Symptomatic MERS-CoV infection reduces the risk of future COVID … – BMC Infectious Diseases

Out of 418 patients, 21 (5.0%) patients were excluded for either short (<3 months) follow-up duration (N=9, 2.2%) or lack of information about MERS-CoV proof (N=5, 1.2%) or COVID-19 proof (N=7, 1.7%). A total of 397 were included in the current analysis, and they were followed for an average 15 months during COVID-19 pandemic, which was on average 4.9 years from the MERS-CoV infection. Out of the included patients, 93 (23.4%) had positive MERS-CoV PCR tests, 61 (15.4%) had symptomatic MERS-CoV infection, and 48 (12.1%) had positive COVID-19 PCR tests (Fig.1).

Diagram of developing COVID-19 infection by MERS-CoV status

As shown in Table1, the mean age was 46.419.3 years. Approximately 54.8% were females, 62.8% were Saudi, and 40.6% were healthcare workers. The main presentations were respiratory symptoms (37.3%) and fever (23.9%), while almost half (51.6%) of patients were asymptomatic. Approximately 8.8% required ICU admission, and 2.8% required Mechanical Ventilation. MERS-CoV was significantly associated with non-Saudi patients, healthcare workers, having respiratory symptoms or fever, having severe disease, and requiring ICU admission or Mechanical Ventilation.

As shown in Table2, the mean age was 51.219.7 years. Approximately 54.2% were females, 70.8% were Saudi, and 31.3% were healthcare workers. The main presentations were respiratory symptoms (66.7%), and fever (33.3%), with the majority (77.1%) of patients having mild/moderate disease (no hypoxia). The main complications were an acute respiratory failure (8.3%) and septic shock (6.3%). The main comorbidity included hypertension (35.4%), diabetes (29.2%), heart diseases (14.6%), lung diseases (14.6%), and renal disease, including hemodialysis (14.6%). Approximately 27.1% required hospital admission, 8.3% needed ICU admission, and 4.2% required Mechanical Ventilation. Diagnosing COVID-19 was significantly associated with developing respiratory symptoms, fever, constitutional symptoms, severe disease, acute respiratory failure, or septic shock, and requiring hospital or ICU admission.

By the end of follow-up, the incidences per 1000 person-years of COVID-19 infection (20.1 versus 28.7), hospital admission (14.1 versus 18.9), and ICU admission (2.0 versus 6.0) were lower in patients with positive MERS-CoV compared with those with negative MERS-CoV, but without reaching statistical significance (Fig.2). The risk of COVID-19 disease was reduced but still insignificant when comparing patients with symptomatic MERS-CoV versus those with negative or asymptomatic MERS-CoV. Table3 shows detailed outcomes, including COVID-19 infection, disease severity, complications, mortality, hospital/ICU admission, use and duration of Mechanical Ventilation, and hospital/ICU length of stay. All outcomes were better in patients with positive or symptomatic MERS-CoV infection but without reaching statistical significance. For example, COVID-19 infection (6.6% versus 13.1%, p=0.150), severe disease (1.6% versus 3.0%, p=0.584), and mortality (1.6% versus 3.3%, p=0.701) were lower in patients with symptomatic MERS-CoV versus those with negative or asymptomatic MERS-CoV. On the other hand, the follow-up time in patients with symptomatic MERS-CoV was significantly longer (5.5 versus 4.9 years, p=0.002). There was no association between COVID-19 infection by followed up time, irrespective of MERS-CoV status.

Incidence of the study outcomes per 1000 patient years at the end of follow up period by baseline MERS-CoV status

As shown in Table4, Cox regression analysis adjusted for the follow-up time in addition to age, gender, and major comorbidity at COVID assessment showed a marginally significant lower risk of COVID-19 infection (hazard ratio=0.533, p=0.085) and hospital admission (hazard ratio=0.411, p=0.061) in patients with positive MERS-CoV. Interestingly, the risk of COVID-19 disease was further reduced and became significant in patients with symptomatic MERS-CoV, COVID-19 infection (hazard ratio=0.324, p=0.034), and hospital admission (hazard ratio=0.317, p=0.042). Similarly, COVID-19-free survival at the end of the follow-up period was better in patients with positive MERS-CoV (p=0.085) and those with symptomatic MERS-CoV (p=0.034) (Fig.3).

Adjusted Cox regression analysis of COVID-19 free survival at the end of follow up period by baseline MERS-CoV status*Adjusted for age at COVID, gender, and major comorbidity (hypertension, diabetes, heart diseases, lung diseases, and renal disease/hemodialysis)

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