SARS-CoV-2 mRNA Vaccination-Associated Myocarditis in Children Ages 12-17: A Stratified National Database Analysis

Authors: RALPH TURCHIANO    • 

Abstract

Establishing the rate of post-vaccination cardiac myocarditis in the 12-15 and 16-17-year-old population in the context of their COVID-19 hospitalization risk is critical for developing a vaccination recommendation framework that balances harms with benefits for this patient demographic. Design, Setting and Participants: Using the Vaccine Adverse Event Reporting System (VAERS), this retrospective epidemiological assessment reviewed reports filed between January 1, 2021, and June 18, 2021, among adolescents ages 12-17 who received mRNA vaccination against COVID-19. Symptom search criteria included the words myocarditis, pericarditis, and myopericarditis to identify children with evidence of cardiac injury. The word troponin was a required element in the laboratory findings. Inclusion criteria were aligned with the CDC working case definition for probable myocarditis. Stratified cardiac adverse event (CAE) rates were reported for age, sex and vaccination dose number. A harm-benefit analysis was conducted using existing literature on COVID-19-related hospitalization risks in this demographic. Main outcome measures: 1) Stratified rates of mRNA vaccine-related myocarditis in adolescents age 12-15 and 16-17; and 2) harm-benefit analysis of vaccine-related CAEs in relation to COVID-19 hospitalization risk. Results: A total of 257 CAEs were identified. Rates per million following dose 2 among males were 162.2 (ages 12-15) and 94.0 (ages 16-17); among females, rates were 13.0 and 13.4 per million, respectively. For boys 12-15 without medical comorbidities receiving their second mRNA vaccination dose, the rate of CAE is 3.7-6.1 times higher than their 120-day COVID-19 hospitalization risk as of August 21, 2021 (7-day hospitalizations 1.5/100k population) and 2.6-4.3-fold higher at times of high weekly hospitalization risk (2.1/100k), such as during January 2021. For boys 16-17 without medical comorbidities, the rate of CAE is currently 2.1-3.5 times higher than their 120-day COVID-19 hospitalization risk, and 1.5-2.5 times higher at times of high weekly COVID-19 hospitalization. Conclusions: Post-vaccination CAE rate was highest in young boys aged 12-15 following dose two. For boys 12-17 without medical comorbidities, the likelihood of post vaccination dose two CAE is 162.2 and 94.0/million respectively. This incidence exceeds their expected 120-day COVID-19 hospitalization rate at both moderate (August 21, 2021 rates) and high COVID-19 hospitalization incidence. Further research into the severity and long-term sequelae of post-vaccination CAE is warranted. Quantification of the benefits of the second vaccination dose and vaccination in addition to natural immunity in this demographic may be indicated to minimize harm.

Millennials Experienced the “Worst-Ever Excess Mortality in History” – An 84% Increase In Deaths After Vaccine Mandates

The most recent data from the CDC shows that U.S. millennials, aged 25-44, experienced a record-setting 84% increase in excess mortality during the final four months of 2021, according to the analysis of financial expert and Blackrock whistleblower, Edward Dowd,

Dowd, with the assistance of an insurance industry expert, compiled data from the CDC showing that, in just the second half of 2021, the total number of excess deaths for millennials was higher than the number of Americans who died in the entirety of the Vietnam War. Between August and December, there were over 61,000 deaths in this age group, compared to 58,000 over the course of 10 years in Vietnam.

In all, excess death among those who are traditionally the healthiest Americans is up by 84%.

Children with long covid

Authors: Helen Thomson

New Sci. 2021 Feb 27; 249(3323): 10–11.Published online 2021 Mar 3. doi: 10.1016/S0262-4079(21)00303-1PMCID: PMC7927578PMID: 33686318

Abstract

Almost half of children who contract covid-19 may have lasting symptoms, which should factor into decisions on reopening schools,

A SERIOUS picture is emerging about the long-term health effects of covid-19 in some children, with UK politicians calling the lack of acknowledgment of the problem a “national scandal”.

Children seem to be fairly well-protected from the most severe symptoms of covid-19. According to the European Centre for Disease Prevention and Control, the majority of children don’t develop symptoms when infected with the coronavirus, or their symptoms are very mild.

However, it is becoming increasingly apparent that a large number of children with symptomatic and asymptomatic covid-19 are experiencing long-term effects, many months after the initial infection.Go to:

Long-term symptoms

Symptoms of long covid were first thought to include fatigue, muscle and joint pain, headache, insomnia, respiratory problems and heart palpitations. Now, support groups and researchers say there may be up to 100 other symptoms, including gastrointestinal problems, nausea, dizziness, seizures, hallucinations and testicular pain.

Most long covid research is based on adults. There is less information about under-18s, in part because it takes longer to get ethical approval to study children, says Natalie Lambert at Indiana University School of Medicine.

A recent study found that 13.3 per cent of adults with symptomatic covid-19 have symptoms lasting more than 28 days (medRxiv, doi.org/ghgdsv). Long-lasting symptoms were more likely to occur with increasing age and BMI, and were more likely in women than men, although it isn’t clear why. Experiencing more than five symptoms in the first week post-infection was associated with a greater likelihood of having symptoms further down the line.

Evidence from the first study of long covid in children suggests that more than half of children aged between 6 and 16 years old who contract the virus have at least one symptom lasting more than 120 days, with 42.6 per cent impaired by these symptoms during daily activities. These interim results are based on periodic assessments of 129 children in Italy who were diagnosed with covid-19 between March and November 2020 at the Gemelli University Hospital in Rome (medRxiv, doi.org/fv9t).

The UK Office for National Statistics’s latest report estimates that 12.9 per cent of UK children aged 2 to 11, and 14.5 per cent of children aged 12 to 16, still have symptoms five weeks after their first infection. Almost 500,000 UK children have tested positive for covid-19 since March 2020.

Most medical bodies say it normally takes a few days or weeks to recover from covid-19, and that most will make a full recovery within 12 weeks.

UK advocacy group Long Covid Kids says that it currently has details of 1200 children with long covid from 890 families in England. “And that number has been rising quickly,” says founder Sammie Mcfarland. “Not one has returned to their previous health, and most are unable to do their normal activities.”

The consequences of long covid in children can be debilitating. At a UK parliamentary briefing on 26 January, Mcfarland described how her 14-year-old daughter started to become vacant, weak and unresponsive after catching covid-19 in March 2020. After three weeks in bed, she did some gentle exercise in the garden and clutched her chest, complaining of heart pain. “She went very floppy and almost couldn’t make it back into the house to bed,” says Mcfarland. “And she pretty much stayed there [in bed] for the next seven months.”

She went very floppy and almost couldn’t make it back to bed. She stayed there for seven months

Since August 2020, Mcfarland says there have been times where her daughter would feel better and they would go out of the house for a picnic, but they soon realised that every trip out triggered a long period of relapse, an issue that seems to be common in adults with long covid too.

Other cases seem to present very differently. Charlie Mountford-Hill has five children, all of whom have long covid after contracting the virus in the early stages of the pandemic. Almost a year after catching covid-19, her 4-year-old still has a sore neck, lethargy, stomach problems and headaches. Her 10-year-old has fatigue and gastric problems with pain around his heart. “Although they have bad periods and better periods, they are never well,” says Mountford-Hill.

Seeking long-covid care

A common frustration among parents is the lack of support from doctors. Mcfarland says they can dismiss the symptoms as not being related to covid-19 because they are so varied. Often, blood tests and scans also fail to supply any answers. “The majority of people known to Long Covid Kids have been unable to get support,” she says. The group is now working with NHS England to try to get access to care.

Several parents gave evidence at the parliamentary briefing on long covid in children, run by MP Layla Moran. She told New Scientist that the “lack of support, acknowledgement and treatment of long covid in children is a national scandal”. In a letter to the Prime Minister that was shown to New Scientist, several MPs refer to the situation as a crisis that needs to be taken more seriously.

The lack of information on long covid in children is especially pertinent to decisions around schools reopening, as they are due to do in parts of the UK and the US in the coming weeks.

500,000 Children in the UK who have tested positive for covid-19

“We certainly don’t have enough data on the long-term impacts of covid in children to make good policy decisions right now,” says Lambert, who is director of research for Survivor Corps, the largest covid-19 advocacy group in the world. On 18 February, the UK’s National Institute for Health Research awarded £1.4 million for a study to assess risk factors and prevalence of long covid in children.

Nurseries have been allowed to stay open in England while primary and secondary schools have remained shut since 5 January. When asked on 5 February whether the impact of long covid in children has been considered in relation to the reopening of schools, the UK Department for Education gave no reply.

12.9% Percentage of UK children aged 2 to 11 who still have covid-19 symptoms five weeks after initial infection

Sending thousands of children back to school is “insane”, says McFarland. “Sending children back to school seems to be inviting the possibility of giving a whole generation long-term chronic health issues. Why take the risk of opening schools before children have been vaccinated?”

14.5% Percentage of UK children aged 12 to 16 who still have covid-19 symptoms five weeks after initial infection

So far, no coronavirus vaccines have been approved for use in children, although CanSino Biologics in China is testing one in 6 to 12-year-olds, according to data revealed at a recent New York Academy of Science meeting. CEO Xuefeng Yu says that preliminary data will be analysed soon. US company Codagenix is also planning to test a nasal vaccine in children.

The good news is that evidence suggests children don’t easily pass covid-19 to each other in the classroom. In one study, a 9-year-old in France with flu and covid-19 was found to have exposed more than 80 other children at three different schools. However, no one became infected with covid-19 as a result, despite numerous flu infections within the schools, suggesting that although the environment was conducive to transmitting respiratory viruses, covid-19 wasn’t passed on as easily.

More recently, a study of children between 5 months and 4 years old in nurseries in France has shown low levels of infection and transmission of covid-19. The study also shows that staff weren’t at greater risk of infection than a control group of adults. The results suggest that children are more likely to get covid-19 from family members than from their peers or teachers at nursery, although more evidence is needed, say the study’s authors, because the study happened when strict measures were in place to control the virus, and before fast-spreading variants appeared.

Until now, the focus of the pandemic has been on preventing severe disease and deaths in the older generations, but Mcfarland says thoughts need to turn to the legacy the virus is leaving on children.

Study: Myocarditis risk 37 times higher for children with COVID-19 than uninfected peers

Authors: Melissa Jenco, News Content Editor August 31, 2021

The risk of myocarditis for children under 16 years is 37 times higher for those infected with COVID-19 than those who haven’t been infected with the virus, according to a new study.

Authors from the Centers for Disease Control and Prevention (CDC) said the study provides more evidence that the benefits of the vaccine outweigh a small risk of myocarditis after vaccination.

Researchers analyzed data from more than 900 hospitals and found inpatient visits for myocarditis were 42% higher in 2020 compared to 2019, according to a new Morbidity and Mortality Weekly Report.

Among 36 million patients, about 0.01% had myocarditis between March 2020 and February 2021. The median age of people with myocarditis was 54 years, and 59% were male.

About 42% of patients with myocarditis had a history of COVID-19, mostly within the same month. The team determined the risk of myocarditis to be 0.146% among those with COVID-19 and 0.009% among those not diagnosed with COVID-19.

Across all ages, the risk of myocarditis was almost 16 times higher for people with COVID-19 compared to those who aren’t infected. The myocarditis risk is 37 times higher for infected children under 16 years and seven times higher for infected people ages 16-39 compared to their uninfected peers.

Some of the myocarditis cases seen in children with COVID-19 may be cases of multisystem inflammatory syndrome, according to the study.

Authors noted the study could not prove COVID-19 causes myocarditis, but the findings of a link between the two are consistent with several other studies.

In recent months, there has been concern about a small risk of myocarditis after receiving an mRNA COVID-19 vaccine. A June study showed among males ages 12-29 years — the group with the highest rates of myocarditis after vaccination — there would be an estimated 39 to 47 cases of myocarditis for every million second doses of vaccine. Authors of the new study say their findings support health officials’ assertions that the benefits of vaccination outweigh the risks.

“These findings underscore the importance of implementing evidence-based COVID-19 prevention strategies, including vaccination, to reduce the public health impact of COVID-19 and its associated complications,” they wrote.Resources

Copyright © 2021 American Academy of Pediatrics

COVID virus linked with headaches, altered mental status in hospitalized kids

Authors: UNIVERSITY OF PITTSBURGH Peer-Reviewed Publication

PITTSBURGH, Jan. 21, 2022 – Of hospitalized children who tested or were presumed positive for SARS-CoV-2, 44% developed neurological symptoms, and these kids were more likely to require intensive care than their peers who didn’t experience such symptoms, according to a new study led by a pediatrician-scientist at UPMC and the University of Pittsburgh School of Medicine

The most common neurologic symptoms were headache and altered mental status, known as acute encephalopathy. Published in Pediatric Neurology, these preliminary findings are the first insights from the pediatric arm of GCS-NeuroCOVID, an international, multi-center consortium aiming to understand how COVID-19 affects the brain and nervous system. 

“The SARS-CoV-2 virus can affect pediatric patients in different ways: It can cause acute disease, where symptomatic illness comes on soon after infection, or children may develop an inflammatory condition called MIS-C weeks after clearing the virus,” said lead author Ericka Fink, M.D., pediatric intensivist at UPMC Children’s Hospital of Pittsburgh, and associate professor of critical care medicine and pediatrics at Pitt. “One of the consortium’s big questions was whether neurological manifestations are similar or different in pediatric patients, depending on which of these two conditions they have.” 

To answer this question, the researchers recruited 30 pediatric critical care centers around the world. Of 1,493 hospitalized children, 1,278, or 86%, were diagnosed with acute SARS-CoV-2; 215 children, or 14%, were diagnosed with MIS-C, or multisystem inflammatory syndrome in children, which typically appears several weeks after clearing the virus and is characterized by fever, inflammation and organ dysfunction. 

The most common neurologic manifestations linked with acute COVID-19 were headache, acute encephalopathy and seizures, while youths with MIS-C most often had headache, acute encephalopathy and dizziness. Rarer symptoms of both conditions included loss of smell, vision impairment, stroke and psychosis.  

“Thankfully, mortality rates in children are low for both acute SARS-CoV-2 and MIS-C,” said Fink. “But this study shows that the frequency of neurological manifestations is high—and it may actually be higher than what we found because these symptoms are not always documented in the medical record or assessable. For example, we can’t know if a baby is having a headache.” 

The analysis showed that neurological manifestations were more common in kids with MIS-C compared to those with acute SARS-CoV-2, and children with MIS-C were more likely than those with acute illness to have two or more neurologic manifestations. 

According to Fink, the team recently launched a follow up study to determine whether acute SARS-CoV-2 and MIS-C—with or without neurologic manifestations—have lasting effects on children’s health and quality of life after discharge from hospital.  

“Another long-term goal of this study is to build a database that tracks neurological manifestations over time—not just for SARS-CoV-2, but for other types of infections as well,” she added. “Some countries have excellent databases that allow them to easily track and compare children who are hospitalized, but we don’t have such a resource in the U.S.” 

This study was partly funded by the Neurocritical Care Society Investing in Clinical Neurocritical Care Research (INCLINE) grant. 

Other researchers who contributed to the study include Courtney L. Robertson, M.D., Johns Hopkins Children’s Center; Mark S. Wainwright, M.D., Ph.D., University of Washington and Seattle Children’s Hospital; Juan D. Roa, M.D., Universidad Nacional de Colombia and Fundación Universitaria de Ciencias de la Salud; Michelle E. Schober, M.D., University of Utah, and other GCS-NeuroCOVID Pediatrics investigators who are listed in the paper. 

To read this release online or share it, visit http://www.upmc.com/media/news/012122-Fink-COVID-Children.  


JOURNAL

Pediatric Neurology

DOI

10.1016/j.pediatrneurol.2021.12.010 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Prevalence and Risk Factors of Neurologic Manifestations in Hospitalized Children Diagnosed with Acute SARS-CoV-2 or MIS-C

ARTICLE PUBLICATION DATE

21-Jan-2022

Link between fever, diarrhea, severe COVID-19, and persistent anti-SARS-CoV-2 antibodies

Authors: By Dr. Liji Thomas, MD Jan 7 2021

Ever since the coronavirus disease 2019 (COVID-19) pandemic began, there have been many attempts to understand the nature and duration of immunity against the causative agent, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

A new preprint research paper appearing on the medRxiv* server describes a link between the persistence of neutralizing antibodies against the virus, disease severity, and specific COVID-19 symptoms.

Permanent immunity is essential if the pandemic is to end. In the earlier SARS epidemic, antibodies were found to last for three or more years after infection in most patients. With the current virus, it may last for six or more months at least, as appears from some reports. Other researchers have concluded that immunity wanes rapidly over the same period, with some patients who were tested positive for antibodies becoming seronegative later on. This discrepancy may be traceable to variation in testing methods, sample sizes and testing time points, as well as disease severity.

Study details

The current study looked at a population of over a hundred convalescent COVID-19 patients, testing most of them for antibodies at five weeks and three months from symptom resolution.

The researchers used a multiplex assay that measured the Immunoglobulin G (IgG) levels against four SARS-CoV-2 antigens, one from SARS-CoV, and four from circulating seasonal coronaviruses. In addition, they carried out an inhibition assay against SARS-CoV-2 spike receptor-binding domain (RBD)-angiotensin-converting enzyme 2 (ACE2) binding and a neutralization assay against the virus. The antibody titers were then plotted against various clinical features and demographic factors.

Antibody titers higher in COVID-19 convalescents

The researchers found that severe disease is correlated with advanced age and the male sex. Patients with underlying vascular disease were more likely to be hospitalized with COVID-19, but those with asthma were relatively spared.

Convalescent COVID-19 patients had higher IgG levels against all four SARS-CoV-2 antigens, relative to controls, and in 98% of cases, at least one of the tests was likely to show higher binding compared to controls. IgGs targeting the viral spike and RBD were likely to be much more discriminatory between SARS-CoV-2 patients and controls. Interestingly, anti-SARS-CoV IgG, as well as anti-seasonal betacoronavirus antibodies, were likely to be higher in these patients.

Anti-spike and anti-nucleocapsid IgG levels, as well as neutralizing antibody titers, were higher in convalescent hospitalized COVID-19 patients than in convalescent non-hospitalized patients, and the titers were positively associated with disease severity.Antibodies against SARS-CoV-2 persist three months after COVID-19 symptom resolution. Sera from COVID-19 convalescent subjects (n=79) collected 5 weeks (w) and 3 months (m) after symptom resolution were subjected to multiplex assay to detect IgG that binds to SARS-CoV-2 S, NTD, RBD and N antigens (A), to RBD-ACE2 binding inhibition assay (B), and to SARS-CoV-2 neutralization assay (C). Dots, lines, and asterisks in red represent non-hospitalized (n=67) and in blue represent hospitalized (n=12) subjects with lines connecting the two time points for individual subjects (*p<0.05 and **p<0.01 by paired t test).Antibodies against SARS-CoV-2 persist three months after COVID-19 symptom resolution. Sera from COVID-19 convalescent subjects (n=79) collected 5 weeks (w) and 3 months (m) after symptom resolution were subjected to multiplex assay to detect IgG that binds to SARS-CoV-2 S, NTD, RBD and N antigens (A), to RBD-ACE2 binding inhibition assay (B), and to SARS-CoV-2 neutralization assay (C). Dots, lines, and asterisks in red represent non-hospitalized (n=67) and in blue represent hospitalized (n=12) subjects with lines connecting the two time points for individual subjects (*p<0.05 and **p<0.01 by paired t test).

Clinical correlates of higher antibody titer

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When antibody titers in non-hospitalized subjects were compared with clinical and demographic variables, they found that older males with a higher body mass index (BMI) and a Charlson Comorbidity Index score >2 were likely to have higher antibody titers. COVID-19 symptoms that correlated with higher antibody levels in these patients comprise fever, diarrhea, abdominal pain and loss of appetite. Chest tightening, headache and sore throat were associated with less severe symptoms.

The link between the specific symptoms listed above with higher antibody titers could indicate that they mark a robust systemic inflammatory response, which in turn is necessary for a strong antibody response. Diarrhea may mark severe disease, but it is strange that in this case, it was not more frequent in the hospitalized cohort. Alternatively, diarrhea may have strengthened the immune antibody response via the exposure of the virus to more immune cells via the damaged enteric mucosa. More study is required to clarify this finding.

Potential substitute for neutralizing assay

The binding assay showed that the convalescent serum at five weeks inhibited RBD-ACE2 binding much more powerfully than control serum. Neutralizing activity was also higher in these sera, but in 15% of cases, convalescent patients showed comparable neutralizing antibody titers to those in control sera. On the whole, however, there was a positive association between neutralizing antibody titer, anti-SARS-CoV-2 IgG titers, and inhibition of ACE2 binding.

Persistent immunity at three months

This study also shows that SARS-CoV-2 antibodies persist in these patients at even three months after symptoms subside, with persistent IgG titers against the SARS-CoV-2 spike, RBD, nucleocapsid and N-terminal domain antigens. Binding and neutralization assays remained highly inhibitory throughout this period. The same was true of antibodies against the other coronaviruses tested as well, an effect that has been seen with other viruses and could be the result of cross-reactive anti-SARS-CoV-2 antibodies. Alternatively, it could be due to the activation of memory B cells formed in response to infection by the seasonal beta-coronaviruses.

Conclusion

IgG titers, particularly against S and RBD, and RBD-ACE2 binding inhibition better differentiate between COVID-19 convalescent and naive individuals than the neutralizing assay,” the researchers concluded.

These could be combined into a single diagnostic test, they suggest, with extreme sensitivity and specificity. The correlation with neutralizing antibody titers could indicate that the neutralizing assay, which is more expensive, sophisticated and expensive, as well as more dangerous for the investigators, could be replaced by the other antibody tests without loss of value.

In short, the study shows that specific antibodies persist for three months at least following recovery; antibody titers correlate with COVID-19-related fever, loss of appetite, abdominal pain and diarrhea; and are also higher in older males with more severe disease, a higher BMI and CCI above 2. Further research would help understand the lowest protective titer that prevents reinfection, and the duration of immunity.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.Journal reference:

Pandemic Impact on Mortality and Economy Varies Across Age Groups and Geographies

Authors: VICTORIA UDALOVA  |  MARCH 08, 2021

The initial impact of the COVID-19 pandemic on the U.S. economy was widespread and affected people across all age groups and all states while the initial mortality impact targeted mostly older people in just a few states according to independent research by the U.S. Census Bureau.

During April 2020, the first full month of the pandemic, the United States experienced an additional 2.4 deaths per 10,000 individuals beyond predictions based on historical mortality trends. This was a 33% increase in all-cause national mortality — deaths caused directly or indirectly by the coronavirus.

There was a weak correlation between increased mortality rates and negative economic impact across states. There were states that experienced significant employment displacement but no additional mortality, for example. On the other hand, there were states that experienced large mortality impacts but modest economic impacts.

These additional deaths during the early days of the pandemic were highly concentrated in older age groups and in a few states.

Recent research examined the relationship between the pandemic’s mortality and economic impacts across different age groups and geography.

Economic Impact of COVID-19 Pandemic

The COVID-19 pandemic has caused a devastating loss of life but it has also devastated the nation’s economy.

Similar to the excess mortality concept, the pandemic’s economic impact is calculated by taking the difference between what is expected (based on historical trends) and what actually happens during a given period.

The ratio of employment to population is one measure of economic activity that shows the share of population 16 years and older working full- or part-time.

This measure closely tracks other possible measures of economic activity such as unemployment rate, percent of population with unemployment insurance claims, consumer spending, and small business employment.

Declines in the employment-to-population ratio that exceeded predictions indicate there was additional employment loss in the country due to the pandemic.

The decline in the employment-to-population ratio in the United States in April 2020 was significant. Historical trends predicted a 61.3% ratio but it turned out to be 51.5%. This additional national decline was 9.9 per 100 individuals in April 2020 (Figure 1). That means there were fewer people employed than was expected before the pandemic.

Impacts Varied by Geography

Deaths caused directly or indirectly by COVID during the first full month of the pandemic were highly geographically concentrated.

About half of all national excess deaths were in just two states: New York and New Jersey.

But the economic impact pattern was completely different because it was more geographically widespread.

Every state, except for Wyoming, experienced a statistically significant decline in the employment-to-population ratio during that time.

The two states with the largest initial declines in employment — Nevada and Michigan — only accounted for about 7% of the national employment displacement.

There was a weak correlation between increased mortality rates and negative economic impact across states. There were states that experienced significant employment displacement but no additional mortality, for example. On the other hand, there were states that experienced large mortality impacts but modest economic impacts.

For More Information: https://www.census.gov/library/stories/2021/03/initial-impact-covid-19-on-united-states-economy-more-widespread-than-on-mortality.html

Clinical determinants of the severity of COVID-19: A systematic review and meta-analysis

PLOS

Abstract

Objective


We aimed to systematically identify the possible risk factors responsible for severe cases.


Methods

We searched PubMed, Embase, Web of science and Cochrane Library for epidemiological studies of confirmed COVID-19, which include information about clinical characteristics and severity of patients’ disease. We analyzed the potential associations between clinical characteristics and severe cases.


Results

We identified a total of 41 eligible studies including 21060 patients with COVID-19. Severe cases were potentially associated with advanced age (Standard Mean Difference (SMD) = 1.73, 95% CI: 1.34–2.12), male gender (Odds Ratio (OR) = 1.51, 95% CI:1.33–1.71), obesity (OR = 1.89, 95% CI: 1.44–2.46), history of smoking (OR = 1.40, 95% CI:1.06–1.85), hypertension (OR = 2.42, 95% CI: 2.03–2.88), diabetes (OR = 2.40, 95% CI: 1.98–2.91), coronary heart disease (OR: 2.87, 95% CI: 2.22–3.71), chronic kidney disease (CKD) (OR = 2.97, 95% CI: 1.63–5.41), cerebrovascular disease (OR = 2.47, 95% CI: 1.54–3.97), chronic obstructive pulmonary disease (COPD) (OR = 2.88, 95% CI: 1.89–4.38), malignancy (OR = 2.60, 95% CI: 2.00–3.40), and chronic liver disease (OR = 1.51, 95% CI: 1.06–2.17). Acute respiratory distress syndrome (ARDS) (OR = 39.59, 95% CI: 19.99–78.41), shock (OR = 21.50, 95% CI: 10.49–44.06) and acute kidney injury (AKI) (OR = 8.84, 95% CI: 4.34–18.00) were most likely to prevent recovery. In summary, patients with severe conditions had a higher rate of comorbidities and complications than patients with non-severe conditions.

Conclusion

Patients who were male, with advanced age, obesity, a history of smoking, hypertension, diabetes, malignancy, coronary heart disease, hypertension, chronic liver disease, COPD, or CKD are more likely to develop severe COVID-19 symptoms. ARDS, shock and AKI were thought to be the main hinderances to recovery.

For More Information: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250602

The incidence, clinical characteristics, and outcomes of pneumothorax in hospitalized COVID-19 patients: A systematic review

Authors: Woon H. Chong,a,⁎Biplab K. Saha,bKurt Hu,c and Amit Chopraa

Abstract

Background

Pneumothorax has been frequently described as a complication of COVID-19 infections.

Objective

In this systematic review, we describe the incidence, clinical characteristics, and outcomes of COVID-19-related pneumothorax.

Methods

Studies were identified through MEDLINE, Pubmed, and Google Scholar databases using keywords of “COVID-19,” “SARS-CoV-2,” “pneumothorax,” “pneumomediastinum,” and “barotrauma” from January 1st, 2020 to January 30th, 2021.

Results

Among the nine observational studies, the incidence of pneumothorax is low at 0.3% in hospitalized COVID-19 patients. However, the incidence of pneumothorax increases to 12.8–23.8% in those requiring invasive mechanical ventilation (IMV) with a high mortality rate up to 100%. COVID-19-related pneumothorax tends to be unilateral and right-sided. Age, pre-existing lung diseases, and active smoking status are not shown to be risk factors. The time to pneumothorax diagnosis is around 9.0–19.6 days from admission and 5.4 days after IMV initiation. COVID-19-related pneumothoraces are associated with prolonged hospitalization, increased likelihood of ICU admission and death, especially among the elderly.

Conclusion

COVID-19-related pneumothorax likely signify greater disease severity. With the high variability of COVID-19-related pneumothorax incidence described, a well-designed study is required to better assess the significance of COVID-19-related pneumothorax.

For More Information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088235/

Neurologic Manifestations Associations of COVID-19

High-quality epidemiologic data is still urgently needed to better understand neurologic effects of COVID-19.

Authors: Shraddha Mainali, MD; and Marin Darsie, MD VIEW/PRINT PDF

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to prevail as a deadly pandemic and unparalleled global crisis. More than 74 million people have been infected globally, and over 1.6 million have died as of mid-December 2020. The virus transmits mainly through close contacts and respiratory droplets.1 Although the mean incubation period is 3 to 9 days (range, 0-24 days), transmission may occur prior to symptom onset, and about 18% of cases remain asymptomatic.2 The highest rates of coronavirus disease 2019 (COVID-19) in the US have been reported in adults age 18 to 29 and 50 to 64 years, representing 23.8% and 20.5% of cases, respectively.3 Although adults age 65 and older make up only 14.6% of total cases in the US, they account for the vast majority of deaths (79.9%).3 Similarly, men appear to be more vulnerable to the disease, accounting for 69% of intensive care unit (ICU) admissions and 58% of deaths despite nearly equal disease prevalence between men and women.4 In terms of ethnicity, Black Americans account for 15.6% of COVID-19 infections and 19.7% of related deaths, whereas Hispanic/Latinx Americans account for 26.3% of COVID-19 infections and 15.7% of COVID-19 deaths, despite these groups comprising 13.4% and 16.7% of the US population, respectively.3,5

The most commonly reported symptoms are fever, dry cough, fatigue, dyspnea, and anorexia.2 Numerous studies have also reported a spectrum of neurologic dysfunctions, including mild symptoms (eg, headache, anosmia, and dysgeusia) to severe complications (eg, stroke and encephalitis). Despite the prolific reports of neurologic associations and complications of COVID-19 in the face of a raging pandemic with limited resources, there is a significant lack of control for important confounders including the severity of systemic disease, exacerbation or recrudescence of preexisting neurologic disease, iatrogenic complications, and hospital-acquired conditions. Moreover, given the ubiquity of the virus, it is challenging to parse COVID-19–related complications from coexisting conditions. There is an urgent need for high-quality epidemiologic data reflecting COVID-19 prevalence by age, sex, race, and ethnicity on a local, state, national, and international level.

Neurologic and Neuropsychiatric Manifestations of COVID-19

Prevalence estimates of acute neurologic dysfunctions caused by COVID-19 are widely variable, with reports ranging from 3.5% to 36.4%.6 A recent study from Chicago showed that in those with COVID-19 who develop neurologic complications, 42% had neurologic complaints at disease onset, 63% had them during hospitalization, and 82% experienced them during the course of illness.7 Considering the widespread nature of the pandemic, with millions infected globally, neurologic complications of COVID-19 could lead to a significant increase in morbidity, mortality, and economic burden.

People over age 50 with comorbidities (eg, hypertension, diabetes, and cardiovascular disease) are prone to neurologic complications.2,8 Common nonspecific symptoms include headache, fatigue, malaise, myalgia, nausea, vomiting, confusion, anorexia, and dizziness. COVID-19 is known characteristically to affect taste (dysgeusia) and smell (anosmia) in the absence of coryza with variable prevalence estimates ranging from 5% to 85%.9 Since the first report on hospitalized individuals in Wuhan, China, numerous other reports have indicated a spectrum of mild-to-severe neurologic complications, including cerebrovascular events, seizures, demyelinating disease, and encephalitis.8,10-13 As a result of fragmented data from across the world with diverse neurologic manifestations and multiple potential mechanisms of injury, the classification of neurologic dysfunctions in COVID-19 is complex and varies across the literature. Here we present 2 pragmatic classification approaches based on 1) type and site of neurologic manifestations disease categories.

For More Information: https://practicalneurology.com/articles/2021-jan/neurologic-manifestations-associations-of-covid-19

Body mass index and severity/fatality from coronavirus disease 2019: A nationwide epidemiological study in Korea

  1. Authors: In Sook Kang , Kyoung Ae Kong Published: June 22, 2021
PLOS

Abstract

Obesity has been reported as a risk factor for severe coronavirus disease 2019 (COVID-19) in recent studies. However, the relationship between body mass index (BMI) and COVID-19 severity and fatality are unclear.

Research design and methods

This study included 4,141 COVID-19 patients who were released from isolation or had died as of April 30, 2020. This nationwide data was provided by the Korean Centers for Disease Control and Prevention Agency. BMI was categorized as follows; < 18.5 kg/m2, 18.5–22.9 kg/m2, 23.0–24.9 kg/m2, 25.0–29.9 kg/m2, and ≥ 30 kg/m2. We defined a fatal illness if the patient had died.

Results

Among participants, those with a BMI of 18.5–22.9 kg/m2 were the most common (42.0%), followed by 25.0–29.9 kg/m2 (24.4%), 23.0–24.9 kg/m2 (24.3%), ≥ 30 kg/m2 (4.7%), and < 18.5 kg/m2 (4.6%). In addition, 1,654 (41.2%) were men and 3.04% were fatalities. Multivariable analysis showed that age, male sex, BMI < 18.5 kg/m2, BMI ≥ 25 kg/m2, diabetes mellitus, chronic kidney disease, cancer, and dementia were independent risk factors for fatal illness. In particular, BMI < 18.5 kg/m2 (odds ratio [OR] 3.97, 95% CI 1.77–8.92), 25.0–29.9 kg/m2 (2.43, 1.32–4.47), and ≥ 30 kg/m2 (4.32, 1.37–13.61) were found to have higher ORs than the BMI of 23.0–24.9 kg/m2 (reference). There was no significant difference between those with a BMI of 18.5–22.9 kg/m2 (1.59, 0.88–2.89) and 23.0–24.9 kg/m2.

Conclusions

This study demonstrated a non-linear (U-shaped) relationship between BMI and fatal illness. Subjects with a BMI of < 18.5 kg/m2 and those with a BMI ≥ 25 kg/m2 had a high risk of fatal illness. Maintaining a healthy weight is important not only to prevent chronic cardiometabolic diseases, but also to improve the outcome of COVID-19.

For More Information: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0253640