COVID-19 studies: Obesity boosts risk; diagnosing health workers
Filed Under:
COVID-19
Mary Van Beusekom | News Writer | CIDRAP News
| Apr 20, 2020
Nearly 36% of the first 393 adults admitted to two New York City hospitals with COVID-19 were obese, according to a research letter published late last week in the New England Journal of Medicine.
Also, a research letter in JAMA said that screening healthcare professionals (HCPs) in King County, Washington, only for fever, cough, shortness of breath, and sore throat might have led their employers to miss 17% of those with symptoms of the novel coronavirus, and broadening diagnostic criteria to include muscle pain and chills may still have missed 10%.
In other research, a study in Clinical Infectious Diseases identified secondary within-household COVID-19 transmission rates of 17.1% of adults and 4% of children in Wuhan, China.
Obesity, male gender, older age increase risk
In the New England Journal of Medicine retrospective case series, the investigators used electronic health record data to describe the clinical characteristics of hospitalized patients admitted from Mar 5 to 27 with the novel coronavirus.
Median age was 62.2 years, 60.6% were men, and 35.8% were obese. “Obesity was common and may be a risk factor for respiratory failure leading to invasive mechanical ventilation,” the authors wrote.
The most common symptoms included cough (79.4%), fever (77.1%), shortness of breath (56.5%), muscle pain (23.8%), diarrhea (23.7%), and nausea and vomiting (19.1%).
The vast majority of patients (90%) had lymphopenia (low levels of lymphocytes, white blood cells important to immunity), while 27% had low platelet levels, and many had signs of compromised liver function and inflammation.
Of the 130 patients on invasive mechanical ventilation from Mar 5 to Apr 10, only 43 (33.1%) have been extubated as of the date the paper was written. Forty patients of the 393 patients (10.2%) had died, and 260 (66.2%) had been released from the hospital. Complete outcome data were unavailable for the other 93 patients (23.7%).
Patients on mechanical ventilation were more often male and obese, with signs of compromised liver function and inflammation. They were also more likely than other patients to require vasopressors (drugs to raise low blood pressure) (95.4% vs 1.5%), have complications such as atrial arrhythmias (17.7% vs 1.9%), and require dialysis for the first time (13.3% vs 0.4%).
Forty patients (30.8%) of those on mechanical ventilation did not require supplemental oxygen in the first 3 hours of arrival at the emergency department.
The researchers noted that the patients’ signs and symptoms at admission were similar to those reported in a large case series in China, but that gastrointestinal symptoms were more common in the New York City patients, which could be a reflection of regional variation or a difference in reporting.
The percentage of patients receiving mechanical ventilation was more than 10 times higher than reported in China, which could be attributed to more severe disease and the early-intubation protocol used in New York City hospitals.
The authors said that the high demand for mechanical ventilation and dialysis might surpass their availability during the pandemic. “The observations that the patients who received invasive mechanical ventilation almost universally received vasopressor support and that many also received new renal replacement therapy suggest that there is also a need to strengthen stockpiles and supply chains for these resources,” they wrote.
Good news:
Yesterday New York Governor Andrew Cuomo said new cases of COVID-19 have peaked in his state, which has been the epicenter of America’s battle with the global pandemic caused by the novel coronavirus.
“We believe NY is past the peak and we are now descending the other side of the mountain,” Cuomo tweeted. “The continuation of this positive trend depends on our actions.” Cuomo also said the infection rate in New York has slowed, with every 10 infected people transmitting the virus to another 9. Today the state reported 478 COVID-19 deaths, the first daily tally of deaths under 500 since Apr 2, the New York Times said.
The state now has 247,512 cases and 14,347 deaths. New York City has 132,467 cases, including 9,101 confirmed coronavirus deaths and 4,582 probable coronavirus deaths, NYC Health said.
Over the weekend, New York health officials also warned the state may soon run out of dialysis machines, as one-third of intensive care unit (ICU) COVID-19 patients are requiring the use of the machines in the wake of acute kidney injury, NPR reported.
Some hospitals have resorted to using ICU dialysis machines on two patients in 12-hours blocks of time, instead of 24 hours each day. Researchers do not know why the virus is attacking the kidneys of some patients, even those without diabetes or rental disease.
According to the tracker maintained by Johns Hopkins University, there are 766,662 confirmed COVID-19 cases in the United States, and 40,931 deaths.
https://www.cidrap.umn.edu/news-perspective/2020/04/cuomo-says-covid-19-cases-have-peaked-new-york