAO: Almost all US nursing homes had multiple COVID-19 outbreaks

From May 2020 to January 2021, US nursing homes had an average of three COVID-19 outbreaks, according to a Government Accountability Office (GAO) report released yesterday.

The authors used Centers for Disease Control and Prevention (CDC) and Centers for Medicare & Medicaid Services (CMS) data and representative and expert interviews to look at COVID-19 outbreaks in 13,380 nursing homes (88% of all CMS-certified nursing homes). An outbreak was defined as anytime a staff member or resident was diagnosed with COVID-19, and it did not end until at least 2 weeks after the last identified case.

The average nursing home had three outbreaks, and 93.8% had more than one. Less than half a percent had no outbreaks. Data also showed that 2.0% of outbreaks were able to be contained after the initial week and that most (84.5%) lasted at least 5 weeks. The average number of COVID-19 cases for these longer outbreaks was 56, and for those shorter, the average case number was 13. Overall, 65.2% of nursing homes reported that the outbreak was first identified with a staff member who tested positive.

The authors found that most of the longer outbreaks were between October and December 2020 and were more likely to occur in nursing homes with a larger number of beds. For instance, those with less than 50 beds were 12% of the analyzed nursing homes but made up only 9% of longer outbreaks and 28% of shorter outbreaks. More than 75% of nursing homes in each state experienced long-term outbreaks except for those in Alaska, Hawaii, Maine, Massachusetts, New Hampshire, Oregon, Vermont, and Washington.

"Officials frequently highlighted the risks posed by a failure or inability of a nursing home to implement robust infection control practices to control the spread of the virus," the authors write, citing the inability to quickly test or quarantine and staffing shortages. "Future GAO reports will examine more broadly infection prevention and control and emergency preparedness in nursing homes and CMS's response to the COVID-19 pandemic."
May 19 GAO report

 

Low vitamin D not associated with COVID-19 infection

Low levels of vitamin D were not associated with SARS-CoV-2 positivity after data were adjusted for variables such as comorbidities, race, and sex, according to a JAMA Network Open study yesterday.

The researchers looked at data from 18,148 Quest Diagnostics employees and spouses across the country who participated in both a health screening from September 2019 to January 2020 (pre-pandemic) and August and November 2020. The mean age of participants was 47 years, and 67.1% were women. Nine hundred (5.0%) tested seropositive, or having SARS-CoV-2 antibodies. The researchers note that similar to other studies, racial disparities appeared: 1 in 3 seropositive people were Black, compared with 1 in 6 seronegative people.

Before adjusting for sex, age, race, US geographical region, body mass index, blood pressure, smoking status, and education, lower vitamin D levels did appear to have an association with seropositivity (odds ratios [ORs], 1.28 to 1.70). After adjustment, however, there was no significant association, with adjusted odd ratios for those with low vitamin D falling between 0.93 to 1.09. During the course of their study, the researchers assessed vitamin D levels before and after the pandemic started, deficient versus insufficient levels (20 vs 30 ng/mL or less), and even a simulation that accounted for 10% of infected people not testing seropositive.

Minority status, not having a college education, and obesity were positively associated with seropositivity, and high blood pressure, smoking, and residency in the northeastern and western parts of the country were negatively associated.

"Although SARS-CoV-2–seropositive individuals did have lower vitamin D levels than seronegative individuals, low vitamin D levels were not independently associated with the risk of seropositivity," the researchers conclude.

"Well-done observational studies are among the means by which we can determine which therapies are worth bringing to clinical trials," Michael A. Polis, MD, MPH, writes in an invited commentary, noting that past vitamin D studies often did not take into account confounding variables. "It is incumbent on us all to recognize when and what analyses are needed before funding and initiating large clinical trials on speculative or insufficient information." Polis is an infectious disease consultant in Bethesda, Maryland.
May 19 JAMA Netw Open study and commentary

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