COVID-19 analysis of February 07, 2022

High-risk COVID outpatients least likely to receive monoclonal antibodies

Non-hospitalized COVID-19 patients most at risk of serious consequences are often the least likely to receive monoclonal antibodies (mAbs), according to a study of more than 1.9 million Medicare beneficiaries published late last week in JAMA.

A team led by a Harvard Medical School researcher reviewed a sample of outpatient, emergency department and laboratory insurance claims for fee-for-service Medicare beneficiaries who were newly diagnosed with COVID-19 or had confirmed exposure from November 2020 to August 2021 mAbs were first available for use in COVID-19 patients in November 2020.

Of the 1,902,914 participants, 7.2% received mAbs. Patients with fewer underlying conditions were more likely than those with more conditions to receive treatment (23.2% with 0 chronic conditions versus 6.3%, 6.0% and 4.7% with 1 to 3 , 4 or 5, and 6 or more chronic conditions, respectively; adjusted odds ratio [aOR]7.43 for 0 against 6 or more).

Black patients were less likely than their white peers to receive an mAb (6.2% versus 7.4%; aOR, 0.77), as were those who were also enrolled in Medicaid (4.6% versus 8.1 %; aOR, 0.74). Participants aged 85 and over were 42% more likely to receive mAbs than those aged 65 to 74.

Administration of mAb also varied significantly by region of the United States, with Rhode Island (24.9%) and Louisiana (21.2%) administering the most, while Alaska (1.1%) and Washington (0.7%) had the lowest rates. Southern states had the highest rates of mAb use (10.6%), with the lowest rates in the West (2.9%).

The study authors said the most-at-risk patients may have had issues navigating the multiple steps required to access the mAb, including timely COVID-19 diagnosis and referral and appointment scheduling. you for an infusion within 10 days. “Additionally, mAb supply may have been low or less utilized by clinicians in some parts of the country,” they wrote.

In a Harvard press release, lead author Michael Barnett, MD, said geographic differences in mAb may have been influenced by supply levels in different parts of the country. “We need new approaches to prevent these inequalities from happening again with new treatments on the horizon,” he said.
Feb 4 JAMA search letter
February 4 Harvard
Press release

COVID-19 patients are at increased risk of cardiovascular complications

A new study suggests that patients with COVID-19 are at increased risk of various cardiovascular complications between 30 days and 1 year after infection. The study, published today in natural medicine, is based on data from the US Department of Veterans Affairs.

A total of 153,760 veterans with COVID-19 were compared to two cohorts of controls. The risk of cardiovascular complications occurred for all patients, including those not hospitalized, but non-hospitalized veterans were less at risk than hospitalized patients, and hospitalized patients were less at risk than those admitted to intensive care units .

Strokes, dysrhythmias, heart muscle inflammation and ischemic heart disease were all more common in COVID-19 patients.

People who survived the first 30 days of COVID-19 had an increased risk of stroke (relative risk [HR],1.52; 95% confidence interval [CI], 1.43 to 1.62), for a burden of 4.03 (95% CI, 3.32 to 4.79) per 1000 people at 12 months. The risks and burdens of outcomes for ischemic heart disease, including myocardial infarction, were 1.66 (95% CI, 1.52, 1.80) and 7.28 (95% CI, 5, 80 to 8.88), respectively. The RR for myocarditis was 5.38 (95% CI, 3.80 to 7.59).

“Our study shows that the risk of incident cardiovascular disease extends well beyond the acute phase of COVID-19,” the authors concluded. “Due to the chronic nature of these conditions, they are likely to have lasting consequences for patients and healthcare systems and will also have broad implications for economic productivity and life expectancy.”
February 7 NatMed to study

Omicron strain much less likely to cause serious consequences, study finds

The first US peer-reviewed study of COVID-19 outcomes in patients infected with the Omicron variant (B.1.1.529) shows that, compared to patients infected with the previous variants Delta (B1617.2) and Alpha (B117), Omicron patients were younger, had significantly higher breakthrough rates, and were significantly less likely to be hospitalized.

The study, published late last week in the American Journal of Pathologyalso found that when hospitalized, Omicron patients required less intense respiratory support and had shorter stays, consistent with early reports of the generally milder nature of cases caused by the highly transmissible strain.

Researchers at Houston Methodist Hospital conducted the study, which extracted electronic health records from 4,468 COVID-19 patients infected with Omicron from late November to early January 2022. Omicron took just 3 weeks to accounting for 90% of COVID-19 cases after it emerged in Texas in November, accounting for 98% of new infections in January, the authors said.

The median age of Omicron patients was 44.3 years, compared to 50.0 for Alpha and 48.3 for Delta. The hospital stay was 3.2 days for Omicron, compared to 5.1 days for Alpha and 5.4 days for Delta; and Omicron resulted in 55.4% of breakthroughs in vaccinated patients, compared with 3.2% and 24.3% of those infected with Alpha and Delta, respectively.

Of all Omicron cases during the study period, 55.9% met the Centers for Disease Control and Prevention criteria for breakthrough infection. There was no clear relationship between the time since receipt of the last primary vaccine dose and breakthrough of infection.

Two asymptomatic COVID-19 patients were found to be infected with Omicron subvariant BA.2, commonly referred to as the “stealth” variant of Omicron, because it can evade detection by some commonly used COVID-19 tests.

“The present study highlights the importance of analyzing SARS-CoV-2 genome data integrated with patient metadata and underscores the need to continue to do so in near real-time as the Omicron push continues. , that the virus evolves and new potentially altered variants of fitness and biomedically relevant phenotypes are generated,” the researchers wrote.
February 3 Am J Pathol to study

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