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COVID-19 Intelligence Report: Primary Care

June 22, 2020

Care for patients with autoimmune disease and COVID-19:  

  • The COVID-19 Global Rheumatology Alliance Physician-Reported Registry found that glucocorticoid exposure of ≥10 mg/day is associated with a higher odds of hospitalization and anti-tumor necrosis factor with a decreased odds of hospitalization in patients with rheumatic disease. Exposure to non-biologic disease modifying anti-rheumatic drugs or non-steroidal anti-inflammatory drugs were not associated with increased odds of hospitalization.
  • Patients with lupus—even if they are using an antimalarial such as hydroxychloroquine as baseline therapy—can develop SARS-CoV-2 infection and severe COVID-19 at similar frequency as patients with lupus not on antimalarials.
  • In a cohort of patients with rheumatic and musculoskeletal diseases in a geographical region with a high prevalence of COVID-19, a poor outcome from COVID-19 seemed to be associated with older age and the presence of comorbidities rather than the type of rheumatic disease or the degree of pharmacological immunosuppression.

June 1, 2020

Title: Lifestyle Risk Factors, Inflammatory Mechanisms, and COVID-19 Hospitalization: A Community-Based Cohort Study of 387,109 Adults in UK Publisher: Brain, Behavior and Immunity

Publication Date: May 23, 2020

URL: https://doi.org/10.1016/j.bbi.2020.05.059

Key Takeaway: This is the first large-scale general population study on lifestyle risk factors (smoking, physical inactivity, obesity, and excessive alcohol intake) for COVID-19 using prospective cohort data with national registry linkage to hospitalisation. Participants were 387,109 men and women (56.4 ± 8.8 yr; 55.1% women) residing in England from UK Biobank study. Finding were:

  • Poorer lifestyle habits and elevated C-reactive protein was associated with greater risk of COVID-19 hospitalisation.
  • Unhealthy lifestyle behaviours in combination accounted for up to 51% of the population attributable fraction of severe COVID-19.
  • Low grade inflammation may be an important mechanism.

The authors recommend, “Adopting simple lifestyle changes could lower the risk of severe COVID-19 infection.”

Title: Decline in Child Vaccination Coverage During the COVID-19 Pandemic — Michigan Care Improvement Registry, May 2016–May 2020

Publisher: MMWR/CDC

Publication Date: May 22, 2020

URL: https://www.cdc.gov/mmwr/volumes/69/wr/mm6920e1.htm?s_cid=mm6920e1_w Key Takeaway: The observed declines in vaccination coverage might leave children and communities vulnerable to vaccine-preventable diseases such as measles due to a decline in herd immunity. Concerted efforts are needed to ensure rapid catch-up for children who are not up-to-date with age-appropriate vaccinations.

Title: It’s time to shift the research focus to studies on living with this disease Publisher: British Medical Journal

Publication Date: May 22, 2020

URL: https://www.bmj.com/content/369/bmj.m2035

Key Takeaway: With 4.7 million people worldwide and over 300 000 have died and without a vaccine or disappearance of the virus, we could be living with COVID-19 disease for the foreseeable future, possibly years. Beyond the hospital, long term outcomes of COVID-19 are unknown. Anecdotal reports have included symptoms that last for weeks or months.

Sequelae of COVID-19 infection might include worsening of chronic conditions and profound needs for rehabilitation. There is much to learn about transmission, immunity and its durability, and, as with other coronaviruses, the potential for reinfection. The authors call for cohort studies of such patients (see below Epidemiology), “If we are going to be managing COVID-19 for the next several years…we need to understand and optimize care before, during, and beyond the hospital.”

 

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