COVID-related syndrome in adults severe, hard to diagnose, study finds
Multisystem inflammatory syndrome in adults (MIS-A) is a rare but severe hyperinflammatory condition that begins roughly 4 weeks after COVID-19 symptom onset and likely results from an outsized immune response, concludes a systematic review yesterday in JAMA Network Open.
Researchers from the US Centers for Disease Control and Prevention conducted a literature review from May 1, 2020, to May 25, 2021, identifying 221 patients around the world diagnosed as having MIS-A. First identified in children (MIS-C) in April 2020, the syndrome has since also been recognized in adults.
MIS-A typically emerges about 4 weeks after COVID-19 symptoms began, producing inflammation and involving a median of five nonpulmonary organs, the authors report. Clinical presentations vary, but the organ systems most often affected were hematologic (92%), cardiovascular (87%), gastrointestinal (83%), and respiratory (74%).
Thirty percent of 205 patients had myocarditis, or inflammation of the heart muscle, and 25% of 175 had pericardial effusion, or fluid buildup around the heart.
Eleven percent of 94 patients were diagnosed as having Kawasaki disease. Of 195 patients, 90% had higher-than-normal concentrations of coagulation and/or inflammation markers, and 5% had arterial or venous thrombosis (blood clots), while 72% of 194 patients had SARS-CoV-2 antibodies.
Median hospital stay was 8 days, and 57% of patients required intensive care, 47% received respiratory support, and 7% died. Sixty-eight percent of 149 patients reported having a symptomatic coronavirus-like illness a median of 28 days earlier.
Common symptoms included fever (96%), low blood pressure (60%), cardiac dysfunction (54%), shortness of breath (52%), and diarrhea (52%). Median patient age was 21 years, 70% were men, 36% were Black, and 58% had no underlying illness.
The authors noted that it can be difficult to distinguish biphasic COVID-19 from MIS-A because MIS-A is complicated by the occurrence of other types of coronavirus-related inflammation, and much more research is needed. "It is important for the clinical and public health community to suspect and identify MIS-A…by exercising clinical acumen and considering empirical treatment to reduce related morbidity and mortality," they wrote.
Sep 22 JAMA Netw Open study
Study estimates Israeli COVID vaccination averted thousands of deaths
Writing in The Lancet Infectious Diseases yesterday, Israeli scientists estimate that, without the national vaccination campaign, Israel would have had triple the number of hospitalizations and deaths compared with what actually occurred during its latest and largest wave of COVID-19, which could have overwhelmed its healthcare system.
From Dec 20, 2020, to Apr 10, 2021, Israel launched a massive national COVID-19 vaccination campaign with the two-dose mRNA vaccine made by Pfizer-BioNTech. Approximately 74% of the country's population aged 16 and older were fully vaccinated by Apr 10, making Israel's the fastest and most comprehensive vaccination campaign in the world.
Even in the face of rising breakthrough cases caused by the Delta (B1617.2) variant and evidence of some waning protection against mild infections, the study authors estimate the vaccination campaign averted 158,665 SARS-CoV infections (95% confidence interval, 144,640 to 172,690), 24,597 hospitalizations (18,942 to 30,252), 17,432 severe or critical hospitalizations (12,770 to 22,094), and 5,532 deaths (3,085 to 7,982) during the study period.
During that period, Israel reported 13,338 hospitalization (8,429 of which were severe or critical), and 2,859 deaths from COVID-19.
In a commentary on the study, Frank Sandmann, PhD, and Mark Jit, PhD, MPH, said the research, "documents the immense success that rapid COVID-19 vaccine roll-out had in terms of reducing COVID-19-related morbidity and mortality at the population level."
Sep 22 Lancet Infect Dis study
Sep 22 Lancet Infect Dis commentary