Coronavirus Disease 2019 Fatality Research Articles

Incidence and case fatality rate of COVID-19 in patients with inflammatory articular diseases.

To describe the incidence and fatality of coronavirus disease 2019 (COVID-19) and identify risk factors to fatality in patients with inflammatory articular diseases (IAD). This is a cross-sectional observational study of IAD patients and COVID-19 with controls matched for age, sex, and RT-PCR. A control group was used to compare the cumulative incidence (CI) and case fatality rate (CFR). The main outcomes of the study were CI and CFR. Other variables included comorbidities, treatments, and characteristics of the COVID-19. Multiple logistic regression analysis was performed to investigate risk factors for fatality in patients with IAD. Of the 1537 patients who fulfilled the inclusion criteria, 23/1537 (1.49%) had IAD 13 (0.8%) had rheumatoid arthritis (RA), 5 psoriatic arthritis (PsA) (0.3%) and 5 axial spondyloarthritis (0.3%). There were no significant differences in CI of COVID-19 and CFR in patients with IAD compared with COVID-19 patients without IAD. In RT-PCR positive patients, the CI of COVID-19 in PsA and AS was higher. Of the 23 IAD patients, 2 RA patients (8.6%) died. The patients did no show characteristics of the COVID-19 disease different from the population. In multivariate analysis, the factor associated with fatality in patients with IAD was older age (OR [95% CI], 1.1 [1.0-1.2]). COVID-19 CI, fatality rate and other features do not seem to be increased in IAD patients. Older age was associated with fatality in patients with IAD.

Is COVID-19 Fatality Rate Associated with Malaria Endemicity?

COVID-19 (coronavirus disease 2019) is a disease caused by the coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). COVID-19 has yielded many reported complications and unusual observations. In this article, we have reviewed one such observation: an association between malaria endemicity and reduced reported COVID-19 fatality. Malaria-endemic regions have a significantly lower reported COVID-19 fatality rate as compared to regions where malaria is non-endemic. Statistical analyses show that there is a strong negative correlation between the reported SARS-CoV-2 fatality and endemicity of malaria. In this review, we have discussed the potential role of CD-147, and potential malaria-induced immunity and polymorphisms in COVID-19 patients. Noteworthy, the results may also be due to underreported cases or due to the economic, political, and environmental differences between the malaria endemic and non-endemic countries. The study of this potential relationship might be of great help in COVID-19 therapy and prevention.

Evidence for treatment with estradiol for women with SARS-CoV-2 infection

BackgroundGiven that an individual’s age and gender are strongly predictive of coronavirus disease 2019 (COVID-19) outcomes, do such factors imply anything about preferable therapeutic options?MethodsAn analysis of electronic health records for a large (68,466-case), international COVID-19 cohort, in 5-year age strata, revealed age-dependent sex differences. In particular, we surveyed the effects of systemic hormone administration in women. The primary outcome for estradiol therapy was death. Odds ratios (ORs) and Kaplan-Meier survival curves were analyzed for 37,086 COVID-19 women in two age groups: pre- (15–49 years) and peri-/post-menopausal (> 50 years).ResultsThe incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is higher in women than men (by about + 15%) and, in contrast, the fatality rate is higher in men (about + 50%). Interestingly, the relationships between these quantities are linked to age: pre-adolescent girls and boys had the same risk of infection and fatality rate, while adult premenopausal women had a significantly higher risk of infection than men in the same 5-year age stratum (about 16,000 vs. 12,000 cases). This ratio changed again in peri- and postmenopausal women, with infection susceptibility converging with men. While fatality rates increased continuously with age for both sexes, at 50 years, there was a steeper increase for men. Thus far, these types of intricacies have been largely neglected. Because the hormone 17ß-estradiol influences expression of the human angiotensin-converting enzyme 2 (ACE2) protein, which plays a role in SARS-CoV-2 cellular entry, propensity score matching was performed for the women’s sub-cohort, comparing users vs. non-users of estradiol. This retrospective study of hormone therapy in female COVID-19 patients shows that the fatality risk for women > 50 years receiving estradiol therapy (user group) is reduced by more than 50%; the OR was 0.33, 95% CI [0.18, 0.62] and the hazard ratio (HR) was 0.29, 95% CI [0.11,0.76]. For younger, pre-menopausal women (15–49 years), the risk of COVID-19 fatality is the same irrespective of estradiol treatment, probably because of higher endogenous estradiol levels.ConclusionsAs of this writing, still no effective drug treatment is available for COVID-19; since estradiol shows such a strong improvement regarding fatality in COVID-19, we suggest prospective studies on the potentially more broadly protective roles of this naturally occurring hormone.

Spread of COVID-19 and policy responses in Vietnam: An overview

ObjectivesDespite the proximity and high travel flows with China, Vietnam has been able to contain the spread of coronavirus disease 2019 (COVID-19). This study describes the characteristics of COVID-19 infections in Vietnam and policy responses to identify potential factors contributing to the relative success of Vietnam in containing this pandemic. MethodsNarrative analyses were applied to describe the pandemic and policy responses. Descriptive statistics, generalized linear regression, and a susceptible-infected-recovered model were used to explore the effectiveness of Vietnamese policy responses to COVD-19. ResultsTo date, Vietnam is one of the few countries that have successfully control the spread of COVID-19. As of 26 October 2020, Vietnam has had 1169 cases of COVID-19, of which 1061 people recovered and 35 people died from the disease. COVID-19 infected patients in Vietnam were relatively younger than those in other countries with an average age of 36. Most of the infected cases were from international travels. Policy responses in Vietnam were implemented early and strictly. ConclusionsDespite the proximity to China, where COVID-19 emerged, Vietnam has experienced a small number of COVID-19 infections and fatalities compared with other countries. Most infected patients were relatively young, and exposure was attributed to international travel. Early policy interventions were the main factors that contributed to the success of Vietnam to date.

Failure to lead on COVID-19: what went wrong with the United States?

PurposeThe purpose of this paper is to review the federal decisions to coronavirus disease 2019 (COVID-19) response in the United States and consider the different approaches employed by the California state government.Design/methodology/approachThis paper focuses on COVID-19-related issues, responses and implications in federal countries, and largely draws comparisons between the Trump Administration and California state.FindingsThe slow response of the federal government could have been avoided, had there been a current and tested national plan. The defunding of the Office of Pandemics and Emerging Threats, and the lack of coordination between the Trump Administration and the states have contributed to its ranking as the country with the highest COVID-19 infection and fatality rates worldwide. California state oversaw an effective initial pandemic response, which was ultimately undermined by a lack of national support and the refusal of some citizens to comply with the restrictions.Research limitations/implicationsThe paper draws upon open-source information published on government websites and news media.Originality/valueAs the COVID-19 pandemic in the United States is currently ongoing, information about the federal governance and state response is still evolving. The authors examine California as a state exemplar, since it is the largest such jurisdiction by populace and the first state to issue statewide mandatory lockdown measures. This comparison offers insights as to the decisive initiatives that could have occurred at the federal level. The “lessons learned” highlight the critical role of crisis leadership in societal and public health preparedness for future pandemic events.

Pseudo-likelihood based logistic regression for estimating COVID-19 infection and case fatality rates by gender, race, and age in California

In emerging epidemics, early estimates of key epidemiological characteristics of the disease are critical for guiding public policy. In particular, identifying high-risk population subgroups aids policymakers and health officials in combating the epidemic. This has been challenging during the coronavirus disease 2019 (COVID-19) pandemic because governmental agencies typically release aggregate COVID-19 data as summary statistics of patient demographics. These data may identify disparities in COVID-19 outcomes between broad population subgroups, but do not provide comparisons between more granular population subgroups defined by combinations of multiple demographics.We introduce a method that helps to overcome the limitations of aggregated summary statistics and yields estimates of COVID-19 infection and case fatality rates — key quantities for guiding public policy related to the control and prevention of COVID-19 — for population subgroups across combinations of demographic characteristics. Our approach uses pseudo-likelihood based logistic regression to combine aggregate COVID-19 case and fatality data with population-level demographic survey data to estimate infection and case fatality rates for population subgroups across combinations of demographic characteristics.We illustrate our method on California COVID-19 data to estimate test-based infection and case fatality rates for population subgroups defined by gender, age, and race/ethnicity. Our analysis indicates that in California, males have higher test-based infection rates and test-based case fatality rates across age and race/ethnicity groups, with the gender gap widening with increasing age. Although elderly infected with COVID-19 are at an elevated risk of mortality, the test-based infection rates do not increase monotonically with age. The workforce population, especially, has a higher test-based infection rate than children, adolescents, and other elderly people in their 60–80. LatinX and African Americans have higher test-based infection rates than other race/ethnicity groups. The subgroups with the highest 5 test-based case fatality rates are all-male groups with race as African American, Asian, Multi-race, LatinX, and White, followed by African American females, indicating that African Americans are an especially vulnerable California subpopulation.

Socio-economic status and COVID-19–related cases and fatalities

ObjectivesThe United States has the highest number of coronavirus disease 2019 (COVID-19) in the world, with high variability in cases and mortality between communities. We aimed to quantify the associations between socio-economic status and COVID-19–related cases and mortality in the U.S. Study designThe study design includes nationwide COVID-19 data at the county level that were paired with the Distressed Communities Index (DCI) and its component metrics of socio-economic status. MethodsSeverely distressed communities were classified by DCI>75 for univariate analyses. Adjusted rate ratios were calculated for cases and fatalities per 100,000 persons using hierarchical linear mixed models. ResultsThis cohort included 1,089,999 cases and 62,298 deaths in 3127 counties for a case fatality rate of 5.7%. Severely distressed counties had significantly fewer deaths from COVID-19 but higher number of deaths per 100,000 persons. In risk-adjusted analysis, the two socio-economic determinants of health with the strongest association with both higher cases per 100,000 persons and higher fatalities per 100,000 persons were the percentage of adults without a high school degree (cases: RR 1.10; fatalities: RR 1.08) and proportion of black residents (cases and fatalities: Relative risk(RR) 1.03). The percentage of the population aged older than 65 years was also highly predictive for fatalities per 100,000 persons (RR 1.07). ConclusionLower education levels and greater percentages of black residents are strongly associated with higher rates of both COVID-19 cases and fatalities. Socio-economic factors should be considered when implementing public health interventions to ameliorate the disparities in the impact of COVID-19 on distressed communities.

Medicolegal Sidebar: Legal Immunity for Healthcare Workers During COVID-19.

Medicolegal Sidebar: Legal Immunity for Healthcare Workers During COVID-19.

Male Sex, Severe Obesity, Older Age, and Chronic Kidney Disease Are Associated With COVID-19 Severity and Mortality in New York City

Male Sex, Severe Obesity, Older Age, and Chronic Kidney Disease Are Associated With COVID-19 Severity and Mortality in New York City

COVID-19: measures to protect older adults from SARS-CoV-2 infection

As every nation battles the coronavirus disease 2019 (COVID-19) pandemic comprehensively, older adults are by far the most affected group in terms of morbidity and mortality rates. Particularly individuals in the age range of >60 years and with comorbidities and other geriatric conditions are at heightened risk of complications from COVID-19 compared to any other age groups in the world. The time between the infection of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV- 2) and the manifestation of the symptoms is between two to twelve days. Typical symptoms of COVID-19 are high temperature, dry cough, and breathing difficulties in complicated cases, while new evidence shows atypical presentations of COVID-19 symptoms in older adults, and are highlighted in this review. From this synopsis, we deduced that firstly, the severity of COVID-19 among older adults is because of biological (dwindling immunity with old age), socio-economic (poverty and over-stretched health system) and physical reasons (frailty and comorbidities). Secondly, there is an upsurge in the rates of transmission and COVID-19 fatalities in nursing homes globally. Lastly, to abate the spread of SARS-CoV-2 among older adults, strict adherence to physical distancing, frequent hand hygiene and respiratory hygiene, frequent disinfection of surfaces, stoppage to unnecessary travel and nonessential hospital’s visitations, appropriate use of face masks, healthy life style choices, proper identification and isolation of infected older adults, assistance and support for older adults in the community, and prevention of infections in nursing homes should all essentially be implemented globally. It is recommended that maximum compliance to measures provided in this review should be ensured and implemented. Governments, civil societies and general public should provide supports for older adults during this COVID-19 pandemic period, and new researches should look more into the global severity of COVID-19 on nursing homes and the geriatric populations generally to get progressively feasible exact information that will enable informed preventive choices.

The pandemic predominantly hits poor neighbourhoods? SARS-CoV-2 infections and COVID-19 fatalities in German districts.

BackgroundReports from the UK and the USA suggest that COVID-19 predominantly affects poorer neighbourhoods. This article paints a more complex picture by distinguishing between a first and second phase of the pandemic. The initial spread of infections and its correlation with socio-economic factors depends on how the virus first entered a country. The second phase of the pandemic begins when individuals start taking precautionary measures and governments implement lockdowns. In this phase the spread of the virus depends on the ability of individuals to socially distance themselves, which is to some extent socially stratified.MethodsWe analyse the geographical distribution of known cumulative cases and fatalities per capita in an ecological analysis across local districts in Germany distinguishing between the first and the second phase of the pandemic.ResultsIn Germany, the virus first entered via individuals returning from skiing in the Alps and other international travel. In this first phase we find a positive association between the wealth of a district and infection rates and a negative association with indicators of social deprivation. During the second phase and controlling for path dependency, districts with a higher share of university-educated employees record fewer new infections and deaths and richer districts record fewer deaths, districts with a higher unemployment rate record more deaths.ConclusionThe social stratification of Covid-19 changes substantively across the two phases of the pandemic in Germany. Only in the second phase and controlling for temporal dependence does Covid-19 predominantly hit poorer districts.

Mortality Attributed to COVID-19 in High-Altitude Populations

Woolcott, Orison O., and Richard N. Bergman. Mortality attributed to COVID-19 in high-altitude populations. High Alt Med Biol. 21:409-416, 2020. Background: Since partial oxygen pressure decreases as altitude increases, environmental hypoxia could worsen Coronavirus Disease 2019 (COVID-19) patient's hypoxemia. We compared COVID-19 mortality at different altitudes. Methods: Retrospective analysis of population-level data on COVID-19 deaths was conducted in the United States (1,016 counties) and Mexico (567 municipalities). Mixed-model Poisson regression analysis of the association between altitude and COVID-19 mortality was conducted using individual-level data from 40,168 Mexican subjects with COVID-19, adjusting for multiple covariates. Results: Between January 20 and April 13, 2020, mortality rates were higher in U.S. counties located at ≥2,000 m elevation versus those located <1,500 m (12.3 vs. 3.2 per 100,000; p < 0.001). In Mexico, between March 13 and May 13, 2020, mortality rates were higher in municipalities located at ≥2,000 m versus those located <1,500 m (5.3 vs. 3.9 per 100,000; p < 0.001). Among Mexican subjects younger than 65 years, the risk of death was 36% higher in those living at ≥2,000 m versus those living at <1,500 m (adjusted incidence rate ratio [IRR]: 1.36; confidence interval [95% CI], 1.05-1.78; p = 0.022). Among Mexican men, the risk of death was 31% higher at ≥2,000 m versus that at <1,500 m (adjusted IRR: 1.31; 95% CI, 1.03-1.66; p = 0.025). No association between altitude and COVID-19 mortality was found among Mexican women or among Mexican subjects 65 years of age and older. Conclusions: Altitude is associated with COVID-19 mortality in men younger than 65 years.

The Enigma of Low COVID-19 Fatality Rate in India.

Coronavirus disease 2019 (COVID-19), an acute onset pneumonia caused by a novel Betacoronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has rapidly evolved into a pandemic. Though its origin has been linked to the Wuhan City of China’s Hubei Province in December 2019, recent reports claim that the original animal-to-human transmission of the virus probably happened sometime between September and October 2019 in Guangdong Province, rather than Hubei. As of July 3, 2020, India has reported a case positivity rate of 6.5% and a fatality rate of 2.8%, which are among the lowest in the world. Also, the severity of the disease is much less among Indians as evidenced by the low rate of ICU admission (15.3%) and the need for mechanical ventilation (4.16%). As per the World Health Organization (WHO) situation report 165 on July 3, 2020, India has one of the lowest deaths per 100,000 population (1.32 deaths against a global average of 6.04). Several factors related to the pathogen, host and environment might have some role in reducing the susceptibility of Indians to COVID-19. These include some ongoing mutations that can alter the virulence of the circulating SARS-CoV-2 strains, host factors like innate immunity, genetic diversity in immune responses, epigenetic factors, genetic polymorphisms of ACE2 receptors, micro RNAs and universal BCG vaccination, and environmental factors like high temperature and humidity which may alter the viability and transmissibility of the strain. This perspective -highlights the potential factors that might be responsible for the observed low COVID-19 fatality rate in Indian population. It puts forward several hypotheses which can be a ground for future studies determining individual and population susceptibility to COVID-19 and thus, may offer a new dimension to our current understanding of the disease.

No clear association emerges between intergenerational relationships and COVID-19 fatality rates from macro-level analyses

The severe acute respiratory syndrome coronavirus 2 originated in Wuhan, China at the end of 2019 and rapidly spread in more than 100 countries. Researchers in different fields have been working on finding explanations for the unequal impact of the virus and deaths from the associated coronavirus disease 2019 (COVID-19) across geographical areas. Demographers and other social scientists have hinted at the importance of demographic factors, such as age structure and intergenerational relationships. Our aim is to reflect on the possible link between intergenerational relationships and spread and lethality of COVID-19 in a critical way. We show that with available aggregate data it is not possible to draw robust evidence to support these links. In fact, despite a higher prevalence of intergenerational coresidence and contacts that is broadly positively associated with COVID-19 case fatality rates at the country level, the opposite is generally true at the subnational level. While this inconsistent evidence demonstrates neither the existence nor the absence of a causal link between intergenerational relationships and the severity of COVID-19, we warn against simplistic interpretations of the available data, which suffer from many shortcomings. We conclude by arguing that intergenerational relationships are not only about physical contacts between family members. Theoretically, different forms of intergenerational relationships may have causal effects of opposite sign on the diffusion of COVID-19. Policies should also take into account that intergenerational ties are a source of instrumental and emotional support, which may favor compliance to the lockdown and "phase-2" restrictions and may buffer their negative consequences on mental health.

Analysis of cardiopulmonary findings in COVID-19 fatalities: High incidence of pulmonary artery thrombi and acute suppurative bronchopneumonia

Since its recognition in December 2019, coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 has rapidly spread globally causing a pandemic that represents the greatest medical challenge in decades. The aim of the study was to evaluate the spectrum of cardiopulmonary pathology of COVID-19 based on (non-minimal invasive) autopsies performed on 14 COVID-19 decedents. Bilateral diffuse alveolar damage (DAD) was found in all patients. Superimposed acute bronchopneumonia was present in 11 of 14 (78.6%) patients and was considered the major cause of death in 2 patients. A key finding was the presence of thrombotic/thromboembolic vascular occlusions. We classified 5 types of pulmonary thrombi: 1. capillary microthrombi (11/14, 78.6%); 2. partially organized thrombi in mid-sized pulmonary arteries with complete vessel occlusion; 3. non-organized thrombi in mid-sized pulmonary arteries that did not completely fill out the vessel lumen and probably represented thromboemboli rather than thrombosis; 4. bone marrow emboli (1/14, 7.1%); and 5. septic pulmonary thromboemboli (1/14, 7.1%). Pulmonary thrombi in mid-sized arteries were noted in 5 of 14 (35.7%) patients, causing pulmonary infarction and/or pulmonary hemorrhage. All patients had evidence of chronic cardiac disease, including myocardial hypertrophy (13/14, 92.9%), mild to marked coronary artery atherosclerosis (14/14, 100%) and focal myocardial fibrosis (3/14, 21.4%). Acute myocardial infarction was found as concurrent cause of death in 3 (21.4%) patients, and significant cardiac hypertrophy (heart weight 750 g) was present in 1 (7.1%) patient with ATTR-positive cardiac amyloidosis. The autopsy findings confirm that COVID-19 is a systemic disease, with major involvement of the lungs, that increases the risk of cardiac and vascular complications including acute myocardial injury and thrombotic/thromboembolic events. Secondary acute bronchopneumonia is a common complication in patients with COVID-19 and may be the major cause of death.

Observations from the COVID-19 Pandemic.

Observations from the COVID-19 Pandemic.

Analysis of Reported Case Fatality Rate and Characteristics of COVID-19 Patients in Italy

In a recent viewpoint publication in the Journal of American Medical Association (JAMA), Onder, et al. provided insight into the coronavirus disease 2019 (COVID-19) outbreak in Italy along with an explanation of the Italian National Institute of Health (Istituto Superiore di Sanita [ISS]) surveillance system [1]. Onder calculated the overall attributed COVID-19 fatality rate of 7.2% in the Italian population, based on the data up to March 17th, 2020 (1625 deaths/22 512 cases) [1]. Onder and colleagues proposed the demographic characteristics of the Italian population (higher older age distribution in the population compared to some other nations) and the associated comorbidities, lack of clearly defined COVID-19 related deaths and the differences in calculation methods in Italy and internationally along with country-specific differences in testing strategies as possible explanations for the higher Italian case-fatality rate compared with some other nations (i.e. China) [1].

COVID-19 and the impact of social determinants of health

COVID-19 and the impact of social determinants of health

Asthma, biologics, corticosteroids, and coronavirus disease 2019

Asthma, biologics, corticosteroids, and coronavirus disease 2019

Acetazolamide, Nifedipine and Phosphodiesterase Inhibitors: Rationale for Their Utilization as Adjunctive Countermeasures in the Treatment of Coronavirus Disease 2019 (COVID-19).

Effective treatments for Coronavirus Disease 2019 (COVID-19) outbreak are urgently needed. While anti-viral approaches and vaccines are being considered immediate countermeasures are unavailable. The aim of this article is to outline a perspective on the pathophysiology of COVID-19 in the context of the currently available clinical data published in the literature. This article appreciates clinical data published on COVID-19 in the context of another respiratory illness - high altitude pulmonary edema (HAPE). Both conditions have significant similarities that portend pathophysiologic trajectories. Following this potential treatment options emerge.Both COVID-19 and HAPE exhibit a decreased ratio of arterial oxygen partial pressure to fractional inspired oxygen with concomitant hypoxia and tachypnea. There also appears to be a tendency for low carbon dioxide levels in both as well. Radiologic findings of ground glass opacities are present in up to 86% of patients with COVID-19 in addition to patchy infiltrates. Patients with HAPE also exhibit patchy infiltrates throughout the pulmonary fields, often in an asymmetric pattern and CT findings reveal increased lung markings and ground glass-like changes as well. Widespread ground-glass opacities are most commonly a manifestation of hydrostatic pulmonary edema. Similarly, elevated fibrinogen levels in both conditions are likely an epiphenomenon of edema formation rather than coagulation activation. Autopsy results of a COVID-19 fatality revealed bilateral diffuse alveolar damage associated with pulmonary edema, pro-inflammatory concentrates, and indications of early-phase acute respiratory distress syndrome (ARDS). HAPE itself is initially caused by an increase in pulmonary capillary pressure and induces altered alveolar-capillary permeability via high pulmonary artery hydrostatic pressures that lead to a protein-rich and mildly hemorrhagic edema. It appears that COVID-19 and HAPE both discretely converge on ARDS. In light of this, a countermeasure that has been shown to be effective in the analogous condition of HAPE is Acetazolamide. Acetazolamide has a myriad of effects on different organ systems, potently reduces hypoxic pulmonary vasoconstriction, improves minute ventilation and expired vital capacity. Other therapeutics to consider that are also directed towards decreased pulmonary pressure include Nifedipine and Phosphodiesterase inhibitors.This review describes COVID-19 in parallel to HAPE. Deranged respiratory parameters that are present in both conditions are highlighted. The utilization of medications found to be effective in HAPE, for the treatment of COVID-19, is proposed. Given the medical emergency of a growing contagion and the thousands of lives at stake, expedient attempts to improve survival are needed. Acetazolamide, Nifedipine and Phosphodiesterase inhibitors may be potential countermeasures.