Virus World

If you suffer from anxiety, depression or loneliness or feel stressed or worry frequently about Covid-19, you may be at higher risk of developing long Covid, a new study found. You may have up to a 50% higher risk of developing long Covid-19 if you suffer from common psychiatric issues such as anxiety or depression. Signs of the malady can include breathing problems, brain fog, chronic coughing, changes in taste and smell, overwhelming fatigue, difficulties in performing daily life functions, and disruptions in sleep that can last months, even years, after the infection has cleared the body.  People who self-identified as having anxiety, depression or loneliness, or who felt extremely stressed or worried frequently about the coronavirus were more likely to experience long Covid-19, according to the study published this month in JAMA Psychiatry. "We found participants with two or more types of psychological distress before infection had a 50% higher risk of getting long Covid," said study coauthor Dr. Siwen Wang, a research fellow in the department of nutrition at the Harvard T.H. Chan School of Public Health in Boston. 

About 40 million adults over 18 in the United States live with an anxiety disorder, while over 21 million have suffered from major depression, according to national statistics. Many mental health conditions often overlap, with concurrent diagnoses, experts say. More than a fifth of adults in the US (22%) and the UK (23%) say they often or always feel lonely, a Kaiser Family Foundation study said. "Having higher levels of psychological distress prior to a Covid infection also increased the risk of getting long Covid by 50%," Wang said. "Those people also reported more symptoms seen in long Covid."  Instead, the study's message should be that people with existing psychological distress are closer to the "disaster" of long Covid, said Ely, codirector of Vanderbilt's Critical Illness, Brain Dysfunction and Survivorship Center. "Imagine 10 people are running a race, and you give five people a head start," Ely said. "Those are the people who already had a mental health issue -- they are just closer to the unfortunate finish line of getting long Covid."

COVID-19 has rapidly affected mortality worldwide1. There is unprecedented urgency to understand who is most at risk of severe outcomes, requiring new approaches for timely analysis of large datasets. Working on behalf of NHS England, here we created OpenSAFELY: a secure health analytics platform covering 40% of all patients in England, holding patient data within the existing data centre of a major primary care electronic health records vendor.

Primary care records of 17,278,392 adults were pseudonymously linked to 10,926 COVID-19-related deaths. COVID-19-related death was associated with: being male (hazard ratio (HR) 1.59, 95% confidence interval (CI) 1.53–1.65); older age and deprivation (both with a strong gradient); diabetes; severe asthma; and various other medical conditions. Compared with people with white ethnicity, Black and South Asian people were at higher risk even after adjustment for other factors (HR 1.48, 1.30–1.69 and 1.44, 1.32–1.58, respectively).

We have quantified a range of clinical risk factors for COVID-19-related death in the largest cohort study conducted by any country to date. OpenSAFELY is rapidly adding further patients’ records; we will update and extend results regularly.

Original Study available at Nature (July 8, 2020):

https://doi.org/10.1038/s41586-020-2521-4

A host of common health problems boost a person’s risk of becoming seriously ill if infected by the new coronavirus. Now an analysis reveals the extent of this vulnerable group: more than 20% of the world’s population has at least one underlying condition that raises the risk of severe disease.

Andrew Clark at the London School of Hygiene & Tropical Medicine and his colleagues examined the prevalence of diabetes, cardiovascular problems and other conditions that predispose people infected with SARS-CoV-2 to severe COVID-19 (A. Clark et al. Lancet Glob. Health http://doi.org/dzk9; 2020). Analysing data from 188 nations, the team estimates that 1.7 billion people worldwide have an elevated risk of ‘severe’ illness. The researchers also estimate that nearly 350 million people — some of whom do not have underlying conditions — would require hospitalization if infected. These findings can be used to assess how many high-risk people will need a vaccine once it is developed, the authors say.

Original Study Published in Lancet Global Health (June 15, 2020):

https://doi.org/10.1016/ S2214-109X(20)30264-3

New study bolsters the case for vaccinating pregnant women.  Since the start of the coronavirus pandemic, it has become increasingly clear that COVID-19 hits pregnant women harder than the general population. Now, one of the first large studies with a proper control group has firmed up earlier evidence for how the virus can alter the course of pregnancy and harm mothers and their newborns. The study of more than 2100 pregnant women enrolled at hospitals in 18 countries found that, compared with uninfected pregnant women, those with COVID-19 are at higher risk for severe illness, death, pregnancy complications, and preterm birth. Those results underscore the importance of including pregnant women in priority groups for COVID-19 vaccines and limiting their exposure to ill people, says corresponding author Aris Papageorghiou, a fetal medicine specialist at the University of Oxford.  “This is a great study,” says physician, epidemiologist, and public health specialist Nathalie Auger of the University of Montreal Hospital Research Centre, who was not involved with the research. “They followed women through pregnancy, which is a really great design, and helped confirm the previous studies that are much easier to critique.”

Many studies have linked pregnancy to worse COVID-19 outcomes, but they have either included too few participants to draw firm conclusions, or have relied on health records that women agree to share after the fact. These registries tend to lack details such as when in pregnancy a woman got infected. They also attract sicker patients, which could make the effects of COVID-19 look worse than they actually are. Such studies also often compare the outcomes for infected women with those for women who gave birth before the pandemic. This lack of a contemporary control group means researchers aren’t getting a realistic picture of the risks to uninfected women who gave birth after COVID-19 had upended global health care systems. To avoid such biases, the new study enrolled women at any stage of pregnancy who received care at 43 medical centers, from Russia to India to Brazil, between March and October 2020. For each infected woman, the researchers immediately enrolled two pregnant women at the same hospital and same stage of pregnancy without a known infection. They then followed both groups of women—706 with a COVID-19 infection and 1424 without—through their babies’ deliveries and after discharge from the hospital. Clear differences emerged between the two groups. Those with COVID-19 had a 76% greater chance of pregnancy-induced high blood pressure, known as preeclampsia or eclampsia. They were three times as likely to have a severe infection and five times as likely to be admitted to an intensive care unit, Papageorghiou’s team reports today in JAMA Pediatrics. Eleven women with COVID-19 died, compared with just one woman in the uninfected group.

The study also linked COVID-19 to a 60% to 97% increased rate of preterm birth, and— in infected women with a fever and shortness of breath—to a fivefold increase in neonatal complications such as immature lungs, brain damage, and eye disorders. About 13% of babies tested positive for the virus, and cesarean delivery was linked to a higher risk of transmission. Breastfeeding didn’t appear to transmit the virus—a small bit of good news. The risk estimates are roughly in line with what other studies have found, Papageorghiou says, including a recently published study that looked at health records for more than 400,000 U.S. pregnant women, nearly 6400 with COVID-19. The new study helps makes the case for offering all pregnant women COVID-19 vaccines, Papageorghiou says. “We believe pregnancy itself [puts women into] a sufficiently high-risk group,” he says. In the United States, the Centers for Disease Control and Prevention (CDC) includes pregnancy under high-risk medical conditions with priority for vaccines, but not all states have included pregnancy in priority groups. In the United Kingdom, pregnant women were only recently added to such groups. Because the approved vaccines were not tested in pregnant women, some health authorities are hesitant to prioritize them for vaccination—despite reassurances from obstetrics experts that the shots appear safe in this group. Preliminary evidence published yesterday in The New England Journal of Medicine supports this view. Using data from a CDC reporting system, researchers found no obvious safety problems in more than 800 U.S. women who gave birth after receiving messenger RNA vaccines in December 2020, January, and February. The higher rates of preterm birth found in the study are especially relevant in lower income countries, where health care systems are less able to care for premature infants, Papageorghiou adds. “The challenge will be much more severe in those settings.”

Findings Published in JAMA Pediatrics (April 22, 2021):

https://doi.org/10.1001/jamapediatrics.2021.1050 

Six months into the outbreak, Nature looks at the pressing questions that researchers are tackling. In late December 2019, reports emerged of a mysterious pneumonia in Wuhan, China, a city of 11 million people in the southeastern province of Hubei. The cause, Chinese scientists quickly determined, was a new coronavirus distantly related to the SARS virus that had emerged in China in 2003, before spreading globally and killing nearly 800 people. Six months and more than ten million confirmed cases later, the COVID-19 pandemic has become the worst public-health crisis in a century. More than 500,000 people have died worldwide. It has also catalysed a research revolution, as scientists, doctors and other scholars have worked at breakneck speed to understand COVID-19 and the virus that causes it: SARS-CoV-2. 

They have learnt how the virus enters and hijacks cells, how some people fight it off and how it eventually kills others. They have identified drugs that benefit the sickest patients, and many more potential treatments are in the works. They have developed nearly 200 potential vaccines — the first of which could be proved effective by the end of the year. But for every insight into COVID-19, more questions emerge and others linger. That is how science works. To mark six months since the world first learnt about the disease responsible for the pandemic, Nature runs through some of the key questions that researchers still don’t have answers to.

One of the most striking aspects of COVID-19 is the stark differences in experiences of the disease. Some people never develop symptoms, whereas others, some apparently healthy, have severe or even fatal pneumonia. “The differences in the clinical outcome are dramatic,” says Kári Stefánsson, a geneticist and chief executive of DeCODE Genetics in Reykjavik, whose team is looking for human gene variants that might explain some of these differences....